Clinical Study On The Percutaneous Occlusion With Single Vascular Approach Of PDA By X-ray Combined With Transthoracic Echocardiography

Objectives:To explore the effectiveness of transthoracic echocardiography（TTE）in patent ductus arteriosus（PDA）intervention occlusion.To explore the safety and feasibility of Percutaneous occlusion with single vascular approach of patent ductus arteriosus（PDA）by X-ray combined with TTE.Methods:From October 2017 to December 2020,a total of 105 patients with PDA underwent transcather PDA closure treatment respectively in catheterization laboratory of Capital Institute of Pediatrics Affiliated Children’s Hospital.Preoperative routine TTE examination was performed to confirm the diagnosis.Ductus artery was exposed and measured in 2-dimensional echocardiography and color doppler under parasternal view and suprasternal view.Echo group including 90cases,occluders were determined by the results of TTE,percutaneous closure was performed via only one vessel（femoral artery or femoral vein）under X-ray and TTE.Angiography group including 15 cases,general percutaneous closure was performed in angiography group and angiography was used to measure the size of PDA in the preoperative and assess the plugging effect in the postoperation.The effectiveness of occlusions were evaluated by TTE and fluoroscopy in both groups.Analyze the difference of procedure duration,contrast medium dose and radiation dose between two groups.which underwent classic interventional treatment using arterial and venous access.The informaion of patients in each group,such as age,gender,weight,auscultation murmur,size of PDA,ejection fraction,left ventricular end diastolic diameter,size of device,punctured vessels,blocking effect,operation duration,contrast dose and X-ray dose were observed after operation.All patients were followed-up for 1 month,3 months,6 months and 12 months after discharge.Results:In this study,all the patients were performed successfully,and no residual shunt occurred after the surgery.Data analysis is divided into two parts according to objective.From the first part,there had no statistically significant difference in PDA size measured by aortography and echocardiography（P>0.05）,but there was a significant correlation between two measurements（R~2=0.93,P<0.001）.There was a significant correlation between the diameter of PDA and the size of occluder in the echo group（R~2=0.79,P<0.001）.According to ROC curve analysis,the selection accuracy of our study is 85.3%,and the most appropriate difference value between the waist and the skirt after the release of the occluder was within 13.4mm.From the second part,the amount of operation duration,contrast dose and X-ray dose in the echo group were significantly less than that in the angiography group（P<0.05）.we also found that,as the study progressed,the operation time was shortened in the echo group.In the echo group,there were 56 cases of femoral vein punctured,22 cases of femoral artery and 12 cases of both femoral artery and vein.In the angiography group,there were 15 cases of femoral artery and vein punctured.TTE or angiography showed that the position of the occluders were goodConclusions:In the percutaneous closure of PDA,Echocardiography is of high accuracy for the evaluation of PDA and the selection of occluder.It’s effective and feasible to treat children with patent ductus arteriosus by X-ray combined with echocardiography.The operation time and radiation dose were significantly reduced,the puncture vessels were reduced,and the hospital stay was not prolonged.Compared with the classic percutaneous treatment,X-ray combined with transthoracic echocardiography has more clinical advantages.