Clinical investigation of percutaneous closure of patent ductus arteriosus under echocardiography guidance_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZOU Mengxuan , OUYANG Wenbin , WEN Bin , GUO Gaili , XIE Yongquan , ZHANG Fengwen , ZHAO Guangzhi , LIU Yao , FANG Nengxin , XU Nan ,  PAN Xiangbin

Department of Structural Heart Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding?author：

PAN Xiangbin, Email: xiangbin428@hotmail.com

Keywords：

Patent ductus arteriosus; occlusion; echocardiography

DOI：

10.7507/1007-4848.201801057

Video：

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Objective To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 yearsvs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kgvs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mmvs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mmvs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuanvs.25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.

Citation： ZOU Mengxuan, OUYANG Wenbin, WEN Bin, GUO Gaili, XIE Yongquan, ZHANG Fengwen, ZHAO Guangzhi, LIU Yao, FANG Nengxin, XU Nan, PAN Xiangbin. Clinical investigation of percutaneous closure of patent ductus arteriosus under echocardiography guidance. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(7): 550-554. doi: 10.7507/1007-4848.201801057 Copy

1.	Olukman O, Calkavur S, Ercan G, et al. Comparison of oral and intravenous Ibuprofen for medical closure of patent ductus arteriosus: which one is better? Congenit Heart Dis, 2012, 7(6): 534-543.
2.	中國醫師協會心血管病分會先天性心臟病工作委員會. 常見先天性心臟病介入治療中國專家共識. 介入放射學雜志, 2011, 20(3): 172-176.
3.	Johnston PG, Gillam-Krakauer M, Fuller MP, et al. Evidence-based use of indomethacin and ibuprofen in the neonatal intensive care unit. Clin Perinatol, 2012, 39(1): 111-136.
4.	Baruteau AE, Hasco?t S, Baruteau J, et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis, 2014, 107(2): 122-132.
5.	丁盛, 劉寶玉, 俞永康, 等. 動脈導管未閉合并重度肺動脈高壓患者的介入與外科治療. 中國胸心血管外科臨床雜志, 2010, 17(3): 250-251.
6.	Marenzi G, Lauri G, Assanelli E, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol, 2004, 44: 1780-1785.
7.	Meinel FG, Nance JW Jr, Harris BS, et al. Radiation risks from cardiovascular imaging tests. Circulation, 2014, 130(5): 442-445.
8.	Andreassi MG, Piccaluga E, Gargani L, et al. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv, 2015, 8(4): 616-627.
9.	王首正, 劉垚, 王珊, 等. 單純超聲引導下經股靜脈行動脈導管封堵術的應用研究. 中華醫學雜志, 2015, 95(27): 2183-2185.
10.	Zahn EM, Nevin P, Simmons C, et al. A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology. Catheter Cardiovasc Interv, 2015, 85(2): 240-248.
11.	Kang SL, Morgan G, Forsey J, et al. Long-term clinical experience with Amplatzer Ductal Occluder Ⅱ for closure of the persistent arterial duct in children. Catheter Cardiovasc Interv, 2014, 83(7): 1102-1108.
12.	Maioli M, Toso A, Leoncini M, et al. Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation, 2012, 125(25): 3099-3107.
13.	Chen W, Yan X, Huang Y, et al. Transthoracic echocardiography as an alternative major guidance to angiography during transcatheter closure of patent ductus arteriosus: technical feasibility and clinical relevance. Pediatr Cardiol, 2015, 36(1): 14-19.
14.	Chugh R, Salem MM. Echocardiography for patent ductus arteriosus including closure in adults. Echocardiography, 2015, 32 Suppl 2: S125-S139.
15.	胡楝, 曹勇, 韋國雄, 等. 單純超聲引導下經皮封堵治療先天性心臟病. 中國胸心血管外科臨床雜志, 2017, 24(1): 52-55.
16.	Pan XB, Ouyang WB, Wang SZ, et al. Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion: a new strategy for interventional treatment. Echocardiography, 2016, 33(7): 1040-1045.
17.	Berdat PA, Chatterjee T, Pfammatter JP, et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg, 2000, 120(6): 1034-1039.
18.	刁明強, 孫曉康, 薛揚, 等. 先天性心臟病介入治療57例. 中國胸心血管外科臨床雜志, 2012, 19(3): 266-269.
19.	Gray DT, Fyler DC, Walker AM, et al. Clinical outcomes and costs of transcatheter as compared with surgical closure of patent ductus arteriosus. The Patient Ductus Arteriosus Closure Comparative Study Group. N Engl J Med, 1993, 329(21): 1517-1523.
20.	Bilkis AA, Alwi M, Hasri S, et al. The Amplatzer duct occluder: experience in 209 patients. J Am Coll Cardiol, 2001, 37(1): 258-261.

1. Olukman O, Calkavur S, Ercan G, et al. Comparison of oral and intravenous Ibuprofen for medical closure of patent ductus arteriosus: which one is better? Congenit Heart Dis, 2012, 7(6): 534-543.
2. 中國醫師協會心血管病分會先天性心臟病工作委員會. 常見先天性心臟病介入治療中國專家共識. 介入放射學雜志, 2011, 20(3): 172-176.
3. Johnston PG, Gillam-Krakauer M, Fuller MP, et al. Evidence-based use of indomethacin and ibuprofen in the neonatal intensive care unit. Clin Perinatol, 2012, 39(1): 111-136.
4. Baruteau AE, Hasco?t S, Baruteau J, et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis, 2014, 107(2): 122-132.
5. 丁盛, 劉寶玉, 俞永康, 等. 動脈導管未閉合并重度肺動脈高壓患者的介入與外科治療. 中國胸心血管外科臨床雜志, 2010, 17(3): 250-251.
6. Marenzi G, Lauri G, Assanelli E, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol, 2004, 44: 1780-1785.
7. Meinel FG, Nance JW Jr, Harris BS, et al. Radiation risks from cardiovascular imaging tests. Circulation, 2014, 130(5): 442-445.
8. Andreassi MG, Piccaluga E, Gargani L, et al. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv, 2015, 8(4): 616-627.
9. 王首正, 劉垚, 王珊, 等. 單純超聲引導下經股靜脈行動脈導管封堵術的應用研究. 中華醫學雜志, 2015, 95(27): 2183-2185.
10. Zahn EM, Nevin P, Simmons C, et al. A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology. Catheter Cardiovasc Interv, 2015, 85(2): 240-248.
11. Kang SL, Morgan G, Forsey J, et al. Long-term clinical experience with Amplatzer Ductal Occluder Ⅱ for closure of the persistent arterial duct in children. Catheter Cardiovasc Interv, 2014, 83(7): 1102-1108.
12. Maioli M, Toso A, Leoncini M, et al. Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation, 2012, 125(25): 3099-3107.
13. Chen W, Yan X, Huang Y, et al. Transthoracic echocardiography as an alternative major guidance to angiography during transcatheter closure of patent ductus arteriosus: technical feasibility and clinical relevance. Pediatr Cardiol, 2015, 36(1): 14-19.
14. Chugh R, Salem MM. Echocardiography for patent ductus arteriosus including closure in adults. Echocardiography, 2015, 32 Suppl 2: S125-S139.
15. 胡楝, 曹勇, 韋國雄, 等. 單純超聲引導下經皮封堵治療先天性心臟病. 中國胸心血管外科臨床雜志, 2017, 24(1): 52-55.
16. Pan XB, Ouyang WB, Wang SZ, et al. Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion: a new strategy for interventional treatment. Echocardiography, 2016, 33(7): 1040-1045.
17. Berdat PA, Chatterjee T, Pfammatter JP, et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg, 2000, 120(6): 1034-1039.
18. 刁明強, 孫曉康, 薛揚, 等. 先天性心臟病介入治療57例. 中國胸心血管外科臨床雜志, 2012, 19(3): 266-269.
19. Gray DT, Fyler DC, Walker AM, et al. Clinical outcomes and costs of transcatheter as compared with surgical closure of patent ductus arteriosus. The Patient Ductus Arteriosus Closure Comparative Study Group. N Engl J Med, 1993, 329(21): 1517-1523.
20. Bilkis AA, Alwi M, Hasri S, et al. The Amplatzer duct occluder: experience in 209 patients. J Am Coll Cardiol, 2001, 37(1): 258-261.

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