两种单静脉法与传统Amplatzer法治疗动脉导管未闭

目的探讨两种单静脉入路法和动静脉双入路法治疗PDA各自的优缺点及最佳适应症,为PDA患者选择合理介入治疗方法提供依据。方法103例PDA患者经三种不同介入方法治疗,其中单静脉入路超声法37例,单静脉入路造影法14例,动静脉双入路法52例。PDA的位置、形态、大小经不同方法观察,单静脉超声法经超声观察,单静脉造影法在PDA内或降主动脉近PDA口外造影观察,动静脉双入路在主动脉弓降部侧位造影观察。选择合适型号的Amplatzer伞经股静脉建立的轨道进行封堵。术后15 min经胸超声及心脏听诊判断有无分流。术前、术后均行血流动力学测定,术后3 d、1个月复查超声心动图,观察大动脉水平有无分流及动脉导管未闭再通。结果103例患者全部一次封堵成功,技术成功率100%。术中操作平均透视时间(10.45±4.35)min,心导管检查测肺动脉收缩压由术前轻度增高[(33.2±3.11)mmHg]降为正常[(22.03±5.3)mmHg]。术后即刻所有患者心前区双期连续性杂音消失,术后无残余分流,无任何并发症发生,随访1个月未发生动脉水平分流及动脉导管再通。结论单静脉入路Amplatzer封堵器治疗动脉导管未闭简化了手术程序,不用或减少造影剂用量,缩短了操作透视时间,手术成功率高,疗效可靠,值得推广应用。

Two single venous approachs and classical Amplatzer method for closure of patent ductus arterious with Amplatzer occluder

Objective To investigate the efficiency of transcatheter closure of patentductus arterious with Amplatzer occluder by two kinds of the single venous approach and the arteriovenous double approach and to search for the adventage and disadventage of each method. Methods 103 cases of PDA were treated through different interventional therapy, 52 through the arteriovenous double approach, 51 through the single venous approach (14 angiography and 37 ultrasound). The location shape size of PDA were observed by different method (the single venous approach by angiography and ultrasound, and the arteriovenous double approach by angiography). The diameter of PDA were (9.35±5.23) mm. According to the diameter PDA observed, the suitable Amplatzer occluder were selected. Echocardiographies and heart auscultation were performed to evaluate the immediater results15 minute safter the procedures. Hemodynamic was studied before and after the procedure, Echocardiographies were performed 3 day, 1 month after the closure to find whether there was residual shunt and recanalization. Results One hundred and three cases had successful device placement the first time. The success rate was 100%. The pulmonic systole pressure revived to normal ( mmHg) after the procedure. No continuous murmur was heard in all patients. The fluoroscopy time was (10.45±4.35) min. There was no complications. No residual shunt and PDA recanalization after the complete closure were found during a follow-up of 1 month. Conclusion The single venous approach clousure of PDA using Amplatzer occluder device simplify operation procedure, reduced or no constrast medium, shorten the fluoroscopy time. Therefore, it should give extended application.