Atiq Mehnaz, Aslam Nadeem, Kazmi Khawar A
Section of Cardiology, Department of Pediatrics, The Aga Khan University Hospital, Karachi, Pakistan.
J Invasive Cardiol. 2007 Jul;19(7):295-8.
Transcatheter closure of patent ductus arteriosus (PDA) has been in place for more than three decades. We share our experience with the newer devices.
Ninety-eight patients, with a mean age of 64 +/- 11 months (range 7 months to 54 years), underwent attempted transcatheter closure of PDA. Thirty-seven patients were infants and 10 were adults. Two patients had residual PDA after surgical ligation. There were 66 females and 32 males.
Sixty-six patients were symptomatic and 32 were asymptomatic. Cardiac catheterization showed significant pulmonary hypertension in 18. The mean size of the PDA on aortogram was 3.1 +/- 1.4 mm (range 1.1 to 11 mm). Seven patients were referred for surgical ligation. The PDAs of 37 patients were closed using coil devices, 52 with Amplatzer duct occluders (ADO) and two with Amplatzer muscular VSD devices. One patient had a very large PDA which was embolized and retrieved surgically. One patient required occlusion with two coils. The occlusion rate in the catheterization laboratory with coils was 84 +/- 7%, and 83% with ADO. After 1 week, the occlusion rate for coils was 96%, and 99% with ADO. One patient with a large PDA requiring a 14/12 ADO was left with a mild gradient of 9 mmHg in the aorta at the end of the procedure. None of our patients had stenosis of the left pulmonary artery.
Transcatheter closure of PDA is the preferred alternative to surgical ligation, which should be reserved for small infants and premature babies or large unfavorably-shaped ducts.
经导管闭合动脉导管未闭（PDA）已有三十多年历史。我们分享使用新型装置的经验。
98例患者，平均年龄64±11个月（7个月至54岁），尝试经导管闭合PDA。37例为婴儿，10例为成人。2例患者在外科结扎后仍有残余PDA。66例为女性，32例为男性。
66例患者有症状，32例无症状。心导管检查显示18例有明显肺动脉高压。主动脉造影显示PDA平均大小为3.1±1.4mm（范围1.1至11mm）。7例患者转至外科结扎。37例患者的PDA使用弹簧圈装置闭合，52例使用Amplatzer动脉导管封堵器（ADO），2例使用Amplatzer肌部室间隔缺损封堵器。1例患者有非常大的PDA，经栓塞后手术取出。1例患者需要用两个弹簧圈封堵。在导管室，弹簧圈封堵成功率为84±7%，ADO为83%。1周后，弹簧圈封堵成功率为96%，ADO为99%。1例需要14/12 ADO的大PDA患者在手术结束时主动脉仍有9mmHg的轻度压差。我们的患者均无左肺动脉狭窄。
经导管闭合PDA是外科结扎的首选替代方法，外科结扎应保留给小婴儿、早产儿或形态不佳的大导管。
