Verin V, Friedli B, Oberhänsli I, Urban P, Meier B
Centre de cardiologie, Hôpital cantonal universitaire de Genève.
Schweiz Med Wochenschr. 1993 Mar 27;123(12):530-2.
Percutaneous closure of patent ductus arteriosus can be performed with the Rashkind technique. This procedure has been performed in 16 patients in Geneva since 1989. The age of the patients varied from 2 to 44 years (4 boys, 7 girls, and 5 women). Pulmonary hypertension was present in only 1 child. A 12 mm Rashkind umbrella was used in 11 patients with ductus of < or = 4 mm inner diameter, while a 17 mm umbrella was used in 5 cases for larger ducts. Ductus closure was carried out through a transvenous femoral approach in 15 cases, while in 1 patient a transarterial approach was employed because of impossibility of passing the ductus from the pulmonary artery. There was neither mortality nor morbidity in this series. The aortography performed just after device placement showed total ductus occlusion in 8 patients and partial closure in 8 others. The follow-up by color Doppler showed disappearance of the residual shunt in 4 of these 8 patients. Prophylaxis of bacterial endocarditis is therefore no longer necessary in 13 patients with complete ductus closure. Our experience with this technique confirms its efficacy and the possibility it offers of avoiding thoracotomy in the vast majority of patients with a patent ductus arteriosus. Further miniaturization of the device and delivery system should make it applicable in the neonatal period.
动脉导管未闭可采用拉什金德技术进行经皮封堵。自1989年以来，日内瓦已对16例患者实施了该手术。患者年龄从2岁至44岁不等（4名男孩、7名女孩和5名女性）。仅1名儿童存在肺动脉高压。11例内径≤4mm的动脉导管患者使用了12mm的拉什金德封堵伞，5例较大导管患者使用了17mm的封堵伞。15例通过经股静脉途径进行导管封堵，1例因无法从肺动脉通过动脉导管而采用经动脉途径。该系列病例无死亡及并发症发生。装置置入后立即进行的主动脉造影显示，8例患者动脉导管完全闭塞，8例部分闭合。彩色多普勒随访显示，这8例患者中有4例残余分流消失。因此，13例动脉导管完全闭合的患者不再需要预防性使用抗生素预防感染性心内膜炎。我们对该技术的经验证实了其有效性以及在绝大多数动脉导管未闭患者中避免开胸手术的可能性。装置和输送系统的进一步小型化应使其适用于新生儿期。
