经导管应用弹簧圈封堵术治疗儿童心血管畸形
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Transcatheter closure of cardiac malformation using coil implantation in children
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    摘要:

    目的 探讨应用弹簧圈治疗儿童心血管畸形的指征、方法学和并发症的预防。方法 133例心血 管畸形患儿接受了经导管应用弹簧圈封堵术。术后随访,定期行心脏超声。结果 101例动脉导管未闭(PDA)中 应用Gianturco弹簧圈14例,Duct Occlud和Nit Occlud弹簧圈87例,PDA最小直径为1.6±0.6mm(0.5~ 3.8mm)。有4例植入2只弹簧圈。即刻封堵率为90.1%(91/101);1月后封堵率98.0%(99/101),1年后封堵率 99.0%(100/101)。应用Gianturco弹簧圈封堵主动脉至肺动脉侧枝血管14例,直径3.5±0.8mm(2.1~5.0mm), 5例植入1只弹簧圈,9例植入2~4只弹簧圈。14例封堵后10~15min完全封堵。封堵冠状动脉瘘共14例,直径 3.8±1.1mm(2.0~5.1mm),其中右冠状动脉右室和右房瘘8例,左冠状动脉前降支或回旋支右室瘘和右房瘘6 例,10例植入1只Gianturco弹簧圈,2例植入2~4只Gianturco弹簧圈,应用Duct Occlud弹簧圈1例,即刻封堵率 为38.5%(5/13),1月后封堵率84.6%(11/13);1例右冠状动脉右室瘘,在封堵后即刻发生弹簧圈漂移至左肺小 动脉,用异物钳取出后再外科手术。肺动静脉瘘2例,全部应用Gianturco弹簧圈,分别植入6和16只弹簧圈,封堵 后外周动脉血氧饱和度从76%上升至91%和96%。应用Nit Occlud弹簧圈各1只封堵有假性室隔

    Abstract:

    Objective This study aimed to reporting the experience in the treatment of cardiac malformation using coil implantation in children. Methods Between February 1995 and January 2004, 133 children (63 males and 70 females, with an age range of 0.8- 13.0 years) with cardiac malformation were referred for closure with coils. The efficacy evaluation was based on: 1) immediate success of the closure as measured by transthoracic echocardiography (TTE); 2) short-, medium-, and long-term follow-up after implantation as assessed by TTE and electrocardiograph; and 3) the incidence of complications. Results A total of 101 patients underwent closure of patent ductus arterious (PDA) using coil implantation. The Gianturco coil was successfully implanted in 14 cases and Duct-Occlud or Nit-Occlud coil in 87 cases. Four patients had 2 coils implantaed. The minimal diameter of PDA was 1.6± 0.6 mm (range 0.5- 3.8 mm). The immediate complete closure rate was 90.1%. This increased to 98.0% and 99.0% at 1 month and 1 year, respectively. The Gianturco coil was used to embolize the collaterals in 14 patients with cyanotic heart diseases. Five patients received 1 coil implantation and the rest had 2-4 coils. The minimal diameter of the collaterals was 3.5± 0.8 mm (range 2.1-5.0 mm). The complete closure rate was 100% at 10-15 minutes after implantation. Fourteen patients with coronary artery fistula, including 8 cases of right coronary artery-right atrial fistula and right coronary artery-right ventricular fistula and 6 cases of left anterior descending and circumflex-right atrial fistula or right ventricular fistula, underwent closure by Gianturco or Duct-Occlud coil implantation. The minimal diameter was 3.8± 1.1 mm (range 2.0- 5.1 mm). Only 1 coil was used in 11 patients, and 2-4 coils in 2 patients. The immediate complete closure rate was 38.5%(5/13), and up to 84.6% (11/13) at 1 month. Unsuccessful deployment of implantation occurred in 1 case with right coronary artery-right ventricular fistula due to the coil movement to distal pulmonary artery trees immediately after embolization. After the coil was successfully retrieved, the patient needed a surgical operation. Two patients with pulmonary arteriovenous fistula received 6 or 16 Gianturco coils implantations respectively. The systemic saturations increased from 76% to 91% and 96% respectively. Two patients underwent closure of perimembranous ventricular septal defect (VSD) with pseudoaneurysm with only 1 Duct-Occlud coil. A minimal residual shunt was seen immediately after closure and disappeared after 24 hrs. A 2 months to 4 years follow-up showed that no complications related to device implantation occurred in any patient. Conclusion Transcatheter closure using coils is safe and effective in selected cases of cardiac malformation in children.

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引用格式: 高伟, 周爱卿, 余志庆, 王荣发, 李奋, 钟玉敏, 张玉奇, 孙锟.经导管应用弹簧圈封堵术治疗儿童心血管畸形[J].中国当代儿科杂志,2005,7(1):43-46

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