Putra Sukman Tulus, Djer Mulyadi M, Idris Nikmah S, Sastroasmoro Sudigdo
Department of Pediatrics, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Acta Med Indones. 2016 Oct;48(4):314-319.
During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.
在2005年1月至2015年12月的11年期间，有18例青少年及成年患者使用动脉导管未闭（PDA）封堵器（ADO）行经导管封堵动脉导管未闭术。其中年龄在14至18岁的有9例，年龄超过18岁的有9例，年龄最大的为46岁。男性2例，女性16例。在手术前，进行了临床评估、心电图、胸部X光及经胸超声心动图（TTE）检查以确诊动脉导管未闭。成年患者在清醒镇静下进行器械植入手术，青少年则使用全身麻醉。动脉导管未闭的大小范围为1.6毫米至11.1毫米。根据克里琴科分类，动脉导管未闭的类型为15例A1型和3例A2型。肺循环与体循环的血流比率在1.1至5.9之间。手术时间为60 - 189分钟，透视时间为7.1 - 77.3分钟。肺动脉压力范围为22至63毫米汞柱。术后血管造影显示，14例即刻结果为完全封堵，4例有烟雾状残余分流或极小残余分流，这可能是由于器械暂时渗漏所致。在24小时内，所有病例（100%）均实现完全封堵，并持续至1个月。在6个月随访时，未检测到残余分流，也无器械栓塞或再通等严重并发症。该病例系列表明，使用Amplatzer封堵器（ADO）对青少年及成年患者行经导管封堵动脉导管未闭术是有效的，效果良好且无严重并发症。然而，需要长期随访以评估长期疗效和安全性。
