中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
23期
1781-1784
,共4页
汪周平%张丽%于明华%黄萍%夏树亮%李伟%黄晓明
汪週平%張麗%于明華%黃萍%夏樹亮%李偉%黃曉明
왕주평%장려%우명화%황평%하수량%리위%황효명
新型动脉导管未闭封堵器%动脉导管未闭%介入治疗%儿童
新型動脈導管未閉封堵器%動脈導管未閉%介入治療%兒童
신형동맥도관미폐봉도기%동맥도관미폐%개입치료%인동
Amplatzer ductal occluder Ⅱ%Patent ductus arteriosus%Transcatheter%Child
目的 总结新型动脉导管未闭封堵器(ADOⅡ)治疗动脉导管未闭(PDA)的早期临床经验.方法 选择2013年1月至2014年4月广州市妇女儿童医疗中心确诊为PDA的患儿12例,成功采用ADOⅡ进行PDA封堵.根据经胸超声心动图、心血管造影确定动脉导管类型、导管最狭窄处直径和主动脉端大小,同时根据肺动脉压力情况选择合适的ADOⅡ.12例患儿中10例术中采用从主动脉侧建立轨道,逆向释放法,2例从肺动脉侧建立轨道,顺向释放法.释放前常规行降主动脉造影和经胸超声心动图观察封堵器位置是否合适,形态是否正常,有无残余分流及降主动脉、肺动脉血流速度;术后1d行经胸超声心动图及心电图检查,若无异常术后第2天出院.术后1、3、6、12个月时门诊随访,行心电图及经胸超声心动图检查.结果 12例介入治疗患儿.男7例,女5例;年龄0.53 ～4.47(1.59±1.10)岁,体质量5.5～18.3(9.52±3.41) kg,平均肺循环血流量/体循环血流量(Qp/Qs) 1.33 ～2.85(1.64±0.45),肺动脉收缩压23 ～58(32.50±10.05) mmHg(1 mmHg=0.133 kPa),导管最窄直径1.6～3.8(2.40±0.68) mm,选择3 mm×4 mm封堵器7例,3 mm×6 mm 3例,6 mm×6 mm2例,输送长鞘为4～5F.X线曝光时间为3.2 ～18.2(6.39±4.16) min.10例即时心血管造影显示即时完全堵闭,2例有微量残余分流.术后经胸超声心动图确定封堵器位置、形态正常,2例有微量残余分流,主动脉血流速度及肺动脉血流速度均在正常范围.24 h后经胸超声心动图检查显示12例完全堵闭,1例出现降主动脉相对狭窄,术后即刻测量升主动脉到降主动脉压差为11 mmHg,术后3个月复查经胸超声心动图提示压差为10 mmHg.6例完成术后1年随诊,3例完成了术后6个月随访.除上述1例出现降主动脉相对狭窄外,其余11例均无严重并发症.结论 ADOⅡ对婴幼儿中、小型、长管型或不规则型PDA能达到完美的封堵效果,能使用4F或5F的输送鞘,可从主动脉端或肺动脉端操作释放封堵器,操作简单、方便,并发症少,封堵安全、有效.从肺动脉端释放封堵器的患儿,建议可用经胸超声心动图代替主动脉造影,可以避免穿刺主动脉,减少血管损伤.
目的 總結新型動脈導管未閉封堵器(ADOⅡ)治療動脈導管未閉(PDA)的早期臨床經驗.方法 選擇2013年1月至2014年4月廣州市婦女兒童醫療中心確診為PDA的患兒12例,成功採用ADOⅡ進行PDA封堵.根據經胸超聲心動圖、心血管造影確定動脈導管類型、導管最狹窄處直徑和主動脈耑大小,同時根據肺動脈壓力情況選擇閤適的ADOⅡ.12例患兒中10例術中採用從主動脈側建立軌道,逆嚮釋放法,2例從肺動脈側建立軌道,順嚮釋放法.釋放前常規行降主動脈造影和經胸超聲心動圖觀察封堵器位置是否閤適,形態是否正常,有無殘餘分流及降主動脈、肺動脈血流速度;術後1d行經胸超聲心動圖及心電圖檢查,若無異常術後第2天齣院.術後1、3、6、12箇月時門診隨訪,行心電圖及經胸超聲心動圖檢查.結果 12例介入治療患兒.男7例,女5例;年齡0.53 ～4.47(1.59±1.10)歲,體質量5.5～18.3(9.52±3.41) kg,平均肺循環血流量/體循環血流量(Qp/Qs) 1.33 ～2.85(1.64±0.45),肺動脈收縮壓23 ～58(32.50±10.05) mmHg(1 mmHg=0.133 kPa),導管最窄直徑1.6～3.8(2.40±0.68) mm,選擇3 mm×4 mm封堵器7例,3 mm×6 mm 3例,6 mm×6 mm2例,輸送長鞘為4～5F.X線曝光時間為3.2 ～18.2(6.39±4.16) min.10例即時心血管造影顯示即時完全堵閉,2例有微量殘餘分流.術後經胸超聲心動圖確定封堵器位置、形態正常,2例有微量殘餘分流,主動脈血流速度及肺動脈血流速度均在正常範圍.24 h後經胸超聲心動圖檢查顯示12例完全堵閉,1例齣現降主動脈相對狹窄,術後即刻測量升主動脈到降主動脈壓差為11 mmHg,術後3箇月複查經胸超聲心動圖提示壓差為10 mmHg.6例完成術後1年隨診,3例完成瞭術後6箇月隨訪.除上述1例齣現降主動脈相對狹窄外,其餘11例均無嚴重併髮癥.結論 ADOⅡ對嬰幼兒中、小型、長管型或不規則型PDA能達到完美的封堵效果,能使用4F或5F的輸送鞘,可從主動脈耑或肺動脈耑操作釋放封堵器,操作簡單、方便,併髮癥少,封堵安全、有效.從肺動脈耑釋放封堵器的患兒,建議可用經胸超聲心動圖代替主動脈造影,可以避免穿刺主動脈,減少血管損傷.
목적 총결신형동맥도관미폐봉도기(ADOⅡ)치료동맥도관미폐(PDA)적조기림상경험.방법 선택2013년1월지2014년4월엄주시부녀인동의료중심학진위PDA적환인12례,성공채용ADOⅡ진행PDA봉도.근거경흉초성심동도、심혈관조영학정동맥도관류형、도관최협착처직경화주동맥단대소,동시근거폐동맥압력정황선택합괄적ADOⅡ.12례환인중10례술중채용종주동맥측건립궤도,역향석방법,2례종폐동맥측건립궤도,순향석방법.석방전상규행강주동맥조영화경흉초성심동도관찰봉도기위치시부합괄,형태시부정상,유무잔여분류급강주동맥、폐동맥혈류속도;술후1d행경흉초성심동도급심전도검사,약무이상술후제2천출원.술후1、3、6、12개월시문진수방,행심전도급경흉초성심동도검사.결과 12례개입치료환인.남7례,녀5례;년령0.53 ～4.47(1.59±1.10)세,체질량5.5～18.3(9.52±3.41) kg,평균폐순배혈류량/체순배혈류량(Qp/Qs) 1.33 ～2.85(1.64±0.45),폐동맥수축압23 ～58(32.50±10.05) mmHg(1 mmHg=0.133 kPa),도관최착직경1.6～3.8(2.40±0.68) mm,선택3 mm×4 mm봉도기7례,3 mm×6 mm 3례,6 mm×6 mm2례,수송장초위4～5F.X선폭광시간위3.2 ～18.2(6.39±4.16) min.10례즉시심혈관조영현시즉시완전도폐,2례유미량잔여분류.술후경흉초성심동도학정봉도기위치、형태정상,2례유미량잔여분류,주동맥혈류속도급폐동맥혈류속도균재정상범위.24 h후경흉초성심동도검사현시12례완전도폐,1례출현강주동맥상대협착,술후즉각측량승주동맥도강주동맥압차위11 mmHg,술후3개월복사경흉초성심동도제시압차위10 mmHg.6례완성술후1년수진,3례완성료술후6개월수방.제상술1례출현강주동맥상대협착외,기여11례균무엄중병발증.결론 ADOⅡ대영유인중、소형、장관형혹불규칙형PDA능체도완미적봉도효과,능사용4F혹5F적수송초,가종주동맥단혹폐동맥단조작석방봉도기,조작간단、방편,병발증소,봉도안전、유효.종폐동맥단석방봉도기적환인,건의가용경흉초성심동도대체주동맥조영,가이피면천자주동맥,감소혈관손상.
Objective To describe early clinical experience with the new amplatzer ductal occluder Ⅱ (ADO Ⅱ) for transcatheter patent ductus arteriosus(PDA) in children.Methods Twelve children were diagnosed as PDA from Jan.2013 to Apr.2014 in Guangzhou Children and Women's Hospital.All the children who were treated with the ADO Ⅱ had the indication of a successful interventional therapy successfully.The size of device was chosen according to aortographic and transthoracic echocardiography(TTE) results and pulmonary pressure.The device was delivered in a consequent or reverse way depending on the type of PDA,the minimal diameter of PDA and the size of duct ampulla.The device was delivered in a reverse way in ten patients,and two in a consequent way before detaching the device.Another aortogram was performed in order to check the position and form of the device,the velocities of blood flow in left pulmonary artery and the descending aorta though TTE and whether there was a residual shunt.All patients were examined by TTE in 24 hours after surgery and discharged without any complications 2 days later.The patients were programmed for the cardiologic consult including an TTE and electrocardiogram in 1,3,6 and 12 months after discharge.Results Twelve patients(7 male,5 female) with a median age of(1.59 ± 1.10) years(range 0.53-4.47 years),a median weight of (9.52 ± 3.41) kg(range 5.5-18.3 kg),a median pulmonary blood flow/systemic blood flow (Qp/ Qs) of 1.64 ± 0.45 (range 1.33-2.85),a median pulmonary artery systolic pressure (32.50 ± 10.05) mmHg (range 23-58 mmHg,1 mmHg =0.133 kPa),and the minimum (2.40 ±0.68) mm (1.6-3.8 mm),underwent transcatheter ductal closure with the ADO Ⅱ.Device sizes used were 3 mm ×4 mm(n =7),3 mm ×6 mm(n =3),6 mm ×6 mm (n =2),respectively and delivered with 4 or 5 F delivery catheters.The median fluoroscopy time was (6.39 ± 4.16) min(range 3.2-18.2 min).Complete ductal occlusion was achieved by the end of the procedure in 10 patients.The TTE showed good position of the occlusion and the velocities of blood flow in left pulmonary artery and the descending aorta were in a normal range.There was a trivial residual shunt after the surgery of 2 patients.No residual shunt was found after 24 hours in all 12 patients.In 1 case,the patient had a descending aortic obstruction with pressure gradient of 11 mmHg.Three months after surgery,the pressure descended to 10 mmHg by TTE.Complete ductal occlusion without aortic arch or left pulmonary artery stenosis had been identified in other 11 remaining patients on TTE follow-up of 6 months of 3 patients and 12 months of 6 patients.Conclusions The ADO Ⅱ achieves excellent ductal closure rates through low profile delivery systems in small infants and children with moderate and small PDA or morphologically varied PDAs.It is simple in use with few complications.Occlusion design allows closure with arterial or venous approach and delivery with 4 or 5 F delivery catheters.The children who used arterial approach,transthoracic echocardiography TTE is recommended to replace aortic angiography,so as to avoid puncturing the aorta and reduce vascular injury.
