Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

경피적 동맥관 폐쇄술에 사용된 Duct-Occlud Coil의 종류에 따른 중-단기 결과의 비교

Impact of Device Evolution in Transcatheter Closure of Patent Ductus Arteriosus Using Duct-Occlud Coils : Comparison of Mid-term Results

  • 김명관 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 한동기 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 최재영 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 김유리아 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 유병원 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 최덕영 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 설준희 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 이승규 (연세대학교 의과대학 심장혈관병원 심혈관연구소, 소아심장과)
  • Kim, Myung Kwan (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Han, Dong Ki (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Choi, Jae Young (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Kim, Yuria (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Yoo, Byung Won (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Choi, Deok Young (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Sul, Jun Hee (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Lee, Sung Kue (Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine)
  • 투고 : 2004.08.30
  • 심사 : 2004.10.09
  • 발행 : 2005.02.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 경피적 동맥관 폐쇄술은 중등도 이하 크기의 동맥관 개존증의 일차적인 치료로 시행되고 있다. 저자들은 본원에서 Duct-Occlud coil(pfm AG, $K{\ddot{o}}ln$, Germany)을 이용한 폐쇄술 후 기구 종류에 따른 추적 관찰 결과의 분석을 위해 본 연구를 시행하였다. 방 법 : 1996년 3월부터 2003년 12월까지 본원에서 다른 심장질환을 동반하지 않는 동맥관 개존증을 진단 받고 Duct-Occlud를 이용한 경피적 폐쇄술을 시행 받은 205명의 환자들을 대상으로 하였다. 대상 환자의 월령은 6-780(median : 38)개월이었고 체중은 6-79(median : 15) kg이었다. 사용된 Duct-occlud는 standard coil, reinforced coil, reinforced reverse cone coil, Nit-Occlud double disk coil 4종류를 사용하였고 시술 후, 1개월, 6개월, 12개월 이후에 이학적 검사, 심장 초음파를 시행하여 동맥관 폐쇄를 확인하였다. 결 과 : 폐쇄를 시도한 209명의 환자에서 216회의 시술을 시행하여 205명에서 성공하였고 5례에서 시술 후 코일의 색전으로 경피적 제거 후 재시술 하였으며 2례에서 잔류 단락을 2차 시술로 폐쇄하였다. 대상 환자들의 동맥관 최소직경은 $2.9{\pm}1.1$(0.8-6.0) mm, Qp/Qs는 $1.4{\pm}0.3$3(1.1-2.1)이었다. 사용된 기구에 따른 임상적, 혈역학적 지표는 통계학적 차이가 없었으며 추적 관찰 12개월 이후에 시행한 심초음파상 standard coil 24명 중 2명(8%), reinforced coil 50명 중 4명(8%), reinforced reverse cone coil 58명 중 2명(4%), Nit-Occlud double disk coil 73명 중 0명(0%)의 잔류 단락을 보였다. Nit-Occlud double disk coil은 시술 후 1일, 1개월, 6개월에 다른 기구들에 비해 통계학적으로 유의하게 낮은 잔류단락률을 보였다. 잔류 단락에 영향을 미치는 지표는 동맥관 최소 직경으로 완전 폐쇄군과 잔류 단락군 사이에 유의한 차이를 보였다(P<0.05). Nit-Occlud double disk coil의 경우 최소 직경이 중등도 이상(>4 mm)의 비교적 큰 동맥관의 경우에 있어서도 시술한 12명에서 모두 6개월 이후 동맥관의 완전 폐쇄를 보였다. 결 론 : Duct-Occlud를 이용한 경피적 폐쇄술은 동맥관 폐쇄에 효과적인 방법으로 사료되며, Nit-Occlud double disk coil은 최소직경이 4 mm보다 큰 동맥관의 경우에도 높은 폐쇄율을 보여 이전의 기구에 비해 보다 효과적인 방법으로 이용될 수 있을 것으로 사료된다.

Purpose : We reviewed the therapeutic results of various Duct-Occlud coils(pfm AG, $K{\ddot{o}}ln$, Germany) to evaluate the efficacy of the most-recently modified Duct-Occlud coil(Nit-Occlud) in the transcatheter closure of patent ductus arteriosus(PDA), including large defects more than 4 mm in diameter. Methods : Two hundred and five patients who underwent percutaneous PDA occlusion using Duct-Occlud devices from March 1996 to December 2003 were enrolled and four types of Duct-Occlud [Standard(S), Reinforced(R), Reinforced reverse cone(RR) and Nit-Occlud(N)] were used in this study. The patients were followed up by echocardiogram and physical examination before discharge, one month, six months and 12 months after the procedure. Results : The rate of residual shunt according to the type of Duct-Occlud were as follows : S-54%, R-72%, RR-50%, N-14%(P<0.05 compared with other devices) at one month, S-25%, R-44%, RR-37%, N-0%(P<0.05 compared with other devices) at six months, S-8%, R-8%, RR-4%, N-0%(P<0.05 compared with S and R) at 12 months and later. Nit-Occlud coil showed the complete occlusion of PDA after six months of follow-up, even in 12 patients with relatively large PDA(>4 mm). Conclusion : The transcatheter closure of PDA using Duct-Occlud was an effective treatment and our study revealed that a Nit-Occlud coil which showed higher rate of occlusion even in PDA with large diameters over than 4 mm, was a more effective modality compared to previous devices.

키워드

참고문헌

  1. Ramsesh A, Partho PS, Aahish KT, Vimail H, Vijay T. Device closure of patent ductus arteriosus. J Interven Cardiol 2003;16:385-91 https://doi.org/10.1046/j.1540-8183.2003.01005.x
  2. Campbell M. Natural history of persistent ductus arteriosus. Br Heart J 1968;30:4-13 https://doi.org/10.1136/hrt.30.1.4
  3. Fisher RG, Moodie DS, Sterba R, Gill CC. Patent ductus arteriosus in adults-long-term follow up : nonsurgical versus surgical treatment. J Am Coll Cardiol 1986;8:280-4 https://doi.org/10.1016/S0735-1097(86)80040-7
  4. Porstmann W, Wierny L, Warnke H. Der verschluss des ductus arteriosus persistens ohne thorakotomie. Thoraxchirugie 1967;15:199-203
  5. Rashkind WJ, Mullins CE, Hellenbrand WE, Trait MA. Non-surgical closure of patent ductus arteriosus : clinical application of the Rashkind PDA occluder system. Circulation 1987;75:583-92 https://doi.org/10.1161/01.CIR.75.3.583
  6. Report of the European registry. Transcatheter occlusion of Persistent arterial duct. Lancet 1992;340:1062-6 https://doi.org/10.1016/0140-6736(92)93079-3
  7. Gray DT, Walker AM, Fyler DC, Chalmers TC. Examination of the early 'learning curve' for transcatheter closure of patent ductus arteriosus Rashkind occluder; PDA clousre comparative study group. Circulation 1994;90:36-42
  8. Arora R, Kalra GS, Nigam M, Khalilulah M. Transcather occlusion of patent ductus arteriosus by Rashkind umbrella device : follow up result. Am Heart J 1994;128:539-41 https://doi.org/10.1016/0002-8703(94)90629-7
  9. Moore JW, George L, Kirkpatrik SE, Mathewson JW, Spicer RL. Percutaneous closure of the small patent ductus arteriosus using occluding coils. J Am Coll Cardiol 1994;23: 759-65 https://doi.org/10.1016/0735-1097(94)90765-X
  10. Cambier PA, Kirby WC, Wortham DC, Moore JW. Percutaneous closure of the small(<2.5 mm) patent ductus arteriosus using coil embolization. Am J Cardiol 1992;69:815-6 https://doi.org/10.1016/0002-9149(92)90514-Y
  11. Lloyd TR, Fedderly R, Mendelsohn AM, Sandhu SK, Beekman III RH. Transcatheter occlusion of patent ductus arteriosus with Gianturco coils. Circulation 1993;88:1412-20 https://doi.org/10.1161/01.CIR.88.4.1412
  12. Shim D, Fedderly RT, Beekman III RH, Ludomirsky FA, Young ML, Shork MA, et al. Follow-up of coil occlusion of patent ductus arteriosus. J Am Coll Cardiol 1996;28:207-11 https://doi.org/10.1016/0735-1097(96)00107-6
  13. Moore JW, DiMeglio D, Javois AP, Takahashi M, Berdjis F, Cheatham JP. Results of the phase I food and drug administration clinical trial of Duct-Occlud device occlusion of patent ductus arteriosus. Cathet Cardiovasc Int 2001;52: 74-8 https://doi.org/10.1002/1522-726X(200101)52:1<74::AID-CCD1018>3.0.CO;2-F
  14. Tometzki AJ, Arnold R, Peart I, Steeram N, Abdulhamed JM, Godman MJ, et al. Transcatheter occlusion of the patent ductus arteriosus with Cook detachable coils. Heart 1996;76:531-5 https://doi.org/10.1136/hrt.76.6.531
  15. Rosenthal E, Qureshi SA, Reidy J, Baker EJ, Tynan M. Evolving use of embolization coils for occlusion of arterial duct. Heart 1996;76:525-30 https://doi.org/10.1136/hrt.76.6.525
  16. Oho S, Ishitawa A. Transcatheter occlusion of the patent ductus arteriosus with new detachable coil system(Duct- Occlud). Jpn Circ J 1998;62:489-93 https://doi.org/10.1253/jcj.62.489
  17. Tometzki A, Chan K, De Giovanni J, Houston A, Martin R, Redel D, et al. Total UK multi-centre experience with a novel arterial occlusion device(Duct Occlud pfm). Heart 1996;76:520-4 https://doi.org/10.1136/hrt.76.6.520
  18. Kang IS, Min JY, Lee HJ. Transcatheter occlusion of patent ductus arteriosus(PDA) with retrievable coil device : 'Duct-Occlud' system. J Korean Pediatr Cardiol Soc 1997; 1:94-100
  19. Kim Y, Choi JY, Lee JK, Sul JH, Lee SK, Park HW, et al. Mid-term reault of the transcather occlusion of Patent ductus arteriosus with Duct-Occlud device and procedurerelated problems. J Korean Pediatr Soc 2004;47:36-43
  20. Trong PL, John WM, Malte BN, Franz F. Duct-occlud for occlusion of patent ductus arteriosus. Current Interventional Cardiology Report 2001;3:165-73
  21. Shin DW, Lee KH, Han HS. Nonoperative treatment of PDA using the Duct-occlud. J Korean Pediatric Soc 1997; 40:635-9
  22. Masura J, Walsh KP, Thanopuolous B, Chan C, Bass J, Goussous Y, et al. Catheter closure of moderate to large sized patent ductus arteriosus using the new Amplatzer duct occluder : immediate and short-term results. J Am Coll Cardiol 1998;31:878-82 https://doi.org/10.1016/S0735-1097(98)00013-8
  23. Vijayalakshmi IB. Present scenario of device closure for congenital heart disease. JAMA 2003;101:86-9