Celiker A, Bilgiç A, Alehan D, Ceviz N, Lenk M
Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Acta Paediatr Jpn. 1996 Oct;38(5):500-5. doi: 10.1111/j.1442-200x.1996.tb03534.x.
Controlled-release coils have become available recently for the closure of patent ductus arteriosus (PDA). Transcatheter closure of patent arterial ducts was attempted in 13 patients, ranging in age from 5 months to 15 years, mean 4.1 years. Implantation of controlled-release PDA coils was attempted via the femoral artery through 5 Fr catheters in all cases except one, in whom both the femoral arterial and venous routes were used. The procedure was successful in 10 of the 13 patients. In these, the pulmonary artery systolic pressure ranged between 25 and 42 mmHg and the duct diameter varied from 1.5 to 6 mm at its narrowest point. Six of the patients received a single coil. Two coils were inserted in three patients and three coils in one patient. In three patients the ducts were too large for safe release of the coils, despite attempted implantation of up to three coils simultaneously. These coils were easily withdrawn into the catheter. Immediately at the end of the procedure, the duct was completely occluded in nine of the 10 patients, and in one patient there was a small residual flow. The procedure time varied between 35 min and 2.5 h, mean 81 min and the fluoroscopy time varied from 5 to 78 min, mean 25 min. None of the patients experienced hemorrhage, diminished lower extremity pulse, hemolysis or infection. In one patient, a 5 mm coil embolized into the right pulmonary artery soon after release. It was retrieved with a snare, then 8 mm and a 5 mm coil were implanted satisfactorily in the arterial duct. At follow-up by color Doppler echocardiography, the duct was completely occluded in all patients. Transcatheter closure of patent arterial ducts by controlled-release PDA coils is effective and safe. Even when more than one coil is inserted, it is still cheaper than transcatheter umbrella closure. This method is therefore of great value, particularly in less affluent countries.
可控释放线圈最近已可用于动脉导管未闭（PDA）的封堵。对13例年龄从5个月至15岁（平均4.1岁）的患者尝试进行经导管动脉导管未闭封堵术。除1例患者同时采用股动脉和静脉途径外，所有病例均尝试经股动脉通过5F导管植入可控释放PDA线圈。13例患者中有10例手术成功。在这些患者中，肺动脉收缩压在25至42mmHg之间，导管最窄处直径为1.5至6mm。6例患者植入单个线圈。3例患者植入2个线圈，1例患者植入3个线圈。3例患者的导管太大，尽管尝试同时植入多达3个线圈，仍无法安全释放线圈。这些线圈很容易被撤回导管内。手术结束时，10例患者中有9例导管完全闭塞，1例患者有少量残余血流。手术时间在35分钟至2.5小时之间（平均81分钟），透视时间在5至78分钟之间（平均25分钟）。所有患者均未发生出血、下肢脉搏减弱、溶血或感染。1例患者在释放后不久，一个5mm的线圈栓塞入右肺动脉。用圈套器将其取出，然后在动脉导管中成功植入一个8mm和一个5mm的线圈。经彩色多普勒超声心动图随访，所有患者的导管均完全闭塞。经导管使用可控释放PDA线圈封堵动脉导管未闭有效且安全。即使植入多个线圈，其费用仍低于经导管伞封堵术。因此，这种方法具有很大价值，尤其在较不富裕的国家。
