Changes Of Cardiac Structure And Function In Children With Patent Ducts Arteriosus And Effects After Occlusion

Objective: To investigate the changes of cardiac structure and function and pulmonary arterial pressure and the differences of different ducts arteriosus diameters,as well as the effects after percutaneous closure.Methods: The demographic and echocardiographic and angiographic data of 306 children with patent ducts arteriosus who successfully underwent percutaneous closure from July 2017 to October 2018 in Children's Hospital of Chongqing medical university were retrospectively analyzed.Patients were included in the follow-up cohort who had completion data in height and weight and echocardiography for 1th day and 1th,3th,6th,12 th month.Results:1.The age of 306 cases of patent ducts arteriosus was 3 months-15 years,the quartile age is 2 years and 1 month(1 year and 1 month,3years and 9months),the ducts arteriosus diameter was 0.8-10 mm,the quartile diameter is 3.3(2.3,4.8)mm.Patients were divided into three groups according to the ducts arteriosus diameter,diameter?2mm group(n=52),2mm<diameter<4mm group(n=137),diameter?4mm group(n=117).With the increase of ducts arteriosus diameter,the Z values of cardiac chamber diameter measured by echocardiography increase(P < 0.05).And the rate of heart enlargement,the rate of pulmonary arterial hypertension increase.For those with diameter?2mm,there was almost no cardiac enlargement and pulmonary arterial hypertension.For those with diameter?4mm,there was 89.7% cardiac enlargement and 56.4% pulmonary arterial hypertension.151 patients(49.4%)had cardiomegaly before percutaneous closure.The left ventricle has the largest proportion of cardiac enlargement.32.7% patients had pulmonary arterial hypertension and the right ventricular enlargement was associated with pulmonary arterial hypertension,the right ventricular enlargement is more likely in older PDA children with in high pulmonary artery pressure.The left ventricular ejection fraction increased,then decreased with the increase of ducts arteriosus diameter.Preoperative echocardiography showed that the diameter of ducts arteriosus was larger than that of angiography.2.A total of 112 cases of patent ducts arteriosus were involved.The Z values of each cardiac chamber decreased gradually after percutaneous closure.More than 80% of the enlarged hearts returned to normal after 6 months,and all of them returned to normal after 12 months.The left ventricular systolic function was decreased,and was back to normal in 6 months.The pulmonary artery pressure decreased significantly 1 day after percutaneous closure,and only 1 case of pulmonary arterial hypertension did not decrease to normal 1 year.In this case,the child was older,the ducts arteriosus diameter was larger,and the pulmonary artery pressure was higher.3.There was no difference in the proportion of different cardiac chamber reversal at the same time point after percutaneous closure.The ducts arteriosus diameters were large and the cardiac chamber reversals were slow.PDA children were older and the cardiac chamber reversals were slow.Conclusions: The proportion and degree of left ventricular enlargement were largest in PDA children.The right ventricular enlargement is more likely in older PDA children with in high pulmonary artery pressure.The proportion of cardiac enlargement and pulmonary arterial hypertension in children with ducts arteriosus diameter?4mm are high,and follow-up and early surgery should be strengthened.All of the enlarged hearts returned to normal 12 months after percutaneous closure.Pulmonary arterial hypertension almost completely recovered one day after percutaneous closure.