| Background Patent ductus arteriosus(PDA) was one of most common congenital heart diseases. Surgical ligation is traditional strategy for therapy against PDA.Recently,transcatheter closure of PDA guided by ultrasonic cardiogram was an essential therapeutic strategy. In China, most studies were focused on transcatheter closure against PDA in clinical. Thus, there are less reports about comparative study of the changes after different surgery. In addition, the occurrence of postoperative left ventricular systolic dysfunction(POLVD) following closure of PDA is rarely reported,and this mechanism is still unknown.Objective To evaluate the therapeutic efficiency of percutaneous closure and surgical ligation against PDA, by analyzing cardiac structure and function using by UCG.Furthermore, to identify the major factors which affected POLVD in patients who underwent operate of PDA.Methods Firstly, 185 patients with PDA were divided into two groups: the transcatheter group and ligation group by various operating methods. UCG was conducted at the preoperative, at approximately 7 day, 1 month, 3month and 6month after PDA closure. And after surgical ligation, the UCG was conducted at at approximately 7day, 1 month and 6 month. Subsequently, the relevant parameters of heart structure and function in this two groups were collected for comparative analysis.Meanwhile, we observed and compared the postoperative residual shunt, valve function, the pulmonic pressure and the left ventricular function recovery were observed and analyzed, respectively. Secondly, the patients without the cardiotonic drug were assigned to two groups depended on whether the left ventricle ejection fraction(LVEF) dropped below 10 percent after therapy, and the relevant variables were selected for logistic regression analysis.Results Left ventricular dimension、left ventricular mass index(LVMI)and left ventricular stroke volume(LVSV) were significantly reduced(P<0.05) in the closure group 7 days after operation, and they were decreased over time; Left atrial dimension(LAD) was slowly reduced, especially 6 months after operation. Pulmonary artery diameter(PAD) was declined instantly 7 days after operation, particularly 3 months after operation(P<0.01). LAD to Aortic dimension(AOD) ratio was decreased extremely significantly(P<0.01) 1 month after operation while pulmonary artery systolic pressure(PASP)was decreased obviously 3 months after operation(P<0.01);LVEF and Left ventricular fractional shortening(LVFS)were decreased obviously in the early stage after operation, and then they gradually increased 1 month after operation until 3 month after operation when they returned to normal. Left ventricular dimension、LAD、LAD/AOD、PAD、LVMI and LVSV started to shrink in the ligation7 days after operation whereas no significantly change occurred in the later stage after operation. PASP was decreased obviously1 months after operation(P<0.05).Both of LVEF and LVFS were reduced slightly in the very early stage after operation, but it rose to normal one month after operation. There is no significantly difference of AOD in two groups before and after treatment(P>0.05). The LVEF mean decreased from(66.9±7.87)% at preoperative to(60.56±9.89)% at postoperative in the closure group,while the mean LVEF decreased from(68.05±6.94)% at preoperative to(64.05±8.58)% at postoperative in the other one. The former had a more decline(P<0.05). But the ligation group needed longer time to recover(P<0.05)and higher incidence of residual shunt than the other. Pulmonary hypertension(PH) were decreased at different extent after operation, but no significantly difference(P>0.05)was observed between these two groups. Moderate and severe matral regurgitation(MR)and aortic regurgitation(AR) occurred after operation in both two groups, thus there also was no significantly difference(P>0.05). By a logistic regression analysis,independent factors that resulted to POLVD were: the narrowest part of PDA, left ventricular end diastolic dimension, left ventricular mass index(LVMI) and combined with MR before operation.Conclusion 1、Both the the transcatheter and surgery therapy have precise therapeutic efficiency. But there were higher incidences of residual shunt in the ligation group. It also needed to take a longer time to recover than the closure group. 2、The narrowest diameter of PDA, larger LVEDD, higher LVMI and preoperative combined MR before operation were independent factors which can result to a risk of POLVD. |
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