Santoro Giuseppe, Giordano Mario, Gaio Gianpiero, Palladino Maria Teresa, Capozzi Giovanbattista, Iacono Carola, Russo Maria Giovanna
Paediatric Cardiology and GUCH Unit, Ospedale del Cuore "G. Pasquinucci", Massa, Italy.
A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy.
Pediatr Cardiol. 2018 Mar;39(3):627-632. doi: 10.1007/s00246-018-1828-5. Epub 2018 Feb 17.
Transcatheter closure of arterial duct (AD) remains challenging in low-weight patients and using Amplatzer Duct Occluder devices is still considered off-label in infants < 6 kg. This study aimed to report a large, single-center experience of percutaneous AD closure in infants < 6 kg as well as to compare the most frequently used devices, Amplatzer Duct Occluder type I (ADO I) and Amplatzer Duct Occluder type II Additional Sizes devices (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN, USA). From March 2000 to March 2017, among the 762 patients submitted to percutaneous closure of AD at our Institution, 33 were infants < 6 kg (age 4.8 ± 2.1 months; weight 5.0 ± 0.9 kg). Fourteen patients (45%) underwent ADO I (Group I) and 19 patients ADO II-AS (Group II) device implantation. AD diameter was 2.6 ± 0.8 (range 1.5-4.0) mm resulting in QP/QS of 2.6 ± 0.0.9 (range 1.1-4.5). Successful device deployment was achieved in all patients without procedural morbidity or mortality. Procedural and fluoroscopy times were not significantly different between the groups. However, total X-ray absorbed dose was significantly higher in Group I (121 ± 69 vs 29 ± 16 mGy/cm, p < 0.01). Immediate, 24 h, and mid-term (46 ± 37 months, median 39) complete occlusion were recorded in 72.7, 90.9, and 97% of patients, respectively without significant difference between the groups. In conclusion, transcatheter closure of AD with Amplatzer Duct Occluder devices is feasible, safe, and effective also in infants less than 6 kg, without significant difference between the most commonly used devices, namely, ADO I and ADO II-AS.
对于低体重患者，经导管闭合动脉导管（AD）仍具有挑战性，并且对于体重小于6 kg的婴儿，使用Amplatzer动脉导管封堵器仍被视为超适应证使用。本研究旨在报告一个大型单中心关于体重小于6 kg婴儿经皮闭合AD的经验，并比较最常用的两种器械，即I型Amplatzer动脉导管封堵器（ADO I）和II型Amplatzer动脉导管封堵器附加尺寸器械（ADO II-AS）（美国明尼苏达州圣保罗市圣犹达医疗公司）。2000年3月至2017年3月，在我院接受经皮闭合AD的762例患者中，33例为体重小于6 kg的婴儿（年龄4.8±2.1个月；体重5.0±0.9 kg）。14例患者（45%）接受了ADO I植入（I组），19例患者接受了ADO II-AS植入（II组）。AD直径为2.6±0.8（范围1.5 - 4.0）mm，导致肺循环血流量与体循环血流量比值（QP/QS）为2.6±0.9（范围1.1 - 4.5）。所有患者均成功植入器械，无手术相关并发症或死亡。两组的手术时间和透视时间无显著差异。然而，I组的总X线吸收剂量显著更高（121±69 vs 29±16 mGy/cm，p<0.01）。分别有72.7%、90.9%和97%的患者在即刻、24小时和中期（46±37个月，中位数39个月）实现完全封堵，两组之间无显著差异。总之，使用Amplatzer动脉导管封堵器经导管闭合AD在体重小于6 kg的婴儿中也是可行、安全且有效的，最常用的器械ADO I和ADO II-AS之间无显著差异。
