Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Jian ,  PAN Zhengxia

Department of Cardiac Surgery of Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P.R.China;

Corresponding?author：

PAN Zhengxia, Email: 1126149732@qq.com

Keywords：

Patent ductus arteriosus; surgery; interventional closure

DOI：

10.7507/1007-4848.201811018

Video：

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Objective To study effect of different surgical treatments for patent ductus arteriosus in children.Method A total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared.Results The operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups.Conclusions In patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.

Citation： FU Jian, PAN Zhengxia. Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 660-663. doi: 10.7507/1007-4848.201811018 Copy

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2.	Ansary A. Management of patent ductus arteriosus. Indian Pediatrics, 2014, 51(7): 586-587.
3.	張金哲, 主編. 張金哲小兒外科學. 北京: 人民衛生出版社出版, 2013, 820-822.
4.	陳笑征, 杜忠東. 早產兒動脈導管未閉的診斷及治療. 中國醫刊, 2018, (4): 1371-1372.
5.	Benitz WE, Newborn COFA. Patent ductus arteriosus in preterm infants. Pediatrics, 2016, 137(1).
6.	Zhang B, Liang J, Zheng X, et al. Transcatheter closure of postoperative residual ventricular septal defects using Amplatzer-type perimembranous VSD occluders. J Invasive Cardiol, 2013, 25(8): 402.
7.	Jhaveri N, MoonGrady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr, 2010, 157(3): 381-387.
8.	Reese J, Waleh N, Poole SD, et al. Chronic in utero cyclooxygenase inhibition alters pge2-regulated ductus arteriosus contractile pathways and prevents postnatal closure. Pediatr Res, 2009, 66(2): 155-161.
9.	庫德熱提·艾比布拉. 先天性心臟病介入封堵術的臨床療效評價. 東南國防醫藥, 2014, 16(3): 304-305.
10.	趙曉波, 劉立新, 周薇莉, 等. 小兒常見先天性心臟病的外科治療. 中國婦幼保健, 2014, 29(10): 1573-1574.
11.	Mosalli R, Alfaleh K. Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants. Cochrane Database Syst Rev, 2008, 1: CD006181.
12.	于波, 孔祥清, 張智偉, 等. 中國動脈導管未閉介入治療指南 2017. 中國介入心臟病學雜志, 2017, 25(5): 241-248.
13.	Pan X, Ouyang W, Wang S, et al. Abstract 10972: Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion. Echocardiography, 2016, 33(7): 1040-1045.
14.	Mcelhinney DB, Geiger E, Blinder J, et al. NKX2.5 mutations in patients with congenital heart disease. J Am Coll Cardiol, 2003, 42(9): 1650-1655.
15.	徐建新, 周紹斌, 金洪來, 等. CT 三維成像指導動脈導管未閉介入封堵術臨床價值. 介入放射學雜志, 2017, 26(3): 206-209.
16.	張偉華, 戴海龍, 尹小龍, 等. 小兒動脈導管未閉 162 例封堵治療臨床分析. 昆明醫學院學報, 2010, 31(8): 62-64.
17.	Brotschi B, Hug M I, Kretschmar O, et al. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart, 2015, 101(12): 948-953.
18.	Richards J, Johnson A, Fox G, et al. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics, 2009, 124(2): 287-293.
19.	Kim EK, Kim DH, Choi CW, et al. Insufficient intimal thickening and scarcity of cell deaths may play a significant role in the pathogenesis of the persistently patent ductus arteriosus in the preterm infant. Early Hum Dev, 2009, 85(3): 181-186.
20.	陳林, 肖穎彬, 閔家新, 等. 合并心內畸形動脈導管未閉的外科治療. 第三軍醫大學學報, 2000, 22(11): 1059-1061.
21.	Cooley DA. Early development of congenital heart surgery: open heart procedures. Ann Thorac Surg, 1997, 64(5): 1544-1548.

1. Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr, 2015, 169(9): 836-872.
2. Ansary A. Management of patent ductus arteriosus. Indian Pediatrics, 2014, 51(7): 586-587.
3. 張金哲, 主編. 張金哲小兒外科學. 北京: 人民衛生出版社出版, 2013, 820-822.
4. 陳笑征, 杜忠東. 早產兒動脈導管未閉的診斷及治療. 中國醫刊, 2018, (4): 1371-1372.
5. Benitz WE, Newborn COFA. Patent ductus arteriosus in preterm infants. Pediatrics, 2016, 137(1).
6. Zhang B, Liang J, Zheng X, et al. Transcatheter closure of postoperative residual ventricular septal defects using Amplatzer-type perimembranous VSD occluders. J Invasive Cardiol, 2013, 25(8): 402.
7. Jhaveri N, MoonGrady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr, 2010, 157(3): 381-387.
8. Reese J, Waleh N, Poole SD, et al. Chronic in utero cyclooxygenase inhibition alters pge2-regulated ductus arteriosus contractile pathways and prevents postnatal closure. Pediatr Res, 2009, 66(2): 155-161.
9. 庫德熱提·艾比布拉. 先天性心臟病介入封堵術的臨床療效評價. 東南國防醫藥, 2014, 16(3): 304-305.
10. 趙曉波, 劉立新, 周薇莉, 等. 小兒常見先天性心臟病的外科治療. 中國婦幼保健, 2014, 29(10): 1573-1574.
11. Mosalli R, Alfaleh K. Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants. Cochrane Database Syst Rev, 2008, 1: CD006181.
12. 于波, 孔祥清, 張智偉, 等. 中國動脈導管未閉介入治療指南 2017. 中國介入心臟病學雜志, 2017, 25(5): 241-248.
13. Pan X, Ouyang W, Wang S, et al. Abstract 10972: Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion. Echocardiography, 2016, 33(7): 1040-1045.
14. Mcelhinney DB, Geiger E, Blinder J, et al. NKX2.5 mutations in patients with congenital heart disease. J Am Coll Cardiol, 2003, 42(9): 1650-1655.
15. 徐建新, 周紹斌, 金洪來, 等. CT 三維成像指導動脈導管未閉介入封堵術臨床價值. 介入放射學雜志, 2017, 26(3): 206-209.
16. 張偉華, 戴海龍, 尹小龍, 等. 小兒動脈導管未閉 162 例封堵治療臨床分析. 昆明醫學院學報, 2010, 31(8): 62-64.
17. Brotschi B, Hug M I, Kretschmar O, et al. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart, 2015, 101(12): 948-953.
18. Richards J, Johnson A, Fox G, et al. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics, 2009, 124(2): 287-293.
19. Kim EK, Kim DH, Choi CW, et al. Insufficient intimal thickening and scarcity of cell deaths may play a significant role in the pathogenesis of the persistently patent ductus arteriosus in the preterm infant. Early Hum Dev, 2009, 85(3): 181-186.
20. 陳林, 肖穎彬, 閔家新, 等. 合并心內畸形動脈導管未閉的外科治療. 第三軍醫大學學報, 2000, 22(11): 1059-1061.
21. Cooley DA. Early development of congenital heart surgery: open heart procedures. Ann Thorac Surg, 1997, 64(5): 1544-1548.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children

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