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未闭动脉导管形态和大小对Amplatzer法封堵治疗效果的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第5期
页码:
446-448
栏目:
介入治疗
出版日期:
2003-09-01

文章信息/Info

Title:
The influence of size and configuration of patent ductus arteriosus on the therapy effect of the Amplatzer duct occluder
作者:
张玉顺; 李寰; 代政学; 贾国良; 王小燕
第四军医大学西京医院心血管内科, 陕西 西安 710032
Author(s):
ZHANG Yu-shun;  LI Huan;  DAI Zheng-xue;  JIA Guo-liang;  WANG Xiao-yan
Department of Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi 710032, China
关键词:
动脉导管未闭; 介入治疗
Keywords:
patent ductus arteriosus;  interventional therapy
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:评价动脉导管未闭(PDA)的大小和形态对Amplatzer封堵器(ADO)治疗效果的影响。方法:全组124例, 年龄26±22(0.6～62)岁。根据造影结果, 按Krichenko方法分型: 其中A型78例,B型8例, C型21例,D型5例, 和E型12例; 按PDA肺动脉端最窄处直径分为: ?组16例(直径<2.5mm), ? 组96 例(直径2. 5～10.0mm) 和? 组12 例(直径>10.0mm)。结果: 124 例ADO治疗均获成功。术后5～10min 降主动脉造影示有微量残余分流26 例(21.0%),24 h 超声心动图有微量残余分流2 例(1.6%), 随访1～6月未发现残余分流和导管再通。不同形态和大小PDA, 其ADO治疗的技术成功率、24 h 完全闭合率和残余分流发生率无显著性差异(P>0.05)。术后5～10 min 微量残余分流与PDA 大小有关, ? 组明显高于? 组和? 组(P<0.05) ; 与A 型比较, C型PDA术中透视时间长(P<0.01) , 再次封堵率高(P<0.05)。结论: PDA 的大小和形态不影响ADO 的最终治疗结果; 大的PDA 封堵5～10 min 后其微量残余分流亦高; C型PDA 的封堵技术操作难度较大。
Abstract:
AIM: To evaluate the influence of size and configuration of patent ductus arteriosus (PDA) on the therapy effect of the Amplatzer duct occluder (ADO) device. METHODS: 124 patients underwent attempted transcatheter closure of a PDA using the ADO at a age of 26±22 years (range 0.6 to 62 years). The patients are divided according to Krichenko methods: A type 78 cases, B type 8 cases, C type 21 cases, D type 5 cases, E type 12 cases; the patients are divided according to the narrowest segment of pulmonary artery: ? group 16 cases (the diameter<215mm), ? group 96 cases (the diameter 2.5～10.0 mm), ? group 12 cases (the diameter>10.0mm). RESULTS: All the 124 patients undertook the procedure successfully. The lateral descending aortographies demonstrated 26 had at race to small shunt 5～10m in after the procedu res; color doppler revealed 2 had at race to small shunt 24 h after the procedures. No residual shunt and PDA recanalization after the complete closure were found in 1～6 month following up. There were no significant difference in successful ADO procedure rate, 24 h completed closure rate and residual shunt rate among different size and configuration PDA patients (P>0.05). Residual shunt 5～10 min after procedure had relationship with the PDA size and the residual shunt in group ? was higher than those in group ? and group ? (P<0.05). Compared to A type, in C type patients there were longer X-ray exposure time and more patients to need second occluding(P<0.05 or P<0.01). CONCLUSION: The size and configuration didn’t in fluence ADO last therapy effect; the bigger size had more small residual shunt 5～10min after the procedure; in C type patients need more the technique skill.

参考文献/References

[1] Masura J, Walsh KP, Thanopoulous B, et al. Catheter closure of moderate-to large-sized patent ductus arteriosus using the new Amplatzer. Duct occluder: immediate and short-term results [J] . J Am Coll Cardiol, 1988, 31(4):878-882.

[2] Krichenko A, Benson LN, Burrows P, et al. Angiographic classification of the isolated, persistently patent ductus and implantations for percutaneous catheter occlusion [J] . Am J Cardiol, 1989, 63(12):877-880.

[3] 张玉顺, 贾国良, 何争, 等. 应用Amplatzer封堵器治疗动脉导管未闭的疗效评价 [J] . 中国介入心脏病杂志, 2000, 8(2):78-80.

[4] Thanopoulos B, Hakim F, Hiari A , et al. Patent ductus arteriosus equipment and technique. Amplatzer Duct Occluder: Intermediate-term follow-up and technical considerations [J] . J Intervent Cardiol, 2001, 14:247-254.

[5] 张玉顺, 代政学, 贾国良, 等. 应用Amplatzer封堵器经导管治疗直径≥8 mm 动脉导管未闭的疗效评价 [J] . 心脏杂志, 2001,13(3):204-208.

[6] Amplatz K. Percutaneous closure of patent ductus arteriosus with an angled disk device. (abstract). AGA 3rd International Amplatzer Symposium. Strasburg, France, 2000.

备注/Memo

备注/Memo:
收稿日期：2002-07-31.
更新日期/Last Update: 2003-09-01