应用可控弹簧栓子封堵动脉导管未闭

　　摘要：目的：评价可控弹簧栓子封堵动脉导管未闭(PDA)的初步疗效。

　　方法：应用可控弹簧栓子经导管封堵PDA共12例。其中静脉法8例，动脉法4例。封堵前、后均行X线胸片、心电图、超声心动图、右心导管及主动脉弓降部造影检查。PDA最窄直径1.3～3.4mm，平均2.5±0.6mm。

　　结果：应用可控弹簧栓子封堵PDA，全组12例均封堵成功，无残余分流及并发症。

　　结论：可控弹簧栓子封堵小PDA安全、有效，一枚弹簧栓子适用于封堵直径≤2.5mm的PDA。

　　中图分类号：R541.1

　　文献标识码：A

　　文章编号：1000-3614(1999)05-0275-03

Transcatheter Closure of Patent Ductus Arteriosus Using Detachable Coils

Jiang Shiliang,Zeng Zheng,Zhang Gejun,et al.

　　Department of Radiology,Cardiovascular Institute and Fu Wai Hospital,CAMS and PUMC,Beijing(100037)

　　Abstract　Objective:To evaluate the immediate results of transcatheter closure of patent ductus arteriosus (PDA) using detachable coils.

　　Methods:Twelve patients with PDA were treated by transcatheter closure with detachable coils.Coils were placed by the transvenous route in 8 patients and by the transarterial route in 4.Before and after the procedure,chest radiograghy,electrocardiography,echocardiography,right heart catheterization and arch-descending aortography were performed in all 12 patients.The narrowest diameter of the ductus arteriosus in patients of the present series was ranged from 1.3～3.4mm,with a mean of 2.5±0.6mm.

　　Results:The PDA was occluded successful in all 12 patients with the detachable coils,and no residual shunting and other complications were found.

　　Conclusion:Transcatheter closure is a safe and effective interventional procedure in the treatment of small PDA with a minimal diameter≤2.5mm using one detachable coil.

　　Key words　Ductus arteriosus，patent;Radiology,interventional

(Chinese Circulation Journal,1999,14:275.)

　　用普通弹簧栓子封堵动脉导管未闭(PDA)时，由于栓子释放难以定位而容易发生脱落和移位［1］。为克服上述不足，国外已有作者采用可控栓子。我们采用可控弹簧栓子(下简称可控栓子)封堵PDA取得满意效果，现报道如下。

　　1　资料与方法

　　临床资料：1996年4月～1999年2月，我科采用可控栓子封堵PDA共12例，其中男3例，女9例；年龄3～31岁，平均11.8±10.4岁，体重10～65kg，平均33.6±20.8kg。胸骨左缘第2～3肋间闻及双期连续性杂音10例，无明确杂音2例。心电图正常10例，左心室肥厚2例。肺循环血流量/体循环血流量(QP/QS)除1例＞2.0外，余11例均＜1.5。肺动脉压正常11例，轻度增高1例。造影证实PDA属Krichenko等［2］A型8例，D型1例，E型3例；PDA最窄处直径1.3～3.4mm，平均2.5±0.6mm。

　　可控栓子及输送器：可控栓子由美国Cook公司生产，其直径及圈数可分为5mm 3圈(MWCE-5-PDA3)；5 mm 5圈(MWCE-5-PDA5)；8mm 3圈(MWCE-8-PDA3)；及8mm 5圈(MWCE-8-PDA5)等型号。推送可控栓子的导丝顶端有与栓子相匹配的螺旋纹，末端附带一旋转柄。经5F输送导管或5F Judkins右冠状动脉造影导管送入。