Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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경피적 동맥관 폐쇄술에서 최근의 기구들의 전략적 이용과 결과

A new strategy for transcatheter closure of patent ductus arteriosus with recent-generation devices

  • 김상이 (연세대학교 의과대학 소아과학교실, 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 이수현 (연세대학교 의과대학 소아과학교실, 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 김남균 (연세대학교 의과대학 소아과학교실, 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 최재영 (연세대학교 의과대학 소아과학교실, 심장혈관병원 심혈관연구소, 소아심장과) ;
  • 설준희 (연세대학교 의과대학 소아과학교실, 심장혈관병원 심혈관연구소, 소아심장과)
  • Kim, Sang Yee (Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center Cardiovascular Research Institute Yonsei University College of Medicine) ;
  • Lee, Soo Hyun (Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center Cardiovascular Research Institute Yonsei University College of Medicine) ;
  • Kim, Nam Kyun (Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center Cardiovascular Research Institute Yonsei University College of Medicine) ;
  • Choi, Jae Young (Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center Cardiovascular Research Institute Yonsei University College of Medicine) ;
  • Sul, Jun Hee (Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center Cardiovascular Research Institute Yonsei University College of Medicine)
  • 투고 : 2008.09.16
  • 심사 : 2008.10.17
  • 발행 : 2009.04.15
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초록

목 적 : 경피적 동맥관 폐쇄술은 동맥관 개존증의 표준 치료로 시행되고 있다. 저자들은 동맥관의 최소 직경(MD)과 체혈류와 폐혈류의 비(Qp/Qs ratio)를 기준으로 하여 선택한 각각의 기구들로 경피적 동맥관 폐쇄술 시행한 후 추적 관찰 결과를 비교, 분석하여 새로운 기구 선택 기준의 효용성과 안전성을 알아보았다. 방 법 : 2003년 2월부터 2006년 1월까지 본원에서 동맥관 개존증을 진단받고 동맥관의 크기 및 Qp/Qs 비에 따라 CDC, PNO, ADO를 선택하여 경피적 동맥관 폐쇄술을 시행받은 138명의 환자를 대상으로 하였다. 그리고 2000년 2월부터 2003년 1월까지 본원에서 DO, PNO로 경피적 동맥관 폐쇄술을 시행받은 89명의 환자들을 대조군으로 설정하였다. 시술 전 환자의 임상적, 혈역학적 지표들을 확인하였고 시술 후 1일, 1개월, 6개월, 12개월, 그리고 12개월 이후 잔류 단락 유무 및 합병증을 평가, 비교하였다. 결 과 : 대상군 138명 모두에서 시술에 성공하였고 기구 색전도 없었으며 시술 후 12개월 이후 잔류 단락이 남아있지 않았다. 주요 합병증의 빈도는 대상군 138명 중 0명(0%), 대조군 89명 중 7명(7.9%)이었고(P<0.05) 전체 합병증의 빈도도 대상군 138명 중 2명(1.4%), 대조군 89명 중 8명(9.0%)으로(P=0.001) 대상군에서 대조군에 비하여 의미 있게 합병증의 빈도가 낮았다. 결 론 : 과거에 경피적 폐쇄가 어려웠던 큰 크기의 동맥관 개존에 ADO를 사용하게 되고 이전 기구들의 단점들이 개선된 최근 기구들을 각각의 특성에 적합하게 전략적으로 선택하여 시술함으로써 경피적 동맥관 폐쇄술의 결과가 향상되었고 더욱 안전하고 완전한 효과를 나타내게 되었다.

Purpose : The aim of this study was to assess the efficacy and safety of recent-generation patent ductus arteriosus (PDA) closure devices applied by a new selection strategy according to the characteristics of each PDA. Methods : From February 2003 to January 2006, 138 patients underwent transcatheter closure of PDA (study group). According to the size and morphology of each ductus, a COOK Detachable Coil or 'flex' PFM Nit-Occlud was used for a small ductus (group 1, n=43); 'medium' PFM Nit-Occlud (group 2, n=49) for a moderate ductus; and an Amplatzer Duct Occluder (group 3, n=46) for a large ductus. The 83 patients who underwent transcatheter closure of PDA from February 2000 to January 2003 were defined as the comparison group. The Qp/Qs ratio, pulmonary/aorta pressure ratio, and MD of the ductus were compared. Immediate and follow-up results including residual shunts and complications were also evaluated and compared among groups. Results : In all 138 patients, complete occlusions were confirmed without major complications, while procedure failure (n=2, 2.2%), device embolization (n=1, 1.1%), and persistent residual shunt (n=4, 4.5%) were documented in the comparison group. Total complication rates were lower in the study group than in the comparison group (study group, 1.4%; comparison group, 9.0%; P<0.05). Conclusion : A novel strategy adopting the merits of various recent-generation devices for transcatheter closure of PDA provides excellent clinical results with minimal risk.

키워드

참고문헌

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피인용 문헌

  1. Use of an Amplatzer Vascular Plug to occlude a tubular type of patent ductus arteriosus vol.52, pp.9, 2009, https://doi.org/10.3345/kjp.2009.52.9.1035
  2. Percutaneous transcatheter closure of patent ductus arteriosus: Initial experience of Sohag University vol.66, pp.2, 2014, https://doi.org/10.1016/j.ehj.2013.01.003