两例经导管闭合失败的ebstein异常足月新生儿大动脉导管早期自发闭合

R. Haddad, D. Bonnet, S. Malekzadeh-Milani
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引用次数: 0

摘要

新生儿Ebstein异常(EA)的独特特征是存在肺闭锁、动脉导管(AD)通畅和肺血管阻力的变异性。在排除或缓解解剖性肺梗阻后促进导管早期闭合可能提高新生儿的存活率。经导管导管闭合是一个有趣的选择,但由于低规格批准装置的可用尺寸有限,对于患有大面积弯曲AD的新生儿来说可能具有挑战性。目的我们报告了连续2例患有EA和大面积AD的足月新生儿,在经导管封堵失败的过程中,机械性AD刺激导致2天后最终封堵。方法从股静脉接近两名连续足月的EA新生儿,尝试闭合导管。在第一名9天大的患者(3公斤)的AD(肺端:6.3毫米,长度8.9毫米)中植入一个8毫米的AVPII,并在释放前取出,以应对重要的渗漏和装置不稳定。10毫米AVPII的分娩非常费力,并且在重要出血后中止了手术。将MVP-9Q植入第二名14天大的患者(2.8 kg)的AD(肺端:7.6 mm,长度16.1 mm)中,并在立即转移到肺动脉干后在释放前取出。由于医疗器械中没有更大的低剖面闭塞装置,手术中止。结果/预期结果患者被送回ICU进行监测并重新讨论管理策略。随访超声显示AD大小自发和渐进性缩小,直到术后两天完全闭合,随访结果良好。结论/透视在需要早期导管闭合的类似病例中,应尝试经导管闭合。在临床可能的情况下,手术结扎可以在干预失败后推迟几天。进一步的研究似乎很有意思,以评估导管壁的机械刺激是否可以成为足月前和足月新生儿自发导管闭合的有用替代方案。
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Early spontaneous closure of large arterial ducts in two term neonates with ebstein anomaly after failed attempts of transcatheter closure

Introduction

The unique features of neonatal Ebstein's anomaly (EA) are the presence of pulmonary atresia, arterial duct (AD) patency, and the variability of pulmonary vascular resistance. Promoting early ductal closure after ruling out or relieving anatomic pulmonary obstruction might improve neonatal survival. Transcatheter ductal closure is an interesting option but can be challenging in tiny neonates with large tortuous AD due to the limited available sizes of low-profile approved devices.

Objective

We report on 2 consecutive term newborns with EA and large AD in whom mechanical AD stimulus during failed attempts of transcatheter closure led after 2 days to definitive closure.

Methods

Two consecutive term neonates with EA were approached from the femoral vein for an attempted ductal closure. An 8 mm-AVPII was implanted in the AD (pulmonary end: 6.3 mm, length 8.9 mm) of the first 9-day-old patient (3 kg) and was removed before release for important leak and device instability. Delivery of 10 mm AVPII was laborious and procedure was aborted after important bleeding. A MVP-9Q was implanted in the AD (pulmonary end: 7.6 mm, length 16.1 mm) of the second 14-day-old patient (2.8 kg) and was removed before release after immediate migration to the pulmonary artery trunk. The procedure was aborted in the absence of a larger low-profile occlusion device in the armamentarium.

Results/Expected results

Patients were sent back to the ICU for surveillance and a re-discussion of the management strategy. Follow-up ultrasound showed a spontaneous and progressive diminution in the AD size until complete closure two days postoperative with good follow-up outcomes.

Conclusion/Perspectives

Transcatheter closure should be attempted in similar cases requiring early ductal closure. Surgical ligation can be postponed a couple of days after failed interventions when clinically possible. Further studies seem interesting to evaluate whether mechanical stimulation of the ductal wall can be a useful alternative to initiate spontaneous ductal closure in pre-term and term neonates.

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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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