Kang Sok-Leng, Morgan Gareth, Forsey Jonathan, Tometzki Andrew, Martin Robin
Bristol Congenital Heart Centre, Bristol Royal Hospital for Children and Bristol Royal Infirmary, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom.
Catheter Cardiovasc Interv. 2014 Jun 1;83(7):1102-8. doi: 10.1002/ccd.25393. Epub 2014 Jan 31.
To describe the long-term clinical experience and follow-up with the Amplatzer Ductal Occluder II (ADO II) in children.
All patients undergoing attempted transcatheter closure of patent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters.
From March 2008 until March 2013, 62 patients with a median age of 1.2 years (range 0.43-11.1 years) and median weight of 9 kg (range 4.7-31.4 kg) underwent the procedure. The median measurement for minimal ductal diameter was 2.7 mm (range 1.3-5 mm). An ADO II was implanted in 60 patients (96.8%). Two patients had significant residual shunting following deployment of the ADO II and underwent closure with the Amplatzer ductal occluder I (ADO I) during the same procedure. In six patients, the initial ADO II was unsatisfactory, and after recapture a different size ADO II was deployed. Device embolization of the ADO II to the pulmonary artery occurred in 6.7% of patients. Of these, one underwent surgical closure and three were closed with an ADO I. Complete occlusion on echocardiography was noted prior to discharge in 87.5% of the deployed occluders and 100% at first follow-up. Five year follow-up (n = 25) revealed a 100% occlusion rate. There were three cases of persistent mild left pulmonary artery stenosis at long-term follow-up.
The ADO II is effective for occlusion of PDA with variable anatomy from either arterial or venous approaches with a low profile delivery system. Stable occluder position is highly dependent on accurate device sizing, good quality imaging to visualize device configuration after deployment and operator experience.
描述使用Amplatzer II型动脉导管封堵器（ADO II）治疗儿童的长期临床经验及随访情况。
纳入所有尝试使用ADO II经导管闭合动脉导管未闭（PDA）的患者。收集的数据包括人口统计学、临床和超声心动图参数。
2008年3月至2013年3月，62例患者接受了该手术，中位年龄1.2岁（范围0.43 - 11.1岁），中位体重9 kg（范围4.7 - 31.4 kg）。最小导管直径的中位测量值为2.7 mm（范围1.3 - 5 mm）。60例患者（96.8%）植入了ADO II。2例患者在部署ADO II后有明显残余分流，并在同一手术中使用Amplatzer I型动脉导管封堵器（ADO I）进行了闭合。6例患者中，最初的ADO II不合适，回收后部署了不同尺寸的ADO II。6.7%的患者发生了ADO II向肺动脉的装置栓塞。其中，1例接受了外科闭合，3例用ADO I进行了闭合。87.5%的已部署封堵器在出院前经超声心动图显示完全闭塞，首次随访时为100%。五年随访（n = 25）显示闭塞率为100%。长期随访中有3例持续性轻度左肺动脉狭窄。
ADO II可通过动脉或静脉途径，利用低轮廓输送系统有效封堵解剖结构各异的PDA。封堵器位置的稳定高度依赖于准确的装置尺寸选择、部署后可视化装置构型的高质量成像以及术者经验。
