Comparaive Study On Effect Of Large Patent Ductus Arteriosus Treatment In Children Aged Under 3 Years:Percutaneous Closure And Surgical Ligation

Objective: To evaluate the efficacy and safety of percutaneous closure versus surgical ligation approach to correct the large patent ductus arteriosus(PDA)in children aged under 3 years.Methods: The clinical data of patients with large PDA aged under 3years who underwent PDA closure in Children’s Hospital of Chongqing Medical University from January 1,2017 to January 1,2020 were retrospectively included.According to the closure method,patients were divided into percutaneous(percutaneous closure)group and ligation(surgical ligation)group.The baseline data,procedure success rate,operation time,hospitalization time,blood transfusion rate,PICU monitoring rate,complication rate and echocardiographic data of the two groups were compared.Results: A total of 66 patients were enrolled.There were 35 patients in the percutaneous group,including 8 males and 27 females.The average age was 10.5±7.6 months(ranged from 2.6 to 36.0 months),the average body weight was 6.7±1.9 kg(ranged from 4.5 to 14.0 kg),and the PDA diameter measured by echocardiography was 7.8±1.4 mm(ranged from 5.7to 11.0 mm).There were 31 patients in the ligation group,including 8males and 23 females.The average age was 13.8±12.0 months(ranged from 1.8 to 36.0 months),and the average body weight was 7.5±2.9 kg(ranged from 3.0 to 14.0 kg),and the PDA diameter measured by echocardiography was 8.5±1.4 mm(ranged from 6.0 to 11.9 mm).31 cases(88.6%)in the percutaneous group were successfully occluded,and 31cases(100.0%)in the ligation group were successfully ligated.There was no significant difference in the procedure success rate between the two groups(P>0.05).In the percutaneous group,4 cases combined with severe pulmonary arterial hypertension(PAH)experienced sudden drops in heart rate,blood pressure,and oxygen saturation during the trial occlusion,and they were all transferred to surgery.The total complication rate,serious complication rate,and non-serious complication rate at 24 hours after operation between percutaneous group and ligation group were 82.9%(29cases)vs 74.2%(23 cases),22.4%(4 cases)vs 0%(0 case),and 71.4%(25cases)vs 74.2%(23 cases),respectively,and there was no significant difference in any of the above indicators between the two groups(All P >0.05).Residual shunt occurred in 16 cases(45.7%)in the percutaneous group and 2 cases(6.4%)in the ligation group 24 hours after operation,a significantly higher rate in the percutaneous group than in the ligation group(P < 0.05).There were 2 cases(5.7%)of residual shunt in the percutaneous group after 3 months,and the residual shunt disappeared in the ligation group.There was no significant difference between the two groups(P>0.05).There was no significant difference in the total complication rate,serious complication rate,and non-serious complication rate between the two groups at 1 month,3 months,6 months and 12 months after operation(All P>0.05).The preoperative left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),left ventricular end diastolic dimension(LVEDD),and left ventricular end systolic dimension(LVESD)in the percutaneous group were(69.8 ± 5.7)%,(39.1 ± 4.2)%,(37.5 ± 6.5)mm,and(23.1 ± 4.5)mm,respectively.The preoperative LVEF,LVFS,LVEDD,and LVESD in the ligation group were(70.1 ± 5.6)%,(39.4 ± 4.5)%,(37.5 ± 6.8)mm,and(22.5 ± 4.1)mm,respectively.There was no statistically significant difference in LVEF,LVFS,LVEDD and LVESD before operation between the two groups(P >0.05).The LVEF and LVFS of the two groups were significantly lower at24 hours,1 month,and 3 months after operation compared with before operation(All P < 0.05).However,there was no significant difference in LVEF and LVFS of the two groups at 6 and 12 months after operation compared with before operation(All P > 0.05).In both groups,LVEDD at24 hours,1 month,3 months,6 months and 12 months after operation were significantly lower compared with those before operation(All P < 0.05).In the percutaneous group,LVESD at 24 hours after operation showed no significant change compared with before operation(P > 0.05).In the ligation group,LVESD was significantly lower at 24 hours after operation compared with before operation(P < 0.05).In both groups,LVESD was significantly lower at 1 month,6 months and 12 months after operation compared with before operation(All P < 0.05).The operation time,hospitalization time,blood transfusion rate within 12 hours after operation,and PICU monitoring rate in the percutaneous group were significantly lower than those in the ligation group [(45.1±23.2)min vs(62.2±14.9)min,9(5,13)d vs 17(15,26)d,14.3%(5 cases)vs 64.5%(20 cases),0%(0 cases)vs 29.0%(9 cases),all P<0.05].Conclusions: Both percutaneous closure and surgical ligation are safe and effective in the treatment of large PDA in children aged under 3 years,with good short and medium-term outcomes.Percutaneous closure has several advantages,such as less blood transfusion,less procedure time,and shorter hospital stay.Therefore,percutaneous closure may be preferred for large PDA in children aged under 3 years.