经导管动脉导管未闭封堵术——哪种封堵器最好？

Trans-catheter closure of patent ductus arteriosus-What is the best device?

机构信息

Department of Pediatric Cardiology and Cardiac Surgery, Shaheed Behshti University of Medical Science, Tehran, Islamic Republic of Iran.

出版信息

Catheter Cardiovasc Interv. 2010 Nov 1;76(5):687-95. doi: 10.1002/ccd.22393.

DOI:10.1002/ccd.22393

PMID:20815044

Abstract

BACKGROUND

Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA) has evolved to be the procedure of choice. Gianturco and Flipper coils are the most commonly used coils in the United States for closure of small and moderate size PDAs. For larger PDAs, interventionalists in the United States commonly use the Amplatzer Duct Occluder (ADO) and those in Europe use the ADO or the Nit-Occlud Coils (NOC). A comparison between Gianturco coils, Flipper coils, ADO, and NOC has never been made.

OBJECTIVE

To compare the success and complication rate associated with the four different devices used for transcatheter closure of PDA. Success was defined as complete closure of PDA with absence of a residual shunt (R.S.) at six months follow-up.

METHODS

Two institutions collaborated in combining their data to evaluate the results of transcatheter closure of PDA.

RESULTS

Totally, 546 patients underwent successful PDA occlusion at both institutions. Gianturco and Flipper coils were used in 120 (22%) and 119 (22%) patients respectively. A total of 152 (28%) patients received ADO and 155 (28%) patients received NOC. Immediate R.S. were noted in 226 (41.4%) patients in the entire study group with the NOC group having the highest percentage of R.S. (80/155, 51.6%, P = 0.004). Of the 484 patients with follow-up echocardiograms at 6 months, 35 (7.2%) patients had persistent R.S. The NOC (3/143, 2.1%) and ADO (5/150, 3.3%) groups had the least R.S. at six months follow-up.

CONCLUSION

摘要

背景

在过去的三十年中，经导管动脉导管未闭（PDA）的封堵已发展成为首选的治疗方法。Gianturco 和 Flipper 线圈是美国最常用来封堵小到中等大小的 PDA 的线圈。对于较大的 PDA，美国的介入医生通常使用 Amplatzer 导管封堵器（ADO），而欧洲的医生则使用 ADO 或 Nit-Occlud 线圈（NOC）。目前尚未对 Gianturco 线圈、Flipper 线圈、ADO 和 NOC 进行过比较。

目的

比较四种不同的封堵器在经导管 PDA 封堵术中的成功率和并发症发生率。成功定义为 PDA 完全关闭，在六个月的随访中没有残余分流（R.S.）。

方法

两家机构合作合并数据，以评估 PDA 经导管封堵的结果。

结果

两家机构共有 546 例患者成功地进行了 PDA 封堵。Gianturco 和 Flipper 线圈分别用于 120 例（22%）和 119 例（22%）患者。共 152 例（28%）患者接受 ADO，155 例（28%）患者接受 NOC。在整个研究组中，226 例（41.4%）患者即刻存在 R.S.，NOC 组的 R.S.发生率最高（80/155，51.6%，P = 0.004）。在 484 例有 6 个月超声心动图随访的患者中，35 例（7.2%）患者存在持续性 R.S.。NOC（3/143，2.1%）和 ADO（5/150，3.3%）组在 6 个月的随访中 R.S.发生率最低。