儿童大型动脉导管未闭介入封堵术治疗的临床效果

Clinical efficiency of transcatheter occlusion of large patent ductus arteriosus in children

摘要:

目的：探讨Amplatzer法介入治疗大型动脉导管未闭(PDA)的临床效果。方法：227例大型PDA患儿，其中合并肺动脉高压者63例，应用Amplatzer封堵器行动脉导管封堵术，年龄中位数为3.2岁，体重中位数为10.6 kg，PDA最窄处直径中位数5.7 mm。结果：227例患儿中，216例封堵成功（95.2％）。合并肺动脉高压者治疗前肺动脉平均压为45±19 mm Hg，封堵术后降为22±12 mm Hg（P<0.05）。216例封堵成功患儿中，术后造影显示即刻完全封堵109例（50.5％），术后24 h超声心动图检查完全封堵者181例（83.8％）。术后6个月和12个月超声心动图检查示封堵成功的患儿均无残余分流。结论：Amplatzer法介入封堵治疗儿童大型PDA是一种安全有效的方法。

Abstract:

OBJECTIVE: To study the clinical efficiency of transcatheter closure of large patent ductus arteriosus (PDA) using Amplatzer ductal occluder in children. METHODS: A retrospective review was performed for 227 children with large PDA, including 63 cases with pulmonary artery hypertension. All cases accepted the transcatheter closure using Amplatzer ductal occluders. The median age of the patients was 3.2 years, and the median weight was 10.6 kg. The median of the narrowest diameter of arterial ducts was 5.7 mm. RESULTS: Successful occlusion was achieved in 216 (95.2%) of the 227 cases. The mean pulmonary artery pressure in children with pulmonary artery hypertension decreased from 45±19 mm Hg before operation to 22±12 mm Hg after operation (P<0.05). In the 216 children achieving a successful occlusion, 109 children (50.5%) showed a complete occlusion immediately after operation by aortography and 181 children (83.8%) showed a complete occlusion by echocardiography 24 hrs after operation. No residual shunt was found in children who achieved a successful occlusion according to the results of echocardiography 6 and 12 months after operation. CONCLUSIONS: The transcatheter occlusion of large PDA using Amplatzer ductal occluders is effective and safe in children.