可控弹簧圈逆行经导管封堵未闭动脉导管的安全性和疗效观察  

Safety and efficacy of transcatheter closure of patent ducts arterious with detachable coil

作　　者：夏呈森[1] 解春红[1] 章毅英[1] 周银宝[2] 

机构地区：[1]浙江大学医学院附属儿童医院心内科,杭州310003 [2]浙江大学医学院附属儿童医院放射科

出　　处：《临床心血管病杂志》2002年第4期161-163,共3页Journal of Clinical Cardiology

摘　　要：目的 :为了确定可控弹簧圈经皮导管封堵小儿未闭动脉导管的安全性和治疗成功率。方法 :70例小儿中、小型动脉导管未闭 (PDA) (最窄内径≤ 4mm)实施逆行经皮导管可控弹簧圈封堵术。男 2 5例 ,女 45例 ,年龄 0 .5～ 11(3.35± 3.0 )岁 ,体重 6 .0～ 2 9(13.4± 6 .8)kg ,心血管造影测定的最小动脉导管内径1.5～ 4.0 (2 .7±0 .9)mm ,1例并发室间隔缺损 ,2例并发主动脉缩窄 ,3例并发肺动脉瓣狭窄 ,外科结扎术后残余分流 3例。结果 :术后即刻采用心脏听诊 ,重复心血管造影 ,术后 10min重复造影 5 2例 ,12例有残余分流 ,再行置入 1～ 2个可控弹簧圈 ,直至残瘘消失 ;未重复造影 18例 ,4例发生机械性溶血 ,第 2天再行可控弹簧圈置入 ,溶血和残瘘终止。术后多普勒超声随访仅 1例至今尚有少数收缩期湍流频谱 ,正侧位胸部摄片可控弹簧圈位置无移动 ,平均可控弹簧圈 /PDA内径比值为 2 .6± 0 .4,平均术后 3d出院。结论 :逆行经导管应用可控弹簧圈封堵小儿中、小型PDA ,手术操作简便 ,安全易行 ,疗效满意 ,完全可以替代外科手术结扎 ,避免了外科创伤 。Objective:To assess the safety and efficacy of percutaneous cathether occlusion of patent ductus arterious (PDA) with detachable coil in infant and children. Method:70 patients with small to moderate size PDA underwent retrograde transcatheter occlusion with detachable coil. The mean age was 3.35± 3.0 years (range, 0.5～11 years); mean weight was 13.4± 6.8 kg (range, 6.0～29 kg). The mean minimum diameter of the PDA was 2.7± 0.9 mm(range, 1.5～ 4.0 mm)by angiography.. Patients included associating with pulmonary stenosis in three cases, ventricular septal defect in one case, aortic coarctation.in two cases, and residual shunt of PDA after surgical ligation in three cases. Result:The results were assessed by cardiac murmur and angiography and Doppler echocardiography. PDA occlusion was achieved with one detachable coil in 54 patients, 2 coils in 15 patients and 3 coils in 1 patient. The mean coil/PDA diameter ratio was 2.6± 0.4.After coil occlusion, cardiac murmur immediately disappeared in 61 patients, a small redidual shunt was found by angiography in 12 cases. No complications were found. In the first 12 hours after coil implantation, hemolysis occurred in four patients. On second day, second coil was implanted, hemolysis disappeared within twenty-four hours. In the first 24 hours after coil implantation, Doppler-echocardiography showed complete occlusion of PDA in 59 patients, Conclusion:Transcatheter occlusion of PDA with detachable coil is easily performed, it is a safe, effective method.

关 键 词：安全性 疗效 动脉导管未闭 心脏导管插入术 可控弹簧圈栓塞术 

分 类 号：R654.2[医药卫生—外科学]