Radhakrishnan S, Marwah A, Shrivastava S
Division of Pediatric Cardiology, Escorts Heart Institute and Research Center, New Delhi.
Indian J Pediatr. 2001 Jan;68(1):31-5. doi: 10.1007/BF02728854.
The aim of the study was the assess feasibility of closing large patent arterial ducts (PDA) in infants and children using the new Amplatzer Duct Occluder. All patients diagnosed to be having PDA were considered as potential candidates to undergo the device closure. 19 patients were diagnosed to be having PDA larger than 4 mm. There were 10 males and 9 females, their age ranged from 6 months to 120 months with a mean of 45 months. Mean body weight was 14.5 kg with a range from 7 kg to 23 kg. The procedure was carried out under Ketamine sedation and local anesthesia. The device was implanted by the transvenous route in all. Mean PDA diameter was 5 mm (range 4 mm-6.7 mm). Complete closure was achieved in 16/18 (88%) within 24 hours of the procedure. All patient have been followed for 3 months, and have documented complete closure, there is no evidence of aortic or left pulmonary stenosis in any of our patients. The unsuccessful attempt was in a malnourished patient (weighing 4.7 kg) with an arterial duct measuring 6.7 mm on angiography. This duct was considered too big for device closure and the procedure was abandoned. This patient subsequently has undergone successful surgical ligation. Catheter closure of large PDA in small children is feasible, safe and efficacious. However, it may still not be possible to close large PDA in very small or underweight children, for the fear of causing obstruction to the descending aorta. Further long-term is follow-up required to show sustained benefits without any side effects.
本研究的目的是评估使用新型Amplatzer动脉导管封堵器关闭婴幼儿及儿童大型动脉导管未闭（PDA）的可行性。所有被诊断为患有PDA的患者均被视为进行器械封堵的潜在候选者。19例患者被诊断为患有直径大于4mm的PDA。其中男性10例，女性9例，年龄范围为6个月至120个月，平均年龄为45个月。平均体重为14.5kg，范围为7kg至23kg。手术在氯胺酮镇静和局部麻醉下进行。所有患者均通过静脉途径植入封堵器。PDA平均直径为5mm（范围4mm - 6.7mm）。16/18例（88%）在术后24小时内实现完全封堵。所有患者均已随访3个月，均记录为完全封堵，我们的任何患者均无主动脉或左肺动脉狭窄的证据。封堵失败的1例为营养不良患者（体重4.7kg），血管造影显示动脉导管直径为6.7mm。该导管被认为对于器械封堵来说太大，手术被放弃。该患者随后成功接受了外科结扎术。小儿大型PDA的导管封堵是可行、安全且有效的。然而，对于非常小或体重过轻的儿童，由于担心导致降主动脉梗阻，可能仍无法封堵大型PDA。需要进一步的长期随访以显示持续的益处且无任何副作用。
