Evaluation And Follow Up Study Of Transcatheter Closure Of Patent Ductus Arteriosus In Children

Objective: To summarize the clinical data of transcatheter closure of patent ductus arteriosus(PDA)in children,and to explore the efficacy and safety of transcatheter closure,so as to provide clinical basis for interventional treatment of PDA in children.Methods: The clinical data and follow-up data of children diagnosed as patent ductus arteriosus and underwent interventional closure were analyzed from January2005 to December 2020 in the First Affiliated Hospital of Guangxi Medical University,including the parameters like sex,age,weight,clinical manifestations,laboratory indicators,ECG,chest radiographs,echocardiography,cardio hemodynamic data,angiocardiography.The size of occluder,operation time,X-ray fluoroscopy time,pulmonary artery pressure,complications and other conditions were followed up.The clinical characteristics of the children,the efficacy and safety of occluder and interventional occlusion were statistically analyzed.Results: 1.A total of 436 children underwent transcatheter closure of patent ductus arteriosus,of which 432 cases(99.1%)were successful to achieve occlusion and 4 cases(0.9%)were not successful.Among the 432 patients who successfully completed transcatheter closure,169(39.12%)were male and 263(60.88%)were female.There were 4 cases of PDA with ASD,6 cases of PDA with VSD and 1 case of PDA with PS,except for 1 case with VSD,the other 10 cases were operated successfully.The average age was 4 ± 3 years old(1 month to 16 years old),average weight 14.05 ± 7.63 kg(3.9 ～ 46 kg)。2.Among 432 children,42 cases(9.7%)were less than 1 year old,219 cases(50.7%)were aged 1-3 years old and 171 cases(39.6%)were aged more than 3 years old.The success rate of operation was 95.5%,99.5% and 99.4% respectively.There was no significant difference among different age groups(P > 0.05).3.Among 432 successful cases,2 cases(0.5%)had early adverse complications and 29(6.7%)of minor complications.No complications such as left pulmonary artery stenosis and aortic stenosis occurred during follow-up,and no serious lifethreatening events occurred.There were 4 cases(9.5%)in the 1-year-old group,14cases(6.4%)in the 1-3-year-old group,13 cases(7.6%)in the group with a age of >3 years old.The incidence of complications in different age groups was statistically different(P > 0.05).4.There were 7 cases(2.9%)in normal PAH group,9 cases(11.4%)in mild PAH group,6 cases(9.7%)in moderate PAH group,9 cases(16.9%)in severe PAH group.The incidence of complications in different pulmonary artery pressure groups was statistically different(P < 0.05).5.In children with patent ductus arteriosus and pulmonary hypertension,the systolic pressure of pulmonary artery decreased in varying degrees after occlusion.Further analysis showed that in the mild,moderate and severe pulmonary hypertension group,the pulmonary artery pressure decreased significantly 1 day and1 year after operation compared with that before operation(P < 0.05).One day after operation,the decrease of pulmonary artery systolic pressure was not related to the age of the children in the < 1-year-old group,1-3-year-old group and > 3-year-old group(all P > 0.05).One year after operation,the decrease of pulmonary artery systolic pressure was related to the age of the children in the severe pulmonary hypertension group(all P < 0.05).In the mild and moderate pulmonary hypertension groups,the decrease of pulmonary artery systolic pressure was not related to the age of the children(all P > 0.05).Conclusion: 1.In this study,the success rate of interventional occlusion in PDA children was 99.1%,and there was no significant difference in the success rate of operation among different age groups.Follow up showed that the long-term prognosis was good.There were no significant adverse events and mortality,indicating that transcatheter closure of patent ductus arteriosus in children is safe and effective with high success rate.2.There was no significant difference in the success rate of interventional therapy among different age groups,the incidence of adverse reactions(early and late).3.The pulmonary arterial pressure of children with PDA and PAH decreased significantly after transcatheter closure.No clinical deterioration or progress was found in these children during follow-up,and the pulmonary arterial pressure of all children returned to normal within 1 year after operation.4.The decrease of varying degree of pulmonary artery pressure after interventional therapy is related to age and the degree of pulmonary artery pressure before operation.The older the children with severe pulmonary hypertension,the less the degree of decrease of pulmonary artery pressure after operation.