国产封堵器介入治疗巨大动脉导管未闭的临床评价(PDF)
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2005年第2期
- 页码:
- 184-186
- 栏目:
- 介入治疗
- 出版日期:
- 2005-03-05
文章信息/Info
- Title:
- Transcatheter closure of large patent ductus arteriosus using the Chinamade occluder: preliminary results
- Author(s):
- ZHANG Yushun; MA Dongjiang; HE Xumei; LI Huan; DAI Zhengxue
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi′an, Shaanxi 710032, China
- Keywords:
- ductus arteriosus; patent; Interventional therapy
- 分类号:
- R541.1
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的 应用国产封堵器经导管治疗巨大动脉导管未闭(PDA)并对其疗效进行评价。方法 全组27(男8，女19)例，年龄6~54（24±15）岁，主动脉造影示PDA最窄径为13~28（16±4）mm。封堵后即刻和30 min行侧位降主动脉造影，术后2 d，1、3、6个月分别行超声心动图及X线平片检查。结果 24例成功，3例PDA封堵后判断为有阻力性肺动脉高压，放弃治疗。成功的患者中，14例选用国产PDA封堵器，10例选用国产ASD封堵器。术后即刻降主动脉造影检查示，使用ASD封堵器中，有2例微量残余分流，5例少量残余分流，1例少~中量残余分流；PDA封堵器中，有4例微量残余分流，2例少量残余分流。术后30 min，ASD封堵器4例微~少量残余分流，1例仍为少~中量残余分流；PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7 h发生溶血，治疗72 h溶血无减轻迹象，外科开胸取出封堵器并行PDA结扎术。术后2 d，超声心动图示PDA封堵器1例微量残余分流，ASD封堵器5例微量残余分流。随访1~6个月，所有左心内径增大的患者均明显回缩，未发现残余分流和导管再通。 结论 应用国产封堵器经导管治疗直径≥13 mm的PDA是一种安全有效地介入方法。
- Abstract:
- AIM To evaluate the safety and efficiency of transcatheter closure of large patent ductus arteriosus (PDA) using the atrial septal defect occluder devices (ASD) or PDA occluder devices which were made in china. METHODS Twentyseven patients (8 male, 19 female) with PDA underwent attempted transcatheter closure of a PDA using the Chinamade occluder devices at a median age of 24±15 years ( range 6 to 54 ). The mean PDA diameter at its narrowest segment was 16±4 mm ( range 13 to 28 ). To evaluate the therapeutic efficacy the lateral descending aortographies were performed immediately and 30 min after the procedure. And echocardiography and Xray examination were done at 2 days, 1 month, 3 months and 6 months after the closure to find whether there was residual shunt and recanalization. RESULTS Twentyfour were successful and three were unsuccessful with resistant pulmonary hypertension. Among 24 successful cases, 14 cases were treated with the ASD occluder devices while the rest 10 cases were done with the PDA occluder devices. The lateral descending aortographies immediately after the procedure showed that of the ASD occluder devices, 2 cases had trivial residual shunts, 5 cases small residual shunts and 1 case small to mederate residual shunt; of the PDA occluder devices, 4 cases had trivial residual shunts and 2 cases small shunts. 30 min after the procedure aortographies showed that of the ASD occluder devices, 4 cases had trivial residual shunts and 1 case still had small to mederate shunt; of the PDA occluder devices, only 2 cases had trivial residual shunts. One patient with ASD occluder device was found hemolysis 7 hours after the procedure and was transferred to surgery 72 hours after procedure to do surgical emergency PDA closure. Echocardiography 2 days after the procedure showed that 1 patient with the ASD occluder device had trivial residual shunt and 5 with the PDA occluder devices had that. In 1~6 months followup, patients with enlargement of left heart were found significantly reduced and in which there was no residual shunt and PDA recanalization. CONCLUSION Anterograde transcatheter closure using the Chinamade occluder device is a safe and effective interventional therapy for patients with a large PDA (diameter ≥13 mm) with satisfied immediate and short term results.
参考文献/References
［1］ Krichenki A, Benson LN, Burrows P, et al. Angiograph classification of the isolated, persistently patent ductus and implantations for percutaneous catheter occlusion［J］. Am J Cardiol, 1989,63(12):877-880.
［2］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.
［3］Moore JW, Gorege L, Kirkpatrick SE,et al. Percutaneous closure of the small patent ductus arterioles using occluding spring coils ［ J ］. J Am Coll Cardiol, 1994,23(3):759-65.
［4］Masura J, Waslsh KP, Thanopoulous B, et al. Catheter closure of moferatetolarge sized patent ductus arterioles using the new Amplatzer. Duct occluder: immediate and shortterm results ［ J ］. J Am Coll Cardiol, 1998,31(4):87882.
［5］石继军,曾国洪,张智伟,等. 国产动脉导管未闭封堵器的临床应用及疗效评价［J］. 中华放射杂志,2003,37(8):723726.
备注/Memo
- 备注/Memo:
- 收稿日期：2004-12-30.
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更新日期/Last Update: 2010-01-05