Arora R, Kalra G S, Nigam M, Khalillulah M
Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
Am Heart J. 1994 Sep;128(3):539-41. doi: 10.1016/0002-8703(94)90629-7.
Seventy-six patients (36 boys and 40 girls) with patent ductus arteriosus who had successful ductal occlusion with a Rashkind umbrella device were monitored for a period of 6 to 60 months (mean 26.7 +/- 12.3 months). All patients were evaluated by pulsed and color Doppler echocardiography before and after the procedure. The prevalence of residual left-to-right shunt and main pulmonary artery flow pattern were assessed. Residual left-to-right shunt was seen in 12 (15.7%) patients 24 hours after the procedure, but the shunt was small with a pulmonary-to-systemic blood flow ratio of < 1.3:1. Repeat echo Doppler study at 14 days showed residual left-to-right shunt in 10 (13.1%) patients. None of these patients showed further decrease in prevalence of residual left-to-right shunt. The patients with residual left-to-right shunt had larger ductii (mean 5.17 +/- 0.88 mm, range 4.23 to 6.6 mm) as compared to patients with no residual left-to-right shunt (3.31 +/- 0.86 mm, range 1.8 to 4.69 mm; p < 0.001). Two patients with residual shunt had successful ductus reocclusion, with 12 and 17 mm devices, respectively, at 28 month of follow-up. The Rashkind umbrella device is effective in closing ducti with diameters of < 5 mm in majority of patients.
76例动脉导管未闭患者（36例男孩和40例女孩）使用Rashkind伞装置成功封堵动脉导管，进行了6至60个月（平均26.7±12.3个月）的监测。所有患者在手术前后均通过脉冲和彩色多普勒超声心动图进行评估。评估残余左向右分流的发生率和主肺动脉血流模式。术后24小时，12例（15.7%）患者出现残余左向右分流，但分流较小，肺循环与体循环血流比<1.3:1。术后14天重复进行超声多普勒检查，10例（13.1%）患者出现残余左向右分流。这些患者中，残余左向右分流的发生率均未进一步降低。与无残余左向右分流的患者相比，有残余左向右分流的患者动脉导管更大（平均5.17±0.88mm，范围4.23至6.6mm）（无残余左向右分流的患者为3.31±0.86mm，范围1.8至4.69mm；p<0.001）。2例有残余分流的患者在随访28个月时分别使用12mm和17mm的装置成功实现动脉导管再封堵。Rashkind伞装置在大多数患者中对直径<5mm的动脉导管封堵有效。
