Challenges encountered during closure of patent ductus arteriosus
Challenges encountered during closure of patent ductus arteriosus
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DOI：
10.1007/s00246-005-1010-8
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发表时间：
2005-06-01
影响因子：
1.6
通讯作者：
Ewert, P
中科院分区：
文献类型：
--
作者：
Ewert, P
经导管封堵动脉导管未闭(PDA)是侵入性心脏病学最早确立的介入治疗方法之一，至今已有30多年的历史。儿童第一批封堵器的成功闭合的挑战包括处理相当大的引导器鞘和僵硬的应用系统。今天，介入性封堵可以用不同类型的塞子、封堵器和弹簧圈来完成。因此，除了婴儿期，几乎所有的病例都可以成功地进行经导管封堵。从技术角度来看，挑战可能是关闭窗式导管，在这种情况下应避免将装置过度突出到降主动脉，以及关闭管状导管，在这种情况下，将一个或多个装置牢固地固定在血管中可能非常困难。对于收缩和开放管道的组合，可以考虑不同的策略。在某些情况下，使用带膜支架可能会有所帮助。从生理学的角度来看，无论是否伴有先天性心脏病，肺动脉高压患者的导管开放都可能是具有挑战性的，因为在决定患者是否可以从最终的导管闭塞中受益之前，可能有必要测试暂时阻断的导管的血管反应性，并选择后续的血管扩张剂治疗。小于8公斤的婴儿的大导管可能很难治疗，因为导管器、塞子或封堵器与小的解剖尺寸相对不匹配。植入多个弹簧圈可能与较高的装置栓塞风险相关。不幸的是，对于体重非常低、管状较大的早产儿，目前还没有标准化的介入治疗方法。
Transcatheter closure of patent ductus arteriosus ( PDA) was one of the first interventions established in invasive cardiology and is now more than 30 years old. The challenges for successful closure with the first devices in children consisted of handling the rather large introducer sheaths and stiff application systems. Today, interventional closure can be performed with different types of plugs, occluders, and coils. Thus, beyond infancy, transcatheter closure can be successfully performed in almost all cases. Challenging from the technical standpoint can be the closure of window-type ducts, in which excessive protrusion of the device into the descending aorta should be avoided, as well as the closure of tubular ducts, in which secure anchoring of one or more devices in the vessel can be very difficult. For the combination of a coarctation and an open duct, different strategies can be considered. In selected cases, use of a covered stent can be helpful. From the physiological standpoint, open ducts in patients with pulmonary hypertension with or without concomitant congenital heart diseases can be challenging because testing of vasoreactivity with temporarily blocked duct and the option of subsequent treatment with vasodilators may be necessary prior to making the decision whether the patient may benefit from definitive duct occlusion or not. Large ducts in infants less than 8 kg can be difficult to treat due to a relative mismatch of introducers, plugs, or occluders to the small anatomic dimensions. The implantation of multiple coils can be associated witha higher risk of device embolization. Unfortunately, for the large group of preterm infants with very low body weights and large ducts of tubular shape there is currently no standardized interventional therapy available.