The Possible Reasons Of Thrombocytopenia In Patients Of Congenital Heart Diseases After Successful Interventional Occlusion.

Objectives:To approach the underlying mechanisms of thrombocytopenia developing after interventional therapy for congenital heart disease patients (including atrial septal defect, ventricular septal defect, patent ductus arteriosus, right coronary right atrial fistula).Methods:The patients aged 8 to 75 with structural heart diseases including ASD, VSD, PDA, ruptured aneurysm of the sins of valsalva were selected. And the patients have the necessity for interventional therapy and correspond to indications were enrolled. The exclusion criteria were dysfunction of coagulation, hematological disorders and warfarin therapy.149 patients were enrolled in this study. The basic clinical data:changes of platelet count, age, gender, type of congenital heart disease, defect size and closure device manufacturers, occluder diameter, cross-defect gradient, residual shunt were collected, and regression analysis was performed on the last 8 factors, independent influencing factors were screened.Results:149 patients were enrolled in this study, of which 43 cases were male (28.9%),106 cases were female (71.1%). Ages range from 8 years to 75 years, mean age was 41.7±15.9 years. There are 95 ASD patients (63.8%),35 PDA patients(23.5%),18 VSD patients(12.1%),1 patient with right coronary to right atrium fistula(0.7%). Further analysis results are as follows:(1)51 patients(34.2%) developed thrombocytopenia, among which were 7 cases with residual shunt (30%); 39 cases with atrial septal defect (76.5%), 10 cases with PDA(19.6%),1 case with VSD(2%),1 case with right coronary to right atrium fistula (2%). Among all the patients,8 patients used occluders provided by Beijing Huayi producer (15.7%),25 patients used occluders provided by Shanghai jiyi producer (49%),18 patients used occluders provided by Shenzhen xianjian producer(35.3%). According to compare the incidence of thrombocytopenia in group VSD with group ASD, P value(0.004) represents that thrombocytopenia occurred between the two groups was statistically significant different in the proportion. Based on comparing the incidence of group ASD and group PDA, P value(0.270) represents that the difference between the two groups was not significant. Based on comparing the incidence of group VSD and group PDA, P value (0.037) represents that there were no differences between the two groups.(2) According to comparing the degree of thrombocytopenia in group PDA with the group ASD, P value (0.7835) suggests no significant difference between the two groups. Based on comparing the degree of thrombocytopenia in group VSD with group ASD, P value (0.000) suggests that there were significant differences between the two groups. According to comparing the degree of thrombocytopenia in group PDA with group VSD, P value(0.0346) represents there were significant differences between the two groups.(3) The P values were 0.258,0.014,0.000,0.000,0.000,0.000,0.000,0.002 respectively, according to the correlation analysis of factors including age, gender, type of congenital heart disease, defect size and closure device manufacturers, occluder diameter, cross-defect gredient, residual shunt that may cause thrombocytopenia. Regression analysis was performed on the above 8 factors, and two factors were selected were the size of residual shunt and closure device(4)5 patients with severe reduction of platelets(≥80%)were performed detection of platelet antibodies (IgA,IgG,IgM) and bone marrow aspiration, and there is no obvious abnormalities.Conclusion:(1)There was no statistical difference between the incidence of post-catheterization occlusion thrombocytopenia in group PDA and group ASD. There were significant differences between the incidence of post-catheterization occlusion thrombocytopenia between group VSD, group ASD, and group PDA.(2)There were no significant differences between the degree of thrombocytopenia between PDA and ASD group, the degree of reduction of platelets in group PDA and group ASD was much greater than group VSD.(3)Occluder size and residual shunt after catheterization occlosion are independent factors in developing thrombocytopenia. Age, sex, type of congenital heart disease, defect size, occluder manufacturers, cross-defect pressure are relatively related factors.(4) Five patients with PDA developed Severe reduction of platelets (≥80%), the occluder size (waist diameter) were 16mm,14mm,16mm,22mm,30mm respectively. Residual shunt were found in four patients. There were no significant differences between the time needed for their platelet acount recovery and the residual shunt closure.(5)Nothing unusual was found in bone marrow and detection of platelet antibodies.