应用Amplatzer堵闭器封堵0～1岁婴儿动脉导管未闭临床分析  

Transcatheter closure of patent ductus arteriosus with Amplatzer Duct Occluder in small infants under one year of age.

作　　者：李俊杰[1] 李渝芬[1] 张智伟[1] 钱明阳[1] 王慧深[1] 

机构地区：[1]广东心血管病研究所心儿科,广州510100

出　　处：《中国实用儿科杂志》2003年第6期350-352,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的　探讨应用AmplatzerDuctOccluder(ADO)封堵 0～ 1岁婴儿动脉导管未闭 (PDA)的可行性 ,并对其疗效及相关技术进行评价。方法　 30例PDA患儿 ,平均年龄 (7 4± 3 6 )个月 ,平均体重 (6 1± 2 7)kg ,15例合并肺动脉高压。所有患儿均应用ADO进行堵闭。结果　PDA最窄处直径平均 (4 8± 2 4 )mm (2 1～7 2mm) ,其中 2 0例 (6 6 7% )为大型PDA(>4 0mm)。 4例操作过程中输送鞘出现了扭曲弯折 (13 3% ) ,后换用Cook长鞘顺利完成堵闭 ,致使手术时间过长 (超过 12 0min)。 30例平均手术时间 (76 9± 30 1)min (4 5～15 0min) ,平均X线透视时间 (7 4± 5 2 )min(4～ 2 5min)。 30例平均随访 1 5年 ,仅 1例存在残余分流 ,完全闭合率达 96 7%。 2例出现降主动脉血流速度增快 (>2 0m/s) ,其余病例均未见溶血、堵闭器脱落、左右肺动脉及降主动脉狭窄。结论　应用ADO关闭 0～ 1岁婴儿PDA是安全、可行、有效的治疗方法 ,但对于体重 5 0kg的婴儿 ,装置及其输送系统尚需进一步改进。Objective To explore the feasibility of the Amplatzer Duct Occluder (ADO) in transcatheter closure of patent ductus arteriosus in small infants and to assess its efficacy and related technique.Methods 30 infants (11male and 19 female) under 1 year of age underwent transcatheter closure of patent ductus arteriosus at average age of 7 4 months and average weight of 6 1kg.Pulmonary hypertension was present in 15 patients.All patients were treated by using ADO.Results The PDAs measured 2 1 ～7 2mm (median 4 8mm) at the narrowest diameter with 20 patients (66 7%) whose PDA minimal diameter were larger than 4 0 mm.Procedure related difficulties occurred in four of 30 patients (13 3%) due to the kinking of AGA sheath,which prolonged the surgery.However,devices were successfully implanted in these patients by using Cook sheath instead of AGA sheath.Median fluoroscopy time was (7 4±5 2) min (from 4 to 25 min) for all procedures.An average 1 5 yrs' follow up showed a 96 7% of complete closure rate,with one patient having trivial shunt residual.Complications were encountered in two patients (6 7%) with increased Doppler flow velocities at the origin of the descending aorta (>2 0m/s).There were no haemolysis,device migration in all patients and no pulmonary artery or descending aorta obstruction in other patients during later follow up.Conclusion Transcatheter closure of patent ductus arteriosus using ADO is a safe and effective therapy for the small infants with PDA.However,the device and the implantation system need further improvement for PDA infants with body weight less than 5 0kg.

关 键 词：动脉导管未闭 AMPLATZER堵闭器 导管插入术 疗效 婴儿 临床分析 

分 类 号：R725.411[医药卫生—儿科]