介入治疗疑难动脉导管未闭的临床研究

目的：介绍利用改良Porstmann方法和带阀门内支架（WYW方法）介入治疗疑难动脉导管未闭（PDA）的临床应用经验。方法：172例PDA患，女性134例，男性38例；年龄3－62岁，平均25岁；3－12岁58例，13－62岁114例。降主动脉造影显示PDA内径（最狭处）1．4－13．3mm，平均5．6mm。PDA形态：漏斗型16例、管型109例、乳头型30例、窗型5例、PDA结扎术后再通12例（其中2例为两次结扎术后再通，1例为体外循环下缝扎术后再通）。其中属疑难PDA范畴共计67例（39％），应用改良Porstmann方法堵闭PDA44例，WYW方法堵闭PDA22例，Spiral Coil方法堵闭1例。结果：用WYW方法一次堵闭成功率为97％（共37例）。即刻PDA造影显示无残余分流，术后第一天，检查胸部正侧位片，见支架固定良好，出院前直声心动图检查无残余分流，随访1－64个月，无一例再通，恢复良好。结论：用改良Porstmann法和WYW方法治疗疑难PDA，该技术及其装置可靠、有效，简化了手术，可堵闭各种类型的PDA，尤其适用于疑难的PDA，值得临床的推广应用。

Transcatheter occlusion of difficult patent ductus arteriosus:a clinical research

Objective To elucidate the clinical effect on occlusion of the difficult patent ductus arteriosus (PDA) with amendeded Porstmann way and WYW way Methods PDA were diagnosed in 170 patients Females and males were 133 and 37 cases respectively Age ranged from 3 to 62 years old The characteristics of morphology were divided into funnel type in 16, tubular type in 108, nipple type in 29, window type in 5, and reopen after surgical occlusion in 12 (including 2 cases reopen after two times surgical occlusion and 1 case reopened after sutured PDA under CPB) 67 cases were difficult PDA treated by transcatheter closure, among whom 44 cases were closed with amended Porstmann device and 22 cases with WYW occlusion device and 1 case with Spiral Coil The stent with valve was delivered to PDA by catheter through femoral artery to close it Results There were no residual shunts in all patients closed by WYW occlusion device examined by echocardiography and cineangiography after the procedure Followed up 4 63 months, all patients recovered satisfactorily Conclusion The successfully clinical usage of WYW occlusin device in patients with difficult PDA demonstrated that the stent shoud be reliable, effective and hopeful to be used in all kinds of PDA