Hijazi Z M, Geggel R L
Department of Pediatrics, Floating Hospital for Children at New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
Heart. 1996 Dec;76(6):536-40. doi: 10.1136/hrt.76.6.536.
To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus (PDA) > or = 4 mm with multiple Gianturco coils. (Transcatheter closure of large PDAs using the Rashkind occluder or the buttoned device is associated with a 7-38% incidence of residual shunt.)
19 patients (7 male, 12 female) underwent an attempt at anterograde transcatheter closure with multiple Gianturco coils of a large PDA at a median age of 3.8 yr (range 2 weeks-34 yr) and median weight of 14 kg (range 2.3-80 kg).
The median PDA diameter at the narrowest segment was 4.3 mm (range 4-7 mm) and the mean (SD) Qp/Qs was 1.9 (0.8). Each patient had left atrial and left ventricular volume overload. A 4F catheter was used to deliver the coils in all patients. There was immediate and complete closure in 16/18; one patient had residual shunt that was closed at a second procedure and the other had spontaneous disappearance of the residual shunt at the six week visit. A short ductus (angiographic type B) in one patient could not be closed. The median number of coils placed at the first attempt to close the ductus was 4 (range 2-6 coils) and the median fluoroscopy time was 40 minutes (range 13-152 minutes). Mild left pulmonary artery stenosis occurred in the two smallest patients. Coil migration to the lung occurred in 3 patients with retrieval of coils in two patients. All procedures but one were done on an outpatient basis. At a median follow up of 1.6 yr (range 2 weeks-2.2 yr) all patients had complete closure with no new complications.
Anterograde transcatheter closure with multiple Gianturco coils is an effective treatment for most patients with large PDA of diameters up to 7 mm. This technique can be performed in small infants on an outpatient basis without the need for general endotracheal anaesthesia.
评估使用多个 Gianturco 弹簧圈经导管闭合直径≥4mm 的动脉导管未闭（PDA）的近期和中期结果。（使用 Rashkind 封堵器或纽扣式装置经导管闭合大型 PDA 时，残余分流发生率为 7%-38%。）
19 例患者（7 例男性，12 例女性）尝试经导管顺行使用多个 Gianturco 弹簧圈闭合大型 PDA，中位年龄 3.8 岁（范围 2 周-34 岁），中位体重 14kg（范围 2.3-80kg）。
最窄处 PDA 直径中位数为 4.3mm（范围 4-7mm），平均（标准差）Qp/Qs 为 1.9（0.8）。所有患者均有左心房和左心室容量超负荷。所有患者均使用 4F 导管输送弹簧圈。16/18 例患者实现即刻完全闭合；1 例患者有残余分流，在第二次手术时闭合，另 1 例患者在 6 周随访时残余分流自发消失。1 例患者的短导管（血管造影 B 型）未能闭合。首次尝试闭合导管时放置弹簧圈的中位数为 4 个（范围 2-6 个弹簧圈），透视时间中位数为 40 分钟（范围 13-152 分钟）。2 例最小的患者出现轻度左肺动脉狭窄。3 例患者发生弹簧圈迁移至肺，其中 2 例患者的弹簧圈被取出。除 1 例手术外，其余均在门诊完成。中位随访 1.6 年（范围 2 周-2.2 年）时，所有患者均实现完全闭合，无新的并发症。
经导管顺行使用多个 Gianturco 弹簧圈闭合是大多数直径达 7mm 的大型 PDA 患者的有效治疗方法。该技术可在小婴儿门诊进行，无需全身气管内麻醉。
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