摘要
目的:评价动脉导管未闭(PDA)外科结扎术后残余分流介入治疗的临床疗效。方法:选取2013年6月至2018年9月,我科收治的PDA外科结扎术后残余分流患者,根据主动脉造影情况选择合适封堵器进行封堵治疗,术后进行长期随访。结果:共26例PDA结扎术后残余分流患者接受介入治疗,年龄(42.4±15.9)岁,介入治疗距离首次手术时间为(21.3±10.8)年,术前心导管检查测量肺动脉平均压为26.33(24,36.67)mm Hg(1 mm Hg=0.133 k Pa),主动脉造影测量残余分流最窄处直径为4(4.6)mm。术中22例应用ADO-Ⅰ封堵器,4例应用ADO-Ⅱ封堵器。除1例患者发生封堵器脱落而急诊外科手术取伞外,其余25例患者均成功封堵,手术成功率为96.2%,术后即刻主动脉造影显示2例有微量残余分流,2例少量残余分流。25例介入成功患者随访60.5(30.5,85.5)个月,3个月随访时复查心脏超声示残余分流均消失。随访期间均未出现感染性心内膜炎、严重残余分流、封堵器移位、主动脉狭窄、恶性心律失常、死亡等严重并发症。结论:经导管封堵治疗PDA结扎术后残余分流安全、有效,中长期随访效果好,可替代再次开胸手术成为此类患者首选治疗方法。
Objective:To evaluate the clinical effect of interventional therapy of residual shunt after surgery ligation of patent ductus arteriosus(PDA).Methods:From Jun.2013 to Sep.2018,Twenty-six patients with residual shunt after surgery ligation of PDA were enrolled,and received interventional therapy.Longterm follow-up was performed by echocardiography and electrocardiogram.Results:A total of 26 patients(42.4±15.9)years old with PDA recanalization were treated by percutaneous closure,and the time from the last operation was(21.3±10.8)years.The mean pulmonary artery pressure was 26.33(24,36.67)mm Hg measured by cardiac catheterization.The narrowest diameter of PDA recanalization was 4(4,6)mm measured by aortic angiography.Among of them,ADO-I occluder was used in 22 patients,ADO-II occluder used in 4 patients.Except for one patient who underwent emergency surgery to remove umbrella because of device dropped,the other 25 patients were successfully occluded,the success rate of percutaneous closure was 96.2%.Twenty-five patients were followed up for 60.5(30.5,85.5)months.Trace residual shunt was immediately founded in 2 patients and minor residual shunt in 2 patients by aortic angiography,but the residual shunt all disappeared after 3 months measured by echocardiography.During the follow-up period,there were no serious complications occurred such as infective endocarditis,severe residual shunt,device displacement,aortic stenosis,malignant arrhythmia,death and so on.Conclusions:Percutaneous closure is a safe and effective method for patients with residual shunt after surgery ligation of PDA,which can be used as the preferred treatment.
作者
肖家旺
朱鲜阳
张端珍
韩秀敏
孟立立
王建铭
王琦光
XIAO Jiawang;ZHU Xianyang;ZHANG Duanzhen;HAN Xiumin;MENG Lili;WANG Jianming;WANG Qiguang(Department of Congenital Heart Disease,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《心肺血管病杂志》
CAS
2021年第7期699-702,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
动脉导管未闭
外科结扎术
残余分流
经导管封堵
Patent ductus arteriosus
Surgical ligation
Residual shunt
Transcatheter closure
