Al-Ata Jameel, Arfi Amin M, Hussain Arif, Kouatli Amjad A, Jalal M Omar
Section of Pediatric Cardiology, Department of Cardiovascular Diseases, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
Cardiol Young. 2005 Jun;15(3):279-85. doi: 10.1017/S1047951105000570.
We have used the Amplatzer ductal occluder for transcatheter closure of large persistently patent arterial ducts, and used our experience to assess the safety and efficacy of the device in young children and infants.
We used the Amplatzer ductal occluder prospectively in 43 patients with large patent arterial ducts, reviewing our experience to identify any problems or complications.
The procedure proved successful in 42 of the patients. We achieved complete occlusion of the duct in 33 (78.5 per cent) of the patients on the day of insertion. In 6 additional patients, complete occlusion occurred 1 week to 6 months after the procedure. Trivial leaks persisted in 2 patients, while one had a significant residual leak. Problems were encountered in 7 patients. The procedure failed in one, a device was wasted in 2, pulled through in 3, while we experienced kinking of the long Mullins sheath, being unable to retrieve the device, in one patient. Minor complications occurred in 6 patients, finding flow at a peak velocity of 2.2 metres per second in the descending aorta in 2 patients, and at 2.5 metres per second in 2 further patients, and flow at 2.5 metres per second in the pulmonary arteries of two patients. One patient experienced a major complication due to excessive bleeding. Out of the 14 patients suffering adverse events, 13 weighed less than 10 kilograms. This rate of problems and complication in these patients weighing less than 10 kilograms was significantly higher than in the patients weighing more than 10 kilograms.
Transcatheter occlusion of moderate to large patent arterial ducts with the Amplatzer ductal occluder device is safe and effective, with a high rate of complete occlusion. Problems and minor complications may be encountered in children weighing less than 10 kilograms. If the device is to be deployed completely in the ductal ampulla, and to avoid descending aortic obstruction, the size of the retention flanges of the occluder should not exceed the largest diameter of the patent arterial duct.
我们已使用Amplatzer动脉导管封堵器经导管闭合大型持续性动脉导管未闭，并利用我们的经验评估该装置在幼儿和婴儿中的安全性和有效性。
我们前瞻性地对43例大型动脉导管未闭患者使用了Amplatzer动脉导管封堵器，回顾我们的经验以识别任何问题或并发症。
该手术在42例患者中取得成功。在插入当天，我们使33例（78.5%）患者的导管完全闭塞。另外6例患者在手术后1周 至6个月实现完全闭塞。2例患者存在轻微渗漏，1例有明显残余渗漏。7例患者出现问题。1例手术失败，2例装置报废，3例装置被拉出，1例患者出现长Mullins鞘扭结，无法取出装置。6例患者出现轻微并发症，2例患者降主动脉峰值流速为2.2米/秒，另外2例为2.5米/秒，2例患者肺动脉流速为2.5米/秒。1例患者因出血过多出现严重并发症。在14例发生不良事件的患者中，13例体重不足10千克。这些体重不足10千克的患者的问题和并发症发生率明显高于体重超过10千克的患者。
使用Amplatzer动脉导管封堵器经导管闭塞中度至大型动脉导管未闭安全有效，完全闭塞率高。体重不足10千克的儿童可能会出现问题和轻微并发症。如果要将装置完全部署在导管壶腹内并避免降主动脉梗阻，封堵器固定盘的尺寸不应超过动脉导管未闭的最大直径。
