To Close or Not to Close: The Very Small Patent Ductus Arteriosus
To Close or Not to Close: The Very Small Patent Ductus Arteriosus
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DOI：
10.1111/j.1747-0803.2010.00435.x
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发表时间：
2010-07-01
影响因子：
0.3
通讯作者：
McElhinney, Doff B.
中科院分区：
文献类型：
--
作者：
Fortescue, Elizabeth B.;Lock, James E.;McElhinney, Doff B.
动脉导管未闭（PDA）约占所有先天性心脏病的10%，发病率至少为每1000例足月分娩2-4例。闭合大的、血流动力学显著的PDA被确立为标准治疗，并且可以使用手术或经导管方法安全有效地进行。对于非常小的、血流动力学不显著的动脉导管未闭的适当处理尚不清楚。主张常规闭合这些缺损，以消除或降低感染性心内膜炎（IE）的风险。然而，小型PDA患者发生IE的风险似乎极低，并且IE是可以治疗的。虽然小PDA的闭合通常是安全的，技术上是成功的，但与观察相比，这种治疗是否真正改善了风险：获益平衡尚不清楚。在这篇文章中，我们回顾了已发表的文献中的自然历史和治疗结果的个人与PDA，流行病学和IE的结果，特别是与PDA，和理由和证据关闭非常小的PDA。
Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2-4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk : benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.