应用Amplatzer封堵器治疗动脉导管未闭的疗效评价

1、应用Amplatzer封堵器治疗动脉导管未闭的疗效评价            【摘要】目的应用Amplatzer封堵器经导管治疗动脉导管未闭并对其疗效进行评价。方法全组33例，平均年龄18.2±14.0(0.851)岁，平均体重36.2±16.9(6.470)kg。动脉导管未闭最窄处直径为4.9±2.1(2.910.0)mm。经6或7 F导管置入Amplatzer封堵器，术后10 min行侧位降主动脉造影观察有无分流。术后1天、1个月、6个月及1

2、年行超声心动图检查观察有无残余分流及动脉导管未闭再通。结果一次封堵成功者32例，二次封堵成功者1例，无任何并发症发生。术后10 min降主动脉造影示8例有微-少量残余分流。术后24 h超声心动图均无残余分流。随访112个月，均未发现有残余分流。结论应用Amplatzer封堵器治疗直径达10 mm的动脉导管未闭是一种安全有效的介入方法，操作简便，成功率高，疗效可靠。  Transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder: preliminary results  

3、;【Abstract】ObjectiveTo evaluate the safety and efficiency of anterograde catheter closure of patent ductus arteriosus (PDA) using the Amplatzer duct occluder (ADO) device. Methods33 patients (5 male, 28 female) underwent attempted transcatheter closure of PDA using the ADO at a median age of 18.2

4、77;14.0 years (range 0.8 to 51) and a median weight of (36.2±16.9)kg (range 6.4 to 70). The mean PDA diameter at its narrowest segment was (4.9±2.1)mm (rang 2.9 to 10). A 6F or 7F long sheath was used for delivery of the ADO. The lateral descending aortographies were performed to evaluate

5、the immediate results 10 minu tes after the procedure. Echocardiographies were performed 1 day, 1 month, 6 months and 1 year after the closure to find whether there was residual shunt and recanalization. Results32 of the 33 patients had successful device placement at the first time. One patient had

6、successful device placement at the second time. There were no complications. Angiography showed that 23 patients had complete immediate closure, 8 had a trace to small shunt 10 minutes after the procedures. Within 24 h, color doppler revealed complete closure in all patients. No residual shunt and P

7、DA recanlization after the complete closure were found during a-follow-up of 1-12 months. ConclusionAnterograde transcatheter closure using the ADO is a safe and effective interventional therapy for patients with a PDA diameter up to 10 mm. It had a high successful rate and satisfied immediate and s

8、hort term results, but the mid-and long-term follow-up were needed. 【Key words】Ductus arteriosus, patentInterventional therapy 采用Porstmann法、Rashkind法及弹簧栓子法治疗动脉导管未闭(PDA)国内外已有许多文献报道1-3，但由于其适应证窄，残余分流发生率高，从而限制了它们的临床应用。Amplatzer封堵器是一种新型的PDA封堵器，1996年Masura等4首先采用该封堵器治疗PDA获得成功。我院自1998年8月开始引进Amplatzer封堵器治疗PD

9、A，也取得满意的临床效果，现报告如下。&n bsp;材料和方法 1.临床资料：全组共33例，男5例，女28例，平均年龄18.2±14.0(0.851)岁，平均体重36.2±16.9(6.470)kg。均经临床、心电图、心脏X线平片及超声心动图检查证实为PDA。胸骨左缘23肋间均可闻及双期连续性杂音。主动脉弓降部造影证实属Krichenko5漏斗型22例，漏斗-管型11例。最窄处直径(2.910)mm,平均(4.9±2.1) mm。肺动脉压正常15例，轻度增高8例，中度增高6例，重度增高4例。 2.Amplatzer封堵器：美国AGA公司制造，由具有自膨胀性

10、的单盘及连接单盘的“腰部”两部分组成，呈蘑菇状，单盘及“腰部”均系镍钛记忆合金编织成的密集网状结构，封堵器长78 mm,“腰部”的直径也有所不同，近单盘侧(主动脉侧)直径分为6、8、10、12、14 mm,另一端(肺动脉侧)直径分为4、6、8、10、12 mm五种型号。输送器由内芯和外鞘组成，内芯顶端有螺丝纹，末端附带一旋转柄，鞘管外径为6 F或7 F。 3.操作步骤：在局麻或基础麻醉下穿刺右股动、静脉，静脉侧行常规右心导管检查。动脉侧置入猪尾导管行主动脉弓降部侧位造影，以观察PDA的位置、形态及大小。将6 F端孔导管自主肺动脉经PDA将其尖端送入降主动脉。经该导管送入0.035英(260 c

11、m)替换导丝于降主动脉，撤出端孔导管，沿导丝将6 F或7 F输送鞘管送入降主动脉，撤出导丝。所测PDA最窄直径2 mm的封堵器，将其安装于输送器内芯的顶端，透视下经输送鞘管封堵器送至降主动脉。待封堵器的单盘完全张开后，将输送鞘管及内芯一齐回撤至PDA的主动脉一侧，然后固定内芯，仅回撤输送鞘管至PDA的肺动脉一侧，使“腰部”完全卡于PDA内。核对心脏杂音有无变化，10 min后重复主动脉弓降部造影，若证实封堵器位置合适、无或仅有少量残余分流时，可操纵旋转柄将封堵器释放，重复右心导管检查后撤出导管压迫止血。术后24 h和1个月分别行超声心动图及心脏X线平片检查。 结果 33例均获成功，其中32例一

12、次封堵成功，一例第2次封堵成功。术后即刻右心导管检查。8例轻度肺动脉高压者均降至正常，6例中度及4例重度肺动脉高压者均降为轻度。主动脉弓降部造影示8例(24.2%)存在微少量残余分流，余25例封堵完全无残余分流。有残余分流者，释放Amplatzer封堵器后再造影，发现5例微量残余分流有3例完全消失，3例少量残余分流明显减少2例。升主动脉降主动脉及左肺动脉主肺动脉连续测压，无收缩压差。听诊双期连续杂音完全消失。24 h彩色多普勒示全部病例动脉水平分流消失。随访1个月(33例)、6个月(21)例、1年(15例)均未发现PDA完全堵塞者有再通及封堵器移位。 讨论 Amplatzer封堵器治疗PDA是一种新的介入疗法。其主要优点为：