| Objective To analyze retrospectively the middle and long term efficacy on patients who were diagnosed as patent ductus arteriosus(PDA) and to explore the factors associated with morphological changes of left ventricular after transcatheter closure.Methods Data of 156 PDA patients who were successfully received the transcatheter interventional closure in Heart Institute of the First Affiliated Hospital of Guangxi Medical University from May 2005 to September 2014 were collected. Pre-interventional closure and post-interventional closure in three days, a month, three months, six months, a year, two years and above. The left atrium end-systolic diameter(LAESD), left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD), left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), main pulmonary artery diameter(MPAD), velocity of PDA shunt(V), pressure drop of PDA shunt(AP) of PDA, The pulmonary to systemic flow ratio(Qp/Qs)and the most narrow diameter of PDA were collected and Standardized by body surface area. The Qp/Qs, the most narrow diameter index of PDA, left ventricular end-diastolic diameter index(LVEDDI), left ventricular end-diastolic volume index(LVEDVI), left ventricular end-systolic volume index(LVESVI), V, △P, Age and ect of PDA patients pre-interventional closure and post-interventional closure were also collected. The factors associated with morphological changes of left ventricular after transcatheter closure were investigated by ROC curve to find the critical value. In addition, 707 cases of normal subjects were involved as control.Results 1.Compared with the normal control group, the LVEDD of 143 PDA patients returned to normal level after closure according to the following up data of two years and above, accounting for about 91.76%. The LVEDD of 93(95.79%) minor patients returned to normal levels in six months after closure, while 50(85.21%) adult patients whose LVEDD returned to normal levels in a year. There are still 13 PDA patients (including 9 adult patients,4 minor patients) whose LVEDD have not returned to normal level, accounting for about8.33%.2. In adult PDA patients, compared with pre-interventional closure, the LAESD, LVEDD, LVESD, MPAD reduced obviously post-interventional closure in three days, a month, three months, six months, a year, two years and above(P<0.05). Compared with post-interventional closure in three days, the LAESD, LVEDD, LVESD, MPAD were reduced in varying degrees in a month, three months, six months、a year, two years and above (P<0.05). What is more, compared with pre-interventional closure, the LAESD, LVEDD, LVESD and MPAD were reduced most obviously in three days post-interventional closure, and then showed a low trendency.3. For PDA patients, The LVEDDI negatively correlated with the Qp/Qs, LVESVI, △P and Age of pre-interventional closure(B=-0.563, P<0.01, B=-0.098, P< 0.01, B=-0.052, P<0.01,-B=-0.875, P< 0.01). There is a certain assessed value in the elements of pre-interventional closure for the morphological changes of left ventricle. Through the analysis by ROC curve, we found that the area under the curve values of Qp/Qs, LVESVI, △P and Age in pre-interventional closure are 0.70、0.85、0.73、0.82. It showed that these indicators have good diagnosis value to the morphological changes of left ventricle. The critical values are 3.3,45.6 mL/m2,87.5mmHg and 26.5y respectively. Also, the sensitivity and specificity are high.Conclusions 1. For most PDA patients, the morphology of left ventricle could return to normal level within a year after transcatheter closure.2. For adult PDA patients, the morphology of left ventricle was reduced most obviously in short term post-interventional closure, and then showed a low trendency.3. There is a certain assessed value in the elements of pre-interventional closure for the morphological changes of left ventricle after transcatheter closure, such as Qp/Qs, LVESVI, AP, Age and ect. |
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