Bussmann W D, Sievert H, Köhler K P, Hanke H, Niemöller E, Kaltenbach M
Department of Cardiology, University Clinic of Frankfurt, West Germany.
Z Kardiol. 1987;76 Suppl 6:85-9.
A patent ductus arteriosus should be closed because of its hemodynamic significance and/or the risk of infective endocarditis. Mortality of surgery is low. In adults, however, technical problems can arise due to calcification of the ductus walls. Using the transfemoral plug technique, developed by Porstmann, we attempted a ductus closure without surgery on 35 patients. The youngest was an 11-year-old girl, the oldest a 63-year-old woman (mean age of all patients: 37 years). The pressure in the pulmonary artery ranged from 15/5 to 70/27 mmHg, the diameter of the ductus from 2 to 9 mm (mean: 4.4 mm). According to the size and shape of the ductus, a plug of polyvinyl alcohol (Ivalon) with an inner steel wire frame was prepared. Threaded over a long arterio-transductal venous track wire, the plug was introduced into the femoral artery and advanced into the ductus by a pushing catheter. After removal of the track wire the plug remained wedged in the ductus. In all 35 patients, transfemoral ductus closure was possible. Patients with complaints improved remarkably within some days. Heart size and pulmonary congestion decreased considerably. All patients were followed for a period of 1-46 months. In two of them, the ivalon plug embolized into a side branch of the left pulmonary artery 7 and 2 weeks after the procedure, but without serious consequences.(ABSTRACT TRUNCATED AT 250 WORDS)
动脉导管未闭因其血流动力学意义和/或感染性心内膜炎风险，应予闭合。手术死亡率较低。然而，在成人中，由于动脉导管壁钙化可能会出现技术问题。我们采用由波斯曼开发的经股动脉封堵技术，尝试对35例患者进行非手术方式的动脉导管闭合。最年轻的是一名11岁女孩，最年长的是一名63岁女性（所有患者平均年龄：37岁）。肺动脉压力范围为15/5至70/27 mmHg，动脉导管直径为2至9 mm（平均：4.4 mm）。根据动脉导管的大小和形状，制备了带有内部钢丝框架的聚乙烯醇（Ivalon）封堵器。封堵器通过一条长的动脉-动脉导管-静脉轨道钢丝穿过，经股动脉引入，通过推送导管推进至动脉导管内。移除轨道钢丝后，封堵器留在动脉导管内。35例患者均成功实现经股动脉动脉导管闭合。有症状的患者在数天内明显改善。心脏大小和肺淤血显著减轻。所有患者随访1至46个月。其中2例患者在术后7周和2周时，Ivalon封堵器栓塞至左肺动脉的一个分支，但未造成严重后果。
