Lázaro Castillo J L, Munayer Calderón J, Aldana Pérez T, San Luis Miranda R, Maza Juárez G, Ramírez Reyes H, Arias Monroy L, Campos Gómez A, Amaya Hernández A
Servicio Hemodinámica Pediátrica, Hospital General Centro Médico La Raza, IMSS, México, D.F.
Arch Inst Cardiol Mex. 2000 Mar-Apr;70(2):167-72.
This study was performed to evaluate the efficacy of transcatheter Coil and Grifka closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Ninety seven patients (36 male and 61 females) underwent occlusion of the PDA. The following variables were compared: age, sex, ductus diameter, morphology, device, occlusion time, residual shunt, multiple device and complications. Data obtained were compared using the Student's test and Chi 2. Median patient age was 7.82 +/- 6.89, forty five patients underwent transcatheter Rashkind-17 closure, 19 patients with Rashkind-12, 18 patients with Coil and 13 patients with Grifka device, in two patients the closure could not be performed. There were differences between the morphology and device used (p = 0.008), between the ductus diameter and device used (p < 0.001). There was immediate closure in 26.7% in the Rashkind-17 group compared with, 57.9% for the Rashkind-12 group, 83.3% for Coil group and of 91.7% for Grifka group. The occlusion within 24 hrs of implantation was 60% with Rashkind-17, 78.9% with Rashkind-12, 94.4% with Coil and 100% with Grifka. Residual shunt persisted for more than a year in 7 patients with Rashkind-17 and 1 with Rashkind 12, (p = 0.001), in 4 patients two devices wore placed. The complications were, 15.5% for Rashkind-17, 26.3% for Rashkind-12, 5.2% for Coil and 30% for Grifka, (p = 0.004), one coil and one Grifka embolized. Transcatheter Coil and Grifka occlusion are more effective in achieving immediate closure than the Rashkind device. The indication to use each device is made according to the morphology and size of the ductus.
本研究旨在评估经导管使用弹簧圈和Grifka封堵动脉导管未闭的疗效，并与我们使用Rashkind伞装置的经验进行比较。97例患者（36例男性和61例女性）接受了动脉导管未闭封堵术。比较了以下变量：年龄、性别、导管直径、形态、装置、封堵时间、残余分流、使用多个装置情况和并发症。使用学生检验和卡方检验对获得的数据进行比较。患者年龄中位数为7.82±6.89岁，45例患者接受了经导管Rashkind-17封堵术，19例使用Rashkind-12，18例使用弹簧圈，13例使用Grifka装置，2例患者无法进行封堵。在使用的形态和装置之间存在差异（p = 0.008），在导管直径和使用的装置之间存在差异（p < 0.001）。Rashkind-17组的即时封堵率为26.7%，Rashkind-12组为57.9%，弹簧圈组为83.3%，Grifka组为91.7%。植入后24小时内的封堵率，Rashkind-17为60%，Rashkind-12为78.9%，弹簧圈为94.4%，Grifka为100%。7例使用Rashkind-17和1例使用Rashkind 12的患者残余分流持续超过一年（p = 0.001），4例患者放置了两个装置。并发症方面，Rashkind-17为15.5%，Rashkind-12为26.3%，弹簧圈为5.2%，Grifka为30%（p = 0.004），1个弹簧圈和1个Grifka发生栓塞。经导管弹簧圈和Grifka封堵在实现即时封堵方面比Rashkind装置更有效。根据导管的形态和大小来决定使用每种装置。
