应用Duct-Occlud PFM装置行动脉导管未闭栓塞术(摘要)
作者：王勇 马长生 蔡志雄 马煜 颜红兵 周玉杰
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：自Porstmann开创经导管栓塞堵闭动脉导管以来，多种方法和装置已成功应用于临床，目前已成为先天性心脏病各型动脉导管未闭(PDA)的首选方法。本研究旨在探讨Duct-Occlud PFM装置行PDA栓堵的可行性。
方法：18例先天性心脏病PDA患者，男8例，女10例，年龄1～52岁。术前超声心动图均证实为PDA。首先用该装置的4～5F带标记猪尾导管行主动脉弓降部造影(左侧位造影剂量1.0～1.5 ml/kg体重，流率10～14 ml/s),确定PDA的形状及大小以选择相应大小的弹簧圈。然后行股静脉穿刺，送入4～5F端孔导管经肺动脉通过未闭动脉导管至降主动脉。通过推送器操纵，将带弹簧圈的核心钢丝经端孔导管送至降主动脉，先释放2～3个圈，并轻轻回拉，使弹簧圈固定于动脉导管内，然后释放剩余弹簧圈数。经主动脉弓降部造影证实定位准确后，再松开安全环，完成最后释放。如定位不准确或弹簧圈塑形不满意可将弹簧圈回收，重新释放。术后10分钟再次造影，测肺动脉压，拔管后回压包扎，卧床24小时。
, 百拇医药
结果：18例PDA，主动脉弓降部造影显示漏斗型12例，管型6例。动脉导管大小测量值为肺动脉端直径2～4 mm,主动脉直径3～11 mm,主动脉导管长度2～6 mm,18例PDA患者，置入18枚PFM弹簧圈，所有病例均获成功，术后杂音消失。17例患者肺动脉平均压降至正常，1例由术前的45 mmHg(1 mmHg=0.133 kPa)降至术后的26 mmHg。术后10分钟造影，9例无残余分流，9例存在少量残余分流，3个月后复查彩色多普勒超声心动图，2例存在少量残余分流。除1例出现穿刺部位血肿外，无其它并发症。
结论：Duct-Occlud PFM装置不同于Lvolon活塞、Rashikind伞、Sideris钮扣、Amplantz伞和Gianturco弹簧圈，该弹簧圈释放后能塑形为哑铃状螺旋圈，能固定于动脉导管，不易脱落，操作过程经股静脉—肺动脉途径在4～5F导管中完成，减轻了血管损伤。除瘤样扩张型PDA、严重肺动脉高压、PDA最窄处直径>6 mm等禁忌症外，对先天性心脏病PDA患者是一种安全有效的治疗方法。
, 百拇医药
Transcatheter Closure of Patent Ductus Arteriosus Using Duct-Occlud PFM (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Wang Yong, Ma Changsheng, Cai Zhixiong, et al.
Objective: To evaluate the efficiency and feasibility of transcatheter closure of patent ductus arteriosus using Duct-Occlud PFM.
Methods: Eighteen patients with patent ductus arteriosus, 8 males, 10 females, aged 1～52 years, were assessed using three dimensional echocardiography (3DE) before transcatheter closure of patent ductus arteriosus. A 5F pigtail catheter was placed in the distal aortic arch. An aortography was performed in the lateral projection. After the internal diameter and length of patent ductus arteriosus were estimated with selective aortography, a suitable occluding coil was selected. A set of coil system was delivered into the patent ductus arteriosus through a catheter engaged. The occluding coil was released and lodged firmly in the patent ductus arteriosus after carefully positioning and repeatedly testing by angiocardiography.
, http://www.100md.com
Results: Twelve patients of megaphone (Type A) and tubular type (Type B) were shown by aortagraphy. The internal diameter of patent ductus arteriosus was 2～4 mm in the vicinity of pulmonary artery and 3～11 mm in the vicinity of aortic artery. The length of patent ductus arterious was 2～6 mm. All patients got success by using 18 coil PFM. The technical successu rate was 100%, No heart murmurs were found in any patient after the occlusion. The pulmonary artery pressure was decreased to normal in 17 patients and immediately improve in 1. Angiography showed that 9 patients with patent ductus arteriosus immediately occurred a complete closure, 9 patients had a trace to small residual shunt between 5%～10%. Color Doppler revealed complete closure in 16 patients and small residual shant in 2 patients 3 months after the procedure. There were no severe complications except one local hematoma.
Conclusion: Transcatheter closure of patent ductus arterious using Duct-Occlud PFM device is a safe and efficient method. It has a high success rate., 百拇医药
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：自Porstmann开创经导管栓塞堵闭动脉导管以来，多种方法和装置已成功应用于临床，目前已成为先天性心脏病各型动脉导管未闭(PDA)的首选方法。本研究旨在探讨Duct-Occlud PFM装置行PDA栓堵的可行性。
方法：18例先天性心脏病PDA患者，男8例，女10例，年龄1～52岁。术前超声心动图均证实为PDA。首先用该装置的4～5F带标记猪尾导管行主动脉弓降部造影(左侧位造影剂量1.0～1.5 ml/kg体重，流率10～14 ml/s),确定PDA的形状及大小以选择相应大小的弹簧圈。然后行股静脉穿刺，送入4～5F端孔导管经肺动脉通过未闭动脉导管至降主动脉。通过推送器操纵，将带弹簧圈的核心钢丝经端孔导管送至降主动脉，先释放2～3个圈，并轻轻回拉，使弹簧圈固定于动脉导管内，然后释放剩余弹簧圈数。经主动脉弓降部造影证实定位准确后，再松开安全环，完成最后释放。如定位不准确或弹簧圈塑形不满意可将弹簧圈回收，重新释放。术后10分钟再次造影，测肺动脉压，拔管后回压包扎，卧床24小时。
, 百拇医药
结果：18例PDA，主动脉弓降部造影显示漏斗型12例，管型6例。动脉导管大小测量值为肺动脉端直径2～4 mm,主动脉直径3～11 mm,主动脉导管长度2～6 mm,18例PDA患者，置入18枚PFM弹簧圈，所有病例均获成功，术后杂音消失。17例患者肺动脉平均压降至正常，1例由术前的45 mmHg(1 mmHg=0.133 kPa)降至术后的26 mmHg。术后10分钟造影，9例无残余分流，9例存在少量残余分流，3个月后复查彩色多普勒超声心动图，2例存在少量残余分流。除1例出现穿刺部位血肿外，无其它并发症。
结论：Duct-Occlud PFM装置不同于Lvolon活塞、Rashikind伞、Sideris钮扣、Amplantz伞和Gianturco弹簧圈，该弹簧圈释放后能塑形为哑铃状螺旋圈，能固定于动脉导管，不易脱落，操作过程经股静脉—肺动脉途径在4～5F导管中完成，减轻了血管损伤。除瘤样扩张型PDA、严重肺动脉高压、PDA最窄处直径>6 mm等禁忌症外，对先天性心脏病PDA患者是一种安全有效的治疗方法。
, 百拇医药
Transcatheter Closure of Patent Ductus Arteriosus Using Duct-Occlud PFM (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Wang Yong, Ma Changsheng, Cai Zhixiong, et al.
Objective: To evaluate the efficiency and feasibility of transcatheter closure of patent ductus arteriosus using Duct-Occlud PFM.
Methods: Eighteen patients with patent ductus arteriosus, 8 males, 10 females, aged 1～52 years, were assessed using three dimensional echocardiography (3DE) before transcatheter closure of patent ductus arteriosus. A 5F pigtail catheter was placed in the distal aortic arch. An aortography was performed in the lateral projection. After the internal diameter and length of patent ductus arteriosus were estimated with selective aortography, a suitable occluding coil was selected. A set of coil system was delivered into the patent ductus arteriosus through a catheter engaged. The occluding coil was released and lodged firmly in the patent ductus arteriosus after carefully positioning and repeatedly testing by angiocardiography.
, http://www.100md.com
Results: Twelve patients of megaphone (Type A) and tubular type (Type B) were shown by aortagraphy. The internal diameter of patent ductus arteriosus was 2～4 mm in the vicinity of pulmonary artery and 3～11 mm in the vicinity of aortic artery. The length of patent ductus arterious was 2～6 mm. All patients got success by using 18 coil PFM. The technical successu rate was 100%, No heart murmurs were found in any patient after the occlusion. The pulmonary artery pressure was decreased to normal in 17 patients and immediately improve in 1. Angiography showed that 9 patients with patent ductus arteriosus immediately occurred a complete closure, 9 patients had a trace to small residual shunt between 5%～10%. Color Doppler revealed complete closure in 16 patients and small residual shant in 2 patients 3 months after the procedure. There were no severe complications except one local hematoma.
Conclusion: Transcatheter closure of patent ductus arterious using Duct-Occlud PFM device is a safe and efficient method. It has a high success rate., 百拇医药