摘要
目的探讨在经胸超声心动图(TTE)引导下经股动脉逆行封堵动脉导管未闭(PDA)的有效性和安全性。方法 2016年2月至2018年11月,选择单纯PDA患者98例,其中漏斗型43例,管型55例。男38例、女60例,年龄2~48(9.8±10.4)岁。所有患者均在TTE引导下经股动脉逆行封堵PDA,通过建立股动脉-腹主动脉-胸主动脉-动脉导管-主肺动脉-右室的轨道,在TTE的引导下由股动脉入路置入合适的封堵伞,封堵后以TTE检查评价治疗效果,术后1、3、6、12个月门诊复诊。结果 98例患者均成功在TTE引导下完成PDA封堵,其中1例成人PDA,因图像质量导致超声对动脉导管内径的诊断有误差,以至多次更换封堵器,但最终成功封堵。手术时间(33.2±5.8)min,选用室间隔缺损肌部封堵器,封堵器腰径(12±6)mm,术后杂音消失,超声示主、肺动脉间无分流,术后住院时间3~4 d。随访1、3、6、12个月均无分流信号。术后左房前后径[(25.8±6.1)mm vs.(30.6±8.4)mm]及左室舒张期末内径[(38.5±9.1)mm vs.(45.2±11.5)mm]明显缩小(P<0.05)。结论 TTE引导下经股动脉逆行法应用室间隔缺损肌部伞封堵PDA是一种安全和有效的治疗方法,避免了X线及造影剂的损伤,临床应用前景较好。
Objective To evaluate the efficacy and safety of transcatheter closure of patent ductus arteriosus(PDA)with transthoracic echocardiography(TTE).Methods From February 2016 to November 2018,98 patients of pure PDA were selected,including 43 patients of funnel type and 55 patients of tube type.There were 38 males and 60 females at age of 2-48(9.8±10.4)years.All patients underwent TTE-guided retrograde closure of the PDA through the femoral artery to establish a femoral-abdominal aorta-thoracic aorta-ductus arteriosus-aorta-right ventricle trajectory.Under the guidance of TTE,a suitable closure umbrella was placed through the femoral artery.One month,3 months,6 months,12 months after the surgery,the patients received out-patient clinical follow-up.Results Ninety eight patients were successfully occluded by TTE.The occluder was replaced many times in an adult PDA patient,but finally it was successfully plugged.The operation time was 33.2±5.8 min.The lumbar diameter was 12±6 mm.And the postoperative murmur disappeared.Ultrasound showed no shunt between the aorta and the pulmonary artery,and the postoperative hospital stay was 3-4 days.No shunt signal was found in 1,3,6,12 months follow-up.Left atrial anteroposterior diameter(25.8±6.1 mm vs.30.6±8.4 mm)and left ventricular end diastolic diameter(38.5±9.1 mm vs.45.2±11.5 mm)were significantly smaller(P<0.05).Conclusion TTE-guided transcatheter closure of PDA via femoral artery is a safe and effective method to avoid the damage of X-ray and contrast medium.The prospect of clinical application is good.
作者
孙保
程端
李波
贺贵宝
王海峰
阿哈提
伊力亚斯
盛唏
李金鹏
萨达姆·胡赛因
SUN Bao;CHENG Duan;LI Bo;HE Guibao;WANG Haifeng;Ahati;Elias;SHENG Xi;LI Jinpeng;Sadam·Hussain(Department of Cardiac Surgey,Xinjiang Cardiac and Neurovascular Disease Hospital,Urumqi,830011,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2019年第12期1208-1212,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
动脉导管未闭
股动脉
经胸超声心动图
封堵器
Ductus arterious
femoral artery
transthoracic echocardiography
occluder
