Evaluation Of The Middle And Long Term Efficacy Of Transcatheter Closure In Pediatric Patients With Patent Ductus Arteriosus Using Transthoracic Echocardiography

Objective To retrospectively analyze the changes of left cardiac morphology and left ventricular systolic function after transcatheter closure in pediatric patients diagnosed patent ductus arteriosus(PDA),and to evaluate the middle and long term effect of closure by transthoracic echocardiographic(TTE).Methods Data of 186 PDA pediatric patients who successfully accepted the transcatheter interventional closure in Heart Institute of the First Affiliated Hospital of Guangxi Medical University from January 2011 to December 2016 was collected.Left atrium end-systolic diameter(LAESD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular fraction shortening(LVFS),main pulmonary artery diameter(MPAD),mean pulmonary arterial pressure(MPAP)and valvular regurgitation of all PDA patients were measured pre-interventional closure,and post closure in three days,a month,three months,six months,a year,two years and above(the longest follow-up is more than four years)by transthoracic echocardiographic(TTE).Results 1.In PDA children patients,compared to pre-interventional closure,LAESD,LVES,LVEDD and MPAD were reduced obviously post-interventional closure in three days,a month,three months,six months,a year,two years and above(P<0.05).Compared to post-interventional closure in three days,LVEDD and LVESD were reduced in varying degrees in a month,three months,six months,a year,two years and above(P<0.05).Moreover,compared to pre-interventional closure,LAESD,LVESD,LVEDD and MPAD were reduced most obviously in three days and a month post-interventional closure,its diameter were reduced to a minimum in six months post-interventional closure.In two years and above post-interventional closure,LAESD,LVESD,LVEDD and MPAD were increased slightly,but there was no statistically significant difference(P > 0.05).LAESD and MPAD in PDA children with pulmonary arterial hypertension(PAH)decreased more obviously than that in PDA children with normal pulmonary arterial pressure in three days post-interventional closure(P<0.05).2.Compared to pre-interventional closure,LVFS was reduced post-interventional closure in three days,a month,three months,six months and LVEF was reduced post-interventional closure in a month and three months(P< 0.05).LVEF in a year and LVFS in six months after closure were progressively increased to the levels as like pre-interventional closure(P<0.05).3.Compared to pre-interventional closure,both the quantity and incidence of aortic regurgitation(AR)were increased within three days after interventional closure(P < 0.05),but reduced in a month,three months,six months,a year,two years and above(P<0.05).Compared to pre-interventionalclosure,the quantity of mitral regurgitation(MR)was reduced post-interventional closure in three days,a month,three months,six months,a year,two years and above(P < 0.05);Moreover,the incidence of MR was reduced in a month,three months,six months,a year,two years and above after interventional closure compared to pre-interventional closure and within three days after interventional closure(P < 0.05).Compared to pre-interventional closure,the quantity of tricuspid regurgitation(TR)was reduced in three days,a month,three months,six months,a year,two years and above post-interventional closure(P<0.05).Compared to post-interventional closure in three days,the quantity of TR was reduced in varying degrees in a month,three months,six months,a year,two years and above(P<0.05).Compared to pre-interventional closure,the incidence of TR was reduced post-interventional closure in three days,a month and three months(P<0.05),but there was no difference between pre-interventional closure and post-interventional closure in six months,a year,two years and above(P > 0.05).Compared to pre-interventional closure,the quantity of pulmonary regurgitation(PR)was reduced in three days,a month,three months,six months and a year post-interventional closure(P<0.05).There was no difference in incidence of PR in different time after interventional closure(P>0.05).4.During the follow-up period,a slightly residual shunt was found in one case nearly one day and seven days after closure,then the occluder was embedded in the opening of the left common carotir artery.Increased velocity of forward flow in descending aorta starting section(the equivalent of occluder device level)was found in one case post-interventional closure in nearly one day,a month,three months,six months and more than a year.Conclusions 1.In PDA pediatric patients,cardiac geometric morphologycould be effectively recovered in a short term after closure,and almost could be recovered post-interventional closure in six months.In addition,PDA pediatric with functional PAH should be actively involved in the treatment of interventional occlusion,avoiding the development of resistant PAH.2.The left ventricular systolic function was decreased after closure,but gradually recovered in six months.3.It need pay great attention to that the quantity and incidence of AR was increased after closure compared to pre-interventional closure.4.Interventional therapy is a safe and effective method for patent ductus arteriosus in pediatric patients.5.TTE could be used to observe the changes of left cardiac morphology,left ventricular systolic function and the regurgitation of the valves termly and repeatedly,which plays an important role in evaluating the result of PDA closure.