心血管外科动脉导管未闭外科结扎术后残余分流介入治疗  

Transcatheter closure of residual shunt after patent ductus arteriosus occlusion or surgical repair

作　　者：肖家旺 朱鲜阳 张端珍 韩秀敏 孟立立 王建铭 王琦光 XIAO Jiawang;ZHU Xianyang;ZHANG Duanzhen;HAN Xiumin;MENG Lili;WANG Jianming;WANG Qiguang(Department of Congenital Heart Disease,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院全军心血管病研究所先心病内科,110016

出　　处：《心肺血管病杂志》2021年第7期699-702,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评价动脉导管未闭(PDA)外科结扎术后残余分流介入治疗的临床疗效。方法:选取2013年6月至2018年9月,我科收治的PDA外科结扎术后残余分流患者,根据主动脉造影情况选择合适封堵器进行封堵治疗,术后进行长期随访。结果:共26例PDA结扎术后残余分流患者接受介入治疗,年龄(42.4±15.9)岁,介入治疗距离首次手术时间为(21.3±10.8)年,术前心导管检查测量肺动脉平均压为26.33(24,36.67)mm Hg(1 mm Hg=0.133 k Pa),主动脉造影测量残余分流最窄处直径为4(4.6)mm。术中22例应用ADO-Ⅰ封堵器,4例应用ADO-Ⅱ封堵器。除1例患者发生封堵器脱落而急诊外科手术取伞外,其余25例患者均成功封堵,手术成功率为96.2%,术后即刻主动脉造影显示2例有微量残余分流,2例少量残余分流。25例介入成功患者随访60.5(30.5,85.5)个月,3个月随访时复查心脏超声示残余分流均消失。随访期间均未出现感染性心内膜炎、严重残余分流、封堵器移位、主动脉狭窄、恶性心律失常、死亡等严重并发症。结论:经导管封堵治疗PDA结扎术后残余分流安全、有效,中长期随访效果好,可替代再次开胸手术成为此类患者首选治疗方法。Objective:To evaluate the clinical effect of interventional therapy of residual shunt after surgery ligation of patent ductus arteriosus(PDA).Methods:From Jun.2013 to Sep.2018,Twenty-six patients with residual shunt after surgery ligation of PDA were enrolled,and received interventional therapy.Longterm follow-up was performed by echocardiography and electrocardiogram.Results:A total of 26 patients(42.4±15.9)years old with PDA recanalization were treated by percutaneous closure,and the time from the last operation was(21.3±10.8)years.The mean pulmonary artery pressure was 26.33(24,36.67)mm Hg measured by cardiac catheterization.The narrowest diameter of PDA recanalization was 4(4,6)mm measured by aortic angiography.Among of them,ADO-I occluder was used in 22 patients,ADO-II occluder used in 4 patients.Except for one patient who underwent emergency surgery to remove umbrella because of device dropped,the other 25 patients were successfully occluded,the success rate of percutaneous closure was 96.2%.Twenty-five patients were followed up for 60.5(30.5,85.5)months.Trace residual shunt was immediately founded in 2 patients and minor residual shunt in 2 patients by aortic angiography,but the residual shunt all disappeared after 3 months measured by echocardiography.During the follow-up period,there were no serious complications occurred such as infective endocarditis,severe residual shunt,device displacement,aortic stenosis,malignant arrhythmia,death and so on.Conclusions:Percutaneous closure is a safe and effective method for patients with residual shunt after surgery ligation of PDA,which can be used as the preferred treatment.

关 键 词：动脉导管未闭 外科结扎术 残余分流 经导管封堵 

分 类 号：R54[医药卫生—心血管疾病]