Tanıdır Ibrahim Cansaran, Güzeltaş Alper, Ergül Yakup, Oztürk Erkut, Ozyılmaz Isa, Odemiş Ender
Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2014 Oct;42(7):643-50. doi: 10.5543/tkda.2014.71609.
The radiation dose from interventional cardiac catheterization is particularly relevant when treating children because of their greater radiosensitivity compared to adults. The transcatheter closure of patent ductus arteriosus (PDA), as well as other more complex pediatric interventions, have raised concerns regarding radiation exposure, particularly relevant when treating children. The purpose of this study is to show how to perform the transcatheter closure of PDA in children while giving less ionized radiation and to prove that the amount of radiation and contrast material can be reduced.
Following appropriate device selection based on PDA morphology and diameter, transthorasic echocardiography images and control aortography findings were analyzed. The following devices were used during the procedure: Gianturco coils (10/63), an Amplatzer Duct Occluder (ADO, 31/63), Flipper coils (19/63), and an Amplatzer vascular plug (3/63).
The scopy time, radiation dose, and contrast were 12 ± 6.4 mins, 28.1 ± 14.7 cmGy/cm²/kg, and 4.2 ± 2.3 cc/kg, respectively. In the control aortography shortly after the procedure, residual shunt was detected at various levels in 39.7% of patients, and 9.5% demonstrated residual shunt in real-time echocardiography. In the control aortography, the exposure to radiation was 13.3% of the total, and the amount of infused contrast was 27.2% of the total.
Patients may be exposed to less radiation and contrast material if an echocardiographic evaluation, instead of a final control aortography injection, is performed after the transcatheter closure of PDA.
由于儿童相较于成人对辐射更敏感，介入性心导管术的辐射剂量在治疗儿童时尤为重要。动脉导管未闭（PDA）的经导管封堵以及其他更复杂的儿科介入治疗引发了对辐射暴露的担忧，这在治疗儿童时尤为突出。本研究的目的是展示如何在减少电离辐射的情况下对儿童进行PDA的经导管封堵，并证明可以减少辐射量和造影剂用量。
根据PDA的形态和直径进行适当的器械选择后，分析经胸超声心动图图像和对照主动脉造影结果。手术过程中使用了以下器械：Gianturco线圈（10/63）、Amplatzer动脉导管封堵器（ADO，31/63）、Flipper线圈（19/63）和Amplatzer血管塞（3/63）。
透视时间、辐射剂量和造影剂用量分别为12±6.4分钟、28.1±14.7厘戈瑞/平方厘米/千克和4.2±2.3毫升/千克。术后不久的对照主动脉造影中，39.7%的患者在不同水平检测到残余分流，9.5%的患者在实时超声心动图中显示有残余分流。在对照主动脉造影中，辐射暴露占总量的13.3%，注入的造影剂用量占总量的27.2%。
如果在PDA经导管封堵术后进行超声心动图评估而非最终的对照主动脉造影注射，患者可能会接触到更少的辐射和造影剂。
