经导管封堵动脉导管未闭外科及介入治疗术后残余分流  

Transcatheter occlusion of residual patent ductus arteriosus after surgical ligation and interventional therapy

作　　者：蒋世良[1] 徐仲英[1] 赵世华[1] 黄连军[1] 郑宏[1] 凌坚[1] 张戈军[1] 金敬琳[1] 戴汝平[1] 刘玉清[1] 王云[2] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院介入导管室放射科,北京市100037 [2]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院介入导管室麻醉科,北京市100037

出　　处：《中国介入心脏病学杂志》2008年第6期302-305,共4页Chinese Journal of Interventional Cardiology

基　　金：科技部社会公益研究专项基金(2002DIB40092)

摘　　要：目的评价经导管封堵动脉导管未闭(PDA)外科结扎及介入治疗术后残余分流的效果。方法1995年6月至2008年9月,42例外科结扎、1例外科结扎术后又行弹簧栓子法、3例Rashkind法及1例Sidires法介入治疗术后残余分流的PDA患者施行了经导管封堵术,其中男9例,女38例,年龄2～53岁,平均25.0±15.5岁。外科手术至介入治疗的时间为1个月～30年,其中1例曾行两次外科结扎术。第一次介入治疗至本次封堵术的时间为4年～14年。43例经股静脉途径植入封堵器,其中2例采用动静脉轨道法;2例经股动脉途径植入可控弹簧栓子。介入术后24h～7.8年行X线胸片、心电图及超声心动图随访。结果残余分流的PDA最窄处直径为1～10mm,平均4.1±2.0mm。技术成功率为95.7%(45/47)。45例封堵术后10min。主动脉弓降部造影示无残余分流40例(88.9%),微量残余分流4例(8.9%),少量残余分流1例(2.2%)。术后24h经胸超声心动图示无残余分流44例(97.8%),少量残余分流1例(2.2%),该例术后9h发生溶血,经保守治疗1周后消失。失败2例,植入封堵器后仍有明显残余分流,收回封堵器,终止介入治疗。本组45例随访1个月～7.8年,除1例于术后4个月发生心房颤动外,余未发现封堵器移位、残余分流及细菌性心内膜炎。结论经导管封堵动脉导管未闭外科结扎及介入治疗术后的残余分流是一种创伤小、成功率高、并发症少、住院时间短、安全有效的方法,基本可以替代外科手术。Objective To evaluate the results of percutaneous closure of residual patent ductus arteriosus （PDA） after surgical ligation and interventional therapy in 47 patients in single institution. Methods From June 1995 to September 2008, 47 patients （9 male, 38 female）with residual PDA after surgical ligation （ n = 42 ） or after surgical closure plus interventional therapy using the coil （ n = 1 ） , Rashkin occlusion （ n = 3 ） and Sidires double umbrella occlusion （ n = 1 ） underwent second transcatheter closure. Patients ranged in age from 2 to 53 years （median 25.0 ± 15.5 years）. The time between surgical ligation and the interventional procedure ranged from one month to thirty years. The time between the first and the second interventional therapy ranged from 4 to 14 years. Implantation of Amplatzer duct occluder （ ADO ）, domestic mushroom oceluder. Rashkind occluder and pfm coil were performed by femoral vein approach. Cook coils were performed by femoral artery approach. Follow-up including patients＇ clinical data, radiologic, electrocardiographic and transthoracic eehocardiographic evaluation was made 24 h after the second closure to 7.8 years. Results The median minimum diameter of residual PDA after surgical ligation was 4. lmm （range 1 to 10 mm）. Forty five of the 47 patients had successful occlusion with two patients failed. Aortograms performed at ten minutes after closure showed complete closure in 40 patients but trivial or small residual shunt was found 4 and 1 patients respectively. Echoeardiography showed complete closure and small residual shunt in 44 and 1 patient, respectively within 24 hours. This patient with small residual shunt developed hemolysis 9 hours after the procedure. At a follow-up of 1 month to 7.8 years in 45 patients, there were no migration of devices, infective endocarditis or residual PDA. One patient developed atrial fibrillation 4 months after occlusion. Conclusion Transcatheter closure of residual PDA after surgical ligation and interventio

关 键 词：动脉导管未闭 心脏导管插入术 心血管外科手术 

分 类 号：R654.2[医药卫生—外科学] R541.1[医药卫生—临床医学]