Zhang Qing,Wu Qi,Yang Shuai,et al.Summary of treatment experience of percutaneous ADOⅡ closure for pediatric patent ductus arteriosus under simple transthoracic echocardiography[J].Journal of Clinical Pediatric Surgery,2019,18(09):763-766.[doi:10.3969/j.issn.1671-6353.2019.09.011]
单纯经胸超声心动图引导下经皮动脉导管未闭ADOⅡ封堵术的单中心临床研究
- Title:
- Summary of treatment experience of percutaneous ADOⅡ closure for pediatric patent ductus arteriosus under simple transthoracic echocardiography
- Keywords:
- Echocardiography; Transthoracic; Ductus Arteriosus; Patent; Occlusion; ADO Ⅱ Occluder; Child
- 分类号:
- R726;R540.4+5;R540.4+6
- 摘要:
- 目的 总结以经胸超声心动图（transthoracic echocardiography，TTE）作为唯一影像学工具，并应用ADOⅡ封堵器开展动脉导管未闭（patent ductus arteriosus，PDA）封堵术的临床治疗经验。方法 以2018年7月至2019年6月浙江大学医学院附属儿童医院收治的68例于单纯TTE下行PDA封堵术的患儿为研究对象，其中男38例，女30例，平均月龄（29.35±16.52）个月，平均体重（13.09±4.19）kg。术前通过TTE测量PDA的主动脉端内径、肺动脉端内径、最细处内径及PDA长度，并根据测量结果选择合适的封堵器。术中采用股动脉径入路，于单纯TTE引导下监测PDA ADOⅡ封堵术的全过程。术后1 d即开始进行病情观察，门诊随访1~6个月。结果 68例PDA肺动脉端平均开口直径（2.38±0.97）mm，主动脉端平均开口直径（4.48±2.70）mm，PDA平均长度（5.37±1.42）mm。ADOⅡ平均大小（4.46±1.20）mm，平均长度（4.38±0.79）mm，其中管型27例，漏斗形41例。64例在TTE引导下成功完成经皮PDA封堵术，平均手术时间（11.16±5.18）min；4例中转为X线引导下经皮PDA封堵术。术后平均住院时间（3.24±1.24）d，平均住院费用（23 732.20±1 686.02）元。术后门诊随访1~6个月，无一例出现封堵器移位、残余分流、肺动脉和主动脉流速增快、上下肢血压反常、瓣膜损伤、心包积液、机械性溶血、外周血管损害等并发症。结论 单纯TTE引导下，应用ADOⅡ经皮封堵婴幼儿PDA的可行性和成功率均较高，同时能够避免X线及造影剂造成的副反应，但对于肺动脉开口细小的PDA则需要做好传统介入封堵术预案。
- Abstract:
- Objective To summarize the clinical experiences of transthoracic echocardiography (TTE) as a sole imaging tool and the application of ADOⅡ occluder for patent ductus arteriosus (PDA).Methods A retrospective analysis was performed for 68 children undergoing PDA closure under TTE from July 20,2019 to June 2019.There were 38 boys and 30 girls with an average age of (29.35±16.52) months and an average body weight of (13.09±4.19) kg.The aortic end of PDA,the inner diameter of pulmonary artery,the innermost diameter of apex and the length of PDA were measured by TTE pre-operation and a suitable occluder was selected according to the measurements.Intraoperative femoral artery access was employed for monitoring the whole process of PDA ADOⅡ closure under TTE guidance.Observations were made at 1 day post-operation and the follow-up period was 1 to 6 months.Results The average opening diameter of pulmonary artery end was (2.38±0.97) mm,the average opening diameter of aortic end (4.48±2.70) mm and the average length of PDA 5.37±1.42 mm.The average size of ADOⅡ was (4.46±1.20) mm and the average length (4.38±0.79) mm,including 27 cases of tube type and 41 cases of funnel shape.All 64 patients underwent percutaneous PDA occlusion under the guidance of TTE.The average operative duration was (11.16±5.18) min.Four patients underwent X-ray guided percutaneous PDA occlusion.The average postoperative hospital stay was(3.24±1.24) days,the average hospitalization cost (23732.20±1686.02) yuan and the follow-up period 1 to 6 months.There was no instance of occluder displacement,residual shunt or pulmonary artery and aortic flow rate increase,upper/lower limb blood pressure abnormalities,valve damage,pericardial effusion,mechanical hemolysis,peripheral vascular damage or other complications.Conclusion Under the guidance of TTE alone,the feasibility and success rate of ADOⅡ percutaneous closure of infantile PDA are high so that radiography and contrast agent may be avoided.For PDAs with small pulmonary opening,an intervention plan is required.
参考文献/References:
1 Porstmann W,Wierny L,Warnke H.Closure of persistent ductus arteriosus without thoracotomy[J].German Medical Monthly,1967,12(6):259-261.
2 张戈军,蒋世良,凌坚,等.应用Amplatzer血管塞封堵动脉导管未闭及初步疗效评价[J].中国循环杂志,2008,23(4):260-262. Zhang GJ,Jiang SL,Ling J,et al.Transcatheter closure of patent ductus arteriosus by Amplatzer vascular plug:preliminary efficacy evaluation[J].Chinese Circulation Journal,2008,23(4):260-262.
3 Chida K,Ohno T,Kakizaki S,et al.Radiation dose to the pediatric cardiac catheterization and intervention patient[J].Am J Roentgenol,2010,195(5):1175-1179.DOI:10.2214/AJR.10.4466.
4 Menon R,Karatasakis A,Patel S,et al.Radiation safety in the catheterization laboratory:current perspectives and practices[J].J Invasive Cardiol,2018,30(8):296-300.
5 Soares BP,Lequin MH,Huisman TAGM.Safety of contrast material use in children[J].Magn Reson Imaging Clin N Am,2017,25(4):779-785.DOI:10.1016/j.mric.2017.06.009.
6 欧阳文斌,胡盛寿,王珊,等.经胸微创封堵术治疗婴幼儿动脉导管未闭的临床研究[J].中国循环杂志,2015,30(10):967-970.DOI:10.3969/j.issn.1000-3614.2015.10.010. Ouyang WB,Hu SS,Wang S,et al.Clinical trial of transthoracic mini-invasive patent ductus arteriosus occlusion in infants and young children[J].Chinese Circulation Journal,2015,30(10):967-970.DOI:10.3969/j.issn.1000-3614.2015.10.010.
7 潘湘斌,欧阳文斌,李守军,等.单纯超声心动图引导下行动脉导管未闭封堵术的安全性和有效性[J].中华心血管病杂志,2015,43(1):31-33.DOI:10.3760/cma.j.issn.0253-3758.2015.01.006. Pan XB,Ouyang WB,Li SJ,et al.Safety and efficacy of percutaneous patent ductus arteriosus closure under simple thoracic echocardiography guidance[J].Chinese Journal of Cardiology,2015,43(1):31-33.DOI:10.3760/cma.j.issn.0253-3758.2015.01.006.
8 Zhang WZ,Gao L,Jin WC,et al.Echocardiography-guided percutaneous closure of patent ductus arteriosus without arterial access:Feasibility and safety for a new strategy[J].Journal of Central South University(Medical sciences),2018,43(9):1000-1006.
9 国家卫生健康委员会国家心外介入质控专家组、国家心血管病中心医疗质量控制中心心外介入专家组.单纯超声心动图引导经皮介入技术中国专家共识[J].中国循环杂志,2018,33(10):946-947.DOI:10.3969/j.issn.1000-3614.2018.10.003. National Expert Group on Quality Control of External Cardiac Intervention,National Expert Group on External Cardiac Intervention,National Center for Cardiovascular Disease Quality Control.chinese expert consensus on transcutaneous interventional technology guided by simple echocardiography[J].Chinese Circulation Journal,2018,33(10):946-947.DOI:10.3969/j.issn.1000-3614.2018.10.003.
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备注/Memo
收稿日期:2017-06-25。
基金项目:浙江省科技厅国际科技合作高技术产业联合研发项目（编号：2016C54006）
通讯作者:徐玮泽,Email:120heart@zju.edu.cn