KT Wong, AKT Chau, YF Cheung, TC Yung, KS Lun

Abstract

Transcatheter closure is an established form of treatment for most patients with patent ductus arteriosus (PDA). The design of previously used devices has been associated with several drawbacks for closing moderate to large PDAs. The aim of this study was to examine the midterm results of transcatheter closure of moderate to large-sized PDA using the Amplatzer Duct Occluder (ADO). Ninety patients, aged 2.9 months to 16.5 years with a moderate to large-sized PDA, underwent successful transcatheter closure using the ADO. The median PDA diameter was 2.8 mm (range 1.5 to 5.0 mm). Complete immediate angiographic closure was seen in 34 of 90 patients (37.7%; 95% CI 27.7% to 47.7%). On colour Doppler interrogation, the closure rates at 1 day, 1 month and 3 months after implant were 81.1% (95% CI 73.0% to 89.2%), 88.9% (95% CI 82.5% to 95.3%) and 93.3% (95% CI 88.1% to 98.5%) respectively. At 12 months, all patients had complete closure. The median fluoroscopy time was 11.5 minutes (range 3 to 49.5 minutes) and the median procedure time was 68 minutes (range 32 to 180 minutes). Mild device-related turbulent blood flow but with no significant obstruction occurred in the left pulmonary artery of two patients and the descending aorta of another patient who had pre-existing isthmal hypoplasia. No device embolisation was encountered. Therefore transcatheter closure of moderate to large-sided PDA using the ADO is an effective and safe therapy. Further studies are required to establish long-term results in a larger patient population.

經心導管閉合 PDA 已成為治療大多數 PDA 患兒的基本方法。目前臨床上所使用的 PDA 閉合器大多數是針對中等至較大直徑動脈導管的，有不同類型的後拉式導管閉合器。本研究選用了 Amplatzer 的導管閉合器(ADO)，治療中等至較大直徑 PDA，並對治療中期結果進行了分析。研究中共有 90 例患兒年齡範圍 2.9 個月至 16.5 歲。都使用 ADO 成功地閉合了 PDA。術後即時動脈造影顯示 90 例患兒中 34 例（平均 37.7%，95% 可信度範圍27.7%-47.7%）PDA 即刻閉合。以超聲多普勒檢查，術後 1 天，1 月及 3 個月的術後 PDA 閉合率分別為 81.1%（95% 可信度範圍 73.0%-89.2%），88.9%（95% 可信度範圍 82.5%-95.3%）及 93.3% 於（95% 可信度範圍88.1%-98.5%），術後 12 個月 PDA 閉合率為 100%。手術過程中 X-光暴露時間平均 11.5 分鐘（3-49.5 分鐘），手術平均時間 68 分鐘。超聲心動圖檢查發現 2 例患兒術後左肺動脈端可見輕微的閉合器相關的紊亂性血流，輕微肺動脈阻塞，但無臨床意義。另 1 例降主動脈起始部血管彈力差的患兒降主動脈端也可見輕微的閉合器引起的紊亂性血流。所有患兒都未因置入閉合器而有血栓形成。經以上結果分析可以証實，使用 ADO 對中等至較大直徑的 PDA 進行心導管方法治療是安全而有效的。遠期研究方向是對大規模的 PDA 患者進行長期治療結果的分析。