Kang Sok-Leng, Jivanji Salim, Mehta Chetan, Tometzki Andrew J, Derrick Graham, Yates Robert, Khambadkone Sachin, de Giovanni Joseph, Stumper Oliver, Dhillon Rami, Bhole Vinay, Slavik Zdenek, Rigby Michael, Noonan Patrick, Smith Ben, Knight Brodie, Richens Trevor, Wilson Neil, Walsh Kevin, James Adam, Thomson John, Bentham Jamie, Hayes Nicholas, Nazir Sajid, Adwani Satish, Shauq Arjamand, Ramaraj Ram, Duke Christopher, Taliotis Demetris, Kudumula Vikram, Yong San-Fui, Morgan Gareth, Rosenthal Eric, Krasemann Thomas, Qureshi Shakeel, Crossland David, Hermuzi Tony, Martin Robin P
Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom.
Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom.
Catheter Cardiovasc Interv. 2017 Dec 1;90(7):1135-1144. doi: 10.1002/ccd.27212. Epub 2017 Aug 11.
This study aimed to report our national experience with transcatheter patent ductus arteriosus (PDA) occlusion in infants weighing <6 kg.
The technique of transcatheter PDA closure has evolved in the past two decades and is increasingly used in smaller patients but data on safety and efficacy are limited.
Patients weighing < 6 kg in whom transcatheter PDA occlusion was attempted in 13 tertiary paediatric cardiology units in the United Kingdom and Ireland were retrospectively analyzed to review the outcome and complications.
A total of 408 patients underwent attempted transcatheter PDA closure between January 2004 and December 2014. The mean weight at catheterization was 4.9 ± 1.0 kg and mean age was 5.7 ± 3.0 months. Successful device implantation was achieved in 374 (92%) patients without major complication and of these, complete occlusion was achieved in 356 (95%) patients at last available follow-up. Device embolization occurred in 20 cases (5%). The incidence of device related obstruction to the left pulmonary artery or aorta and access related peripheral vascular injury were low. There were no deaths related to the procedure.
Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.
本研究旨在报告我国对体重<6 kg婴儿进行经导管动脉导管未闭（PDA）封堵术的经验。
在过去二十年中，经导管PDA封堵技术不断发展，越来越多地应用于较小的患者，但关于其安全性和有效性的数据有限。
对英国和爱尔兰13个三级儿科心脏病学单位中尝试进行经导管PDA封堵术的体重<6 kg的患者进行回顾性分析，以评估手术结果和并发症。
2004年1月至2014年12月期间，共有408例患者尝试进行经导管PDA封堵术。导管插入时的平均体重为4.9±1.0 kg，平均年龄为5.7±3.0个月。374例（92%）患者成功植入封堵器，且无重大并发症，其中356例（95%）患者在最后一次随访时实现了完全封堵。20例（5%）发生封堵器栓塞。封堵器相关的左肺动脉或主动脉梗阻以及穿刺相关的外周血管损伤发生率较低。无手术相关死亡。
尽管大多数导管封堵器制造商推荐的体重限制为6 kg，但在选定的体重<6 kg的婴儿中仍可完成经导管PDA封堵术。栓塞率高于先前报道的较大患者。在决定手术结扎或经导管治疗哪种是更好的治疗选择之前，需要仔细考虑封堵器的可回收性和导管形态。
