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目的:评价应用不同封堵装置治疗儿童动脉导管未闭(Patent ductus arteriosus,PDA)的可行性和临床效果。方法:2009年3月至2011年9月间确诊为PDA并接受介入治疗的患儿共443例,男218例,女225例,平均年龄7.8岁(0.6~13岁),平均体重17.5 kg(5.3~48 kg),合并其他畸形者均排除。根据PDA大小分别选择弹簧圈、PDA封堵器和室间隔缺损(Ventricular sep-tal defect,VSD)封堵器治疗。根据PDA的形态和大小分别采用经股动脉逆行或经股静脉顺行释放。结果:431例(97.3%)成功封堵。4例因释放前存在主动脉缩窄,3例存在左肺动脉狭窄而放弃,5例大PDA合并肺动脉高压者封堵试验阳性而放弃。心导管检查肺动脉平均压32.5 mmHg(23~67 mmHg),Qp/Qs:1.62(1.4~3.2)。其中45例采用弹簧圈封堵,53例应用动脉导管未闭封堵器-Ⅱ(Amplatzer duct occluder-Ⅱ,ADO-Ⅱ),12例为膜部VSD封堵器,其余均采用ADO进行封堵。25例(5.8%)术后出现少量残余分流,18例1月随访时消失,3月随访时全部消失。6例(1.3%)术后出现主动脉轻度狭窄,压差<10 mmHg,无需处理,随访无进展。2例(0.46%)术后出现血小板降低,对症治疗2周后出院,随访无异常发现。1例出现术后溶血。1例随访出现三尖瓣中度返流。结论:对不同类型和大小的PDA可应用不同装置进行封堵,术中操作仔细,避免损失三尖瓣,部分大PDA封堵后可存在残余分流、主动脉狭窄和血小板变化,随访时需密切观察。
Objective: To evaluate the feasibility and clinical efficacy of different occlusion devices in the treatment of patent ductus arteriosus (PDA) in children. Methods: From March 2009 to September 2011, 443 children were diagnosed as PDAs and received interventional therapy. There were 218 males and 225 females, with an average age of 7.8 years (ranged from 0.6 to 13 years) and an average body weight of 17.5 kg 5.3 ~ 48 kg), combined with other malformations were excluded. According to the PDA size were selected coil, PDA occluder and ventricular septal defect (Ventricular sep-tal defect, VSD) occluder treatment. According to the shape and size of the PDA, respectively, by the femoral artery retrograde or via the femoral vein in parallel. Results: 431 cases (97.3%) successfully blocked. 4 cases of aorta narrowing before release, 3 cases of left pulmonary artery stenosis and give up, 5 cases of large PDA with pulmonary embolism positive test and give up. Cardiac catheterization average pulmonary artery pressure 32.5 mmHg (23 ~ 67 mmHg), Qp / Qs: 1.62 (1.4 ~ 3.2). Among them, 45 cases were occluded by coils, 53 cases were treated with Amplatzer duct occluder-Ⅱ (ADO-Ⅱ), 12 cases were treated with membranous VSD occluder, and the rest were blocked with ADO . A small amount of residual shunt occurred in 25 cases (5.8%), disappeared in 18 cases at 1 month follow-up and all disappeared in 3 months follow-up. Six patients (1.3%) had mild aortic stenosis with pressure <10 mmHg, no treatment was needed and no progress was found. Two patients (0.46%) had thrombocytopenia postoperatively and were discharged after 2 weeks of symptomatic treatment. No abnormality was found in the follow-up. One case had postoperative hemolysis. Tricuspid regurgitation occurred in one case. Conclusion: Different devices of different types and sizes can be used for occlusion. Careful operation during operation can avoid the loss of tricuspid valve. Residual shunt, aortic stenosis and platelet changes may occur after some large PDA occlusion, and follow-up should be close Observed.