第二代Amplatzer动脉导管未闭封堵器介入治疗小儿先天性心脏病

摘要

Objective To summarize the clinical experience and efficacy of interventional therapy for pediatric congenital heart disease(CHD) with the Amplatzer Duct Occluder Ⅱ (ADO-Ⅱ). Methods A total of 24 patients had received intervention of CHD with the ADO-Ⅱ,including 18 patients of patent ductus arteriosus(PDA),2 patients of ventricular septal defect(VSD) of muscular part,and 4 patients of coronary artery fistula.All patients were screened by transthoracic echocardiogram before the operations.preoperative. Transthoracic echocardiography was performed to determine the device position, residual shunt and procedural complications during and after ADO-Ⅱ implantation.Results 16 patients with PAD had suecessful transcatheter closure without residual shunt and other complications during the follow-up.Minimal residual shunt was found in 2 PDA patients immediately after the occlusion which became undetectable on control echocardiography the day after operation.3 coronary artery fistula patients had suecessful transcatheter closure without residual shunts,and minimal residual shunt was found in 1 patient with coronary artery fistula at 1 month follow up.All the 2 of VSD patients had suecessful transcatheter closure without residual shunts. No complication and no atrioventricular conduction block were found in these 2 patients. Conclusions Transcatheter closure using the ADO-Ⅱ is safe and effective for interventional therapy for pediatric congenital heart disease.%目的 总结第二代Amplatzer动脉导管未闭封堵器(amplatzer duct occluderⅡ,ADO-Ⅱ)介入治疗小儿先天性心脏病的疗效和经验.方法 对湖南省儿童医院2014年1月至2015年6月采用ADO-Ⅱ进行封堵的24例先天性心脏病患儿临床资料进行总结.其中动脉导管未闭18例、室间隔缺损(肌部)2例以及冠状动脉瘘4例.术前经临床以及经胸超声心动图筛选,术中心导管造影结合经胸超声心动图及术后即刻和随访,观察术后残余分流、封堵器位置以及并发症.结果 16例动脉导管未闭即刻封堵成功,无残余分流,无并发症;2例动脉导管未闭即刻封堵时有少许残余分流,无其他并发症.3例冠状动脉瘘封堵器无残余分流,1例冠状动脉瘘封堵处术后1个月少许线样分流.2例室间隔缺损均即刻封堵成功,无残余分流,心电图未见明显房室传导阻滞.结论 ADO-Ⅱ封堵器以其操作相对简便、成功率高以及并发症少的优点,在把握适应证的前提下值得临床推广.