Thanopoulos B D, Hakim F A, Hiari A, Goussous Y, Basta E, Zarayelyan A A, Tsaousis G S
Department of Pediatric Cardiology, Aghia Sophia Children's Hospital, Athens, Greece.
J Am Coll Cardiol. 2000 Mar 15;35(4):1016-21. doi: 10.1016/s0735-1097(99)00626-9.
The aim of this study was to report further experience with transcatheter closure of the patent ductus arteriosus (PDA) using the Amplatzer duct occluder (ADO).
The design of previously used devices is not ideal for this purpose, and their use has been associated with several drawbacks, especially in large PDAs.
Forty-three patients, aged 0.3 to 33 years (mean 6.4+/-6.7 years), with a moderate to large, type A to E PDA, underwent attempted transcatheter closure using the ADO. The device is a plug-shaped repositionable occluder made of 0.004-in. nitinol wire mesh. It is delivered through a 5F to 6F long sheath. The mean PDA diameter (at the pulmonary end) was 3.9+/-1.2 mm (range 2.2 to 8 mm). All patients had color flow echocardiographic follow-up (6 to 24 months) at 24 h, 1 and 3 months after closure, and at 6-month intervals thereafter.
The mean ADO diameter was 6.1+/-1.4 mm (range 4 to 10 mm). Complete angiographic closure was seen in 40 of 43 patients (93%; 95% confidence interval [CI] 85.4% to 100%). The remaining three patients had a trivial angiographic shunt through the ADO. At 24 h, color flow mapping revealed no shunt in all patients. A 9F long sheath was required for repositioning of a misplaced 8-mm device into the pulmonary artery. The mean fluoroscopy time was 7.9+/-1.6 min (range 4.6 to 12 min). There were no complications. No obstruction of the descending aorta or the pulmonary artery branches was noted on Doppler follow-up studies. Neither thromboembolization nor hemolysis or device failure was encountered.
Transcatheter closure using the ADO is an effective and safe therapy for the majority of patients with patency of the arterial duct. Further studies are required to establish long-term results in a larger patient population.
本研究旨在报告使用Amplatzer动脉导管封堵器（ADO）经导管闭合动脉导管未闭（PDA）的更多经验。
先前使用的装置设计对此目的并不理想，其使用存在若干缺点，尤其是在大型PDA中。
43例年龄在0.3至33岁（平均6.4±6.7岁）、PDA为A至E型且中度至大型的患者，尝试使用ADO进行经导管闭合。该装置是一种由0.004英寸镍钛诺丝网制成的可重新定位的塞形封堵器。通过5F至6F长鞘管输送。PDA平均直径（在肺动脉端）为3.9±1.2mm（范围2.2至8mm）。所有患者在封堵后24小时、1个月和3个月以及此后每6个月进行彩色血流超声心动图随访（6至24个月）。
ADO平均直径为6.1±1.4mm（范围4至10mm）。43例患者中有40例（93%；95%置信区间[CI]85.4%至100%）造影显示完全闭合。其余3例患者通过ADO有微量造影分流。在24小时时，彩色血流图显示所有患者均无分流。将一枚误置入的8mm装置重新定位到肺动脉需要使用9F长鞘管。平均透视时间为7.9±1.6分钟（范围4.6至12分钟）。无并发症发生。在多普勒随访研究中未发现降主动脉或肺动脉分支梗阻。未发生血栓栓塞、溶血或装置故障。
使用ADO经导管闭合对大多数动脉导管未闭患者是一种有效且安全的治疗方法。需要进一步研究以确定更大患者群体的长期结果。
