Clinical Study Of Myocardial Injury, Inflammatory Reaction And The Changes Of Heart Function After Transcatheter Clousure Of Patent Ductus Ateriosus

ObjectiveBy measuring the index of myocardial injury(cTnI, CKMB, AST) andinflammatory reaction(CRP) before and Immediately,6h,24h,72h,7d afterinterventional therapy, and measuring the changes of cardiac function before,3d and3m(months), after interventional therapy in37patients with PDA, this study aims toanalyze the extent of myocardial injury and inflammatory reaction after transcatheterclousure of patent ductus ateriosus (PDA) could occur, to analyze the influencingfactors on myocardial injury, and to provides theoretical basis for the safety oftranscatheter clousure of PDA. At the same time, by comparing the trend of leftventricular systolic function before and3d,3m after interventional therapy, we illustratethe recovery of heart structure and function.Materials and Methods1Study objects37CHD patients (15boys,22girls) were selected, who were hospitalized inPediatric Clinical College of Anhui Medical University (Anhui Provincial Children’sHospital) from Oct.2008to Aug. The blood pressure of four limbs and oxygen saturation were in normal range after physical examinations by the Resident of ourDepartment. By the examination of electrocardiogram (EKG), chest X-ray and UCG, allthe PDA patients were Left to Right Shunt.37cases of PDA who were undergoneinterventional therapy, of which the median age was36m (4~192m), the weight was13kg（6~60kg, there were Male15cases and female7cases. All the patients wereaccordance with the interventional therapy standards (The guideline of transcathetertherapy of congenital heart disease, Chinese Journal of Practical Pediatrics,2004, no.3).All the patients had Indications, without contraindications, without infection or werecured, without organic pulmonary hypertension, of which the heart function was innormal range. The informed consent was fulfilled according the principle ofinterventional therapy, and the guardians were informed of possible interventional risks.On the premise of sufficient understanding，informed consent for interventionaltherapy and research were signed. The homemade nitinol occluder was used in thepatient that was in accordance with the Indications. The concentration of cTnI, CKMB,AST and CRP were measured at preprocedure, immediately,6h,24h,72h and7d afterprocedure for every patient who was eligible. The heart function was measured by UCGat preprocedure,3d and3m after procedure.2. MethodsThe concentration of cTnI, CKMB, AST and CRP were measured at preprocedure, c,6h,24h,72h and7d after procedure for every patient who was eligible. The serumsamples at preprocedure,6h,24h,72h and7d after procedure were collected by theresearcher in person, and the serum samples at immediately after procedure werecollected by operator from catheter. The related risk factors (age, the size of defect,duration of exposition and procedure) were sought. The heart function was measured byUCG, and the trend of heart function was analyzed. EpiDate3.0was used for data entry and SPSS13.0for data analysis.ResultsThe cTnI(μg·L-1) levels at immediate post procedure,6h,27h and72h was0.08(0~1.37),0.09(0~0.68),0.06(0~0.96) and0.04(0~0.96), which were higher thanthat before procedure [0.05(0~0.58)]. The cTnI level at7d [0.04(0~0.44)] was lowerthan that before procedure. The peak levels of cTnI occurred at6h post procedure andthe elevation of cTnI was significant (P＜0.05). All the cTnI levels post procedure werelower than normal; The CKMB level at immediate post procedure [14.00(4.00~75.00)]was higher than that before procedure [11.00(6.00~42.00)], but the difference was notsignificant. The AST (mg·L-1) levels began to ascend at6h [0.36(0~28)] after theprocedure and reached peak levels at24h, and the difference was significant. The CRP(mg·L-1) levels began to ascend at6h [0.36(0~28)] after the procedure and reached peaklevels at72h post procedure, then decreased. The CRP levels24h[2.5（0~30.5）],72h[7.79(0.2~52.4)] and7d[4.1(0.2~34.57)] were higher than before procedure and thedifferences were significant(P＜0.05). The CRP levels were in normal range at everypoint after procedure. The cTnI levels of post procedure weren’t significantly correlatedwith age, size of defect, duration of exposure and duration of procedure LVDD andLVDS has the trend to descend, and the difference of LVDD and LVDS betweenpreprocedure and was significant. At the same time, LVEF and LVFS descend, and thedifference was significant(P＜0.01or0.05), and then tended to increase, approached thepreprocedure level.Conclusion Transcatheter closure of PDA may result in transitory elevation of cTnI, CKMB,AST and CRP levels post procedure, but cTnI levels wasn’t significantly correlated withage, size of defect, duration of exposure and duration of procedure. So transcatheterclousure of PDA is safe and effective without causing obvious myocardial injury andinflammatory reaction. The accompanying transitory ongoing decline of LVDD andLVDS after procedure was caused by the change of correction of anatomical structuredeformities, and the accompanying transitory decline of left ventricular systolic functionafter procedure was the compensatory response after return to a normal hemodynamic.The decline of left ventricular systolic function can approach the preprocedure level3mafter procedures, and the clinic intervention was not needed.