经股动脉入路无导引导管行动脉导管支架置入术15例分析  

Analysis of 15 cases of ductus arteriosus stent placement without a guiding catheter through femoral artery approach

作　　者：罗刚[1] 泮思林[1] 纪志娴[1] 王思宝 任悦义[1] Luo Gang;Pan Silin;Ji Zhixian;Wang Sibao;Ren Yueyi(Heart Center,Women and Children′s Hospital,Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,青岛266034

出　　处：《中华儿科杂志》2025年第3期283-287,共5页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2023YFC2705700);国家自然科学基金(82471753、82271725);青岛市科技惠民示范专项(23-2-8-smjk-10-nsh);青岛大学"医学+"学科集群攻关项目(YX2024302)。

摘　　要：目的探讨经股动脉入路无导引导管行动脉导管支架置入术的可行性。方法回顾性总结青岛大学附属妇女儿童医院2018年1月至2023年6月接受动脉导管支架置入术的15例肺循环依赖动脉导管的先天性心脏病患儿的出生体重、手术时年龄、术前超声心动图及术中血管造影等临床资料及随访情况(Nakata指数和最终循环状态等)。所有患儿选择在无导引导管的情况下置入动脉导管支架,分析该方案实施手术的有效性及安全性。结果15例患儿中男9例、女6例,出生体重(3.3±0.3)kg,手术时年龄(15.0±0.1)日龄。9例为室间隔完整型肺动脉闭锁,6例为室间隔完整的危重肺动脉瓣狭窄。术前15例患儿三尖瓣瓣环直径为(8.8±0.8)mm,三尖瓣瓣环Z值为-0.7±0.9。右心室轻度发育不良3例、中度发育不良9例、重度发育不良3例。15例患儿均成功完成手术,无重大并发症。动脉导管最窄处直径(2.2±0.1)mm,动脉导管支架直径(3.9±0.3)mm,术前血氧饱和度0.83±0.03,术后血氧饱和度0.96±0.02。15例患儿随访时间为(7.0±0.5)个月,术前Nakata指数为(163±30)mm^(2)/m^(2),末次随访为(173±34)mm^(2)/m^(2)。14例患儿动脉导管支架均闭合,实现双心室循环;1例仍密切随访。结论经股动脉逆行无导引导管置入动脉导管支架可以作为室间隔完整型肺动脉闭锁或危重肺动脉瓣狭窄伴右心发育不良综合征新生儿安全有效的实施方法。Objective To investigate the feasibility of ductus arteriosus(DA)stent placement through femoral artery approach without guiding catheter.Methods In this retrospective case study,the birth weight,intervention age,preoperative echocardiography,intraoperative angiography and other clinical data,as well as the follow-up status(Nakata index and final circulatory status,etc.)of 15 patients with congenital heart disease who are dependent on the DA for pulmonary circulation at Women and Children′s Hospital,Qingdao University between January 2018 to June 2023 were collected.All pediatric patients underwent placement of a DA stent without a guiding catheter,the efficacy and safety of this approach were analyzed.Results Among all 15 cases,there were 9 males and 6 females,with the birth weight of(3.3±0.3)kg and the intervention age of(15.0±0.1)d.Of which,there were 9 cases of pulmonary atresia with intact ventricular septum(PA-IVS),and 6 cases of critical pulmonary stenosis(CPS)with intact ventricular septum.The tricuspid annulus diameter before intervention was(8.8±0.8)mm,and the tricuspid annulus Z-score was-0.7±0.9.There were 3 cases of mild right ventricular dysplasia,9 cases of moderate dysplasia,and 3 cases of severe dysplasia.All patients successfully completed the intervention without major complications.The narrowest diameter of the DA was(2.2±0.1)mm,the diameter of the DA stent was(3.9±0.3)mm,the preoperative percutaneous oxygen saturation(SpO 2)was 0.83±0.03,and the postoperative SpO 2 was 0.96±0.02.The follow-up time was(7.0±0.5)months.The Nakata index was(163±30)mm^(2)/m^(2)before intervention,and was(173±34)mm^(2)/m^(2)at the last follow-up.Biventricular circulation was successfully achieved in 14 patients,and the other one patient currently under close observation.Conclusion The placement of a ductus arteriosus stent through femoral artery retrogradely without guiding catheter could serve as an effective and safe plan for neonates with PA-IVS or CPS accompanied by hypoplastic right heart syndrome

关 键 词：动脉导管 支架 婴儿 新生 

分 类 号：R726.5[医药卫生—儿科]