Stop up and close and treat child's artery conduit and has not closed _'s prevention and health care by the conduit spring coil

Stop up and close and treat child's artery conduit and has not closed _'s prevention and health care by the conduit spring coil
Stop up and close and treat child's artery conduit and has not closed by the conduit spring coil

Chinese pediatrics magazine Vol. 36 of number 9 of 1998 Treatise

Author: Qian MingYang Zhang ZhiWei Li YuFen Li Hong

Unit: 510100 Guangzhou, the pediatrics of research institute of vascular disease that Guangdong saves worry

Keyword: The artery conduit has not been closed; Thromboembolism; Therapeutic

[Summary ] Purpose Appraise and stop up and close child's artery conduit and has not closed (PDA) by the conduit spring coil Result. The method stopped up and closed and treated 25 PDA infants from January to October in 1997, 1.5-14.0 years old, 6.8 is 2.7 years old on average; Weight 10- 37 kg, average 19.7 7.9 kg. The diameter 1.3- 2.8 mm in PDA narrowest place, PDA length 5.0- 10.9 mm; There are short in charge ofing type, long in charge ofing type, funnel type in the shape. Adopt 3 kinds of spring coils that U.S.A. Cook Company produces and stop up and close PDA. Success rate was 100% finally, the radiography of postoperative cardiovascular vessel revealed, 80% (20/25) Infant have a few remnants shunt very much, postoperative 24-hour color exceed, reexamine, have 2 examples have a few remnants to shunt only, the color exceeds reexamining and has not shunted residually in the same way in postoperative month. Conclusion stop up, close the intersection of child and PDA by the intersection of conduit and spring coil, and wound little to turn on the chest method than security, suitable for infant and pre-school children, especially the infant of the diameter of PDA narrowest place within 3 mm.

Transcatheter coil occlusion treatment of patent ductus arteriousus in children

Qian Mingyang, Zhang Zhiwei, Li Yufen, et al. Department of Paediatric Cardiology, Guangdong Provincial Cardiovascular Hospital, Guangzhou 510100

[Abstract ]Objective For evaluating the method of transcatheter occlusion of patent ductus arteriosus (PDA) . Methods From Jan. to Oct. 1997,25 patients of PDA were collected. The age ranged from 1.5 to 14.0 years and the body weight ranged from 10 to 37 kg. Aortogram showed the narrowest diameter of ductus was 1.3- 2.8 mm and the length of ductus was 5.0- 10.9 mm with the types of short broad, long tubule and long conie. Cook coils were used to close the PDA. Results The occlusion success rate was 100 percent. Aortogram showed an 80% (20/25) of small residual shunt. Echocardiography showed a small shunt only in 2 cases 24 hours after occlusion, and none 1 month later. Conclusion Transcatheter coil occlusion in the treatment of PDAs in children is safe, effective and inexpensive, with an indication for infants. For those with a diameter of ductus smaller than 3 mm, the coil occlusion should be the first choice.

[Key words ]Ductus arteriosus, patent Embolization, therapeutic

U.S.A. Rothman,etc. in 1993[1,2]Report that employs the spring coil to be stopped up and close child's artery conduit and has not closed (PDA) at first . Recently, a lot of foreign materials have verified, the spring coil stops up and closes PDA, already safe and effective and the price has been cheap[3- 6]. Our department stopped up and closed PDA, success to 25 PDA infants by the conduit spring coil from January to October in 1997, report as follows now.

Target and method

First, target

Close 25 PDA infants stifledly altogether, 18 women among them, 7 men; 1.5-14 years old, 6.8 is 2.7 years old on average; Weight 10- 37 kg, average 19.5 7.8 kg. 23 of simple PDA (PDA ligature skill among them or stop up and close and shunt 4 postoperative residually) ,Room lack mend postoperative residual the intersection of PDA and 2. 25 are heard among the second rib of left reason of brestbone and noise, 23 are continuity, 2 are the systolic phase noise. The aorta radiography reveals PDA narrowest place internal diameter 1.3- 2.8 mm, average 1.9 0.5 mm, PDA length 5.0- 10.9 mm, average 7.3 1.6 mm, funnel type 10, in charge ofing 15.

Second, instrument and equipment

Use the Dutch Model Philips BC-3000 cardiovascular vessel radiography machine, the controllable type and non- controlled type spring coil which U.S.A. Cook Company produces, there are 3 kinds of types respectively: (1)Diameter 8 mm, there are 5 circles; (2)Diameter 5 mm, there are 5 circles; (3)Diameter 5 mm, there are 3 circles.

Third, working technique

Each one carries on physical examination, auscultation heart murmur property and sonority ago the skill, and make X-ray chest and take a photograph of one, interesting the electrocardiogram, colored Doppler's supersound and pursue to measure PDA size.

Infant until the intersection of office and flax or vein compound, anaesthetize, puncture whifves of the intersection of sound and pulse or puncture the arteria femoralis simply, fetch the left location, in the radiography of lowering department of arch of aorta, reveal PDA position, shape, measurement its narrowest place internal diameter and length.

Use the intersection of 5F and the intersection of end and the intersection of hole and conduit by arteria femoralis, lower aorta until PDA to the lung artery and from one burst of veins, the lung artery reaches the aorta of dropping through PDA.

That 1.2 mm steel wire push and send the spring coil along 5F end hole conduit by transporting the steel wire or diameter specializedly, make it lower the aorta and enclose and count and take the majority. If 5 circle lower the intersection of aorta and end, put 2.5- 3.0 circle, lung artery carry 1.5-2.0 lap; If 3 circle lower the intersection of aorta and end, put 1.5- 2.0 circle, lung artery carry 1 circle, stop up and close PDA. Can select the spring coil of 3 circles for use while lowering the aorta and is made degree and below 6 mm again in postoperative 10 minutes.

Group this have 6 example adopt, it passes burst to be intravenous, the intersection of lung and through PDA to lower aorta, stop up and close PDA artery; Have 19 examples to adopt by the arteria femoralis, lower the aorta and stop up and close PDA to the lung artery through PDA. While stopping up closing by the venous system, it is high because of PDA aorta lateral pressure, so the spring coil emits 2- 3 circles on PDA aorta end first, then go back to draw and fix and lower the side of aorta in PDA, the remaining spring coil will be very easy to emit and fix in PDA lung artery. While stopping up closing by the arterial system, the spring coil is emitted on PDA lung artery side first, go back to draw when it is released that PDA lowers the side of aorta, the blood flow of aorta is very apt to print the spring coil to the lung artery entirely, so should transport the steel wire to strain at this moment, go back, dismiss from conduit slowly, make spring coil succeed, enclose, take shape and fix, lower the intersection of aorta and end under certain tension.

In a word, stop up, it closes skills to be an safe, effective, economy wound light driving the chest to treat the method of PDA by spring coil, PDA of conduit, can be suitable for infant and pre-school children, and PDA person who smaller thans 3 mm should choose this method first.

References

1 Rothman A, Tong AD. Percutaneous coil embolization of superfluous vascular connections in patients with congenital heart disease. Am Heart J, 1993, 126:206-213.

2 Lloyd TR, Fedderly R, Mendelsohn AM, et al. Transcatheter occlusion of patent ductus arteriosus with gianturco coies. Circulation, 1993, 88:1412-1420.

3 Tometzki AJP, Arnold R, Peart I, et al. Transcatheter occlusion of the patent ductus arteriosus with look detachable coils. Heart, 1996, 76:531-535.

4 Hawkins JA, Minich LL, Tani LY, et al. Cost and efficacy of sugical ligation versus transcatheter coil occlusion of patent ductus arteriosus. J Thorac Cardiovasc Surg, 1996, 112:1634-1639.

5 are big intelligently, once the country was big, Li YuFen,etc.. The artery conduit has not closed three kinds to stop up comparison which close the method. Chinese pediatrics magazine, 1996, 33: 116-118.

6 de Moor M, a1-Fadley F, Galal O. Closure of residual leak after umbralla occlusion of the patent arterial duct, using Gianturco coils. Int J Cardiology, 1996, 56:5-9.

(Accept the draft: 1998-02-27 Build, answer: 1998-05-28)


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