Ye Zankai, Li Zhiqiang, Yi Hanlu, Zhu Yaobin, Sun Yan, Li Pei, Ma Ning
Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
J Cardiothorac Surg. 2020 May 24;15(1):107. doi: 10.1186/s13019-020-01119-w.
For many years, percutaneous interventional occlusion of congenital patent ductus arteriosus (PDA) has been completed using radiation and contrast agents. In this study, transthoracic echocardiography without radiation and contrast agents was used to complete percutaneous occlusion of pediatric PDA.
Thirty-two children (8 males and 24 females) with normal heart function and no other intracardiac deformities were diagnosed with PDA (20 funnel type; 12 tube type), One patient had peripheral facial paralysis, 1 patient had epilepsy, and 1 case had multiple cervical deformities. All procedures were performed in the surgical operating room (without Digital Subtraction Angiography (DSA) equipment) under basic anesthesia through the femoral artery pathway. The procedures were guided by transthoracic echocardiography (TTE) by establishing an orbit with a catheter through the femoral artery to thepatent ductus arteriosus,pulmonary artery and right ventricle. A suitable ventricular septal defect occluder was placed using the femoral artery approach,and the treatment effect was evaluated by echocardiography after occlusion. The Outpatient follow-up was performed at 1, 3 months after the operation.
All cases had successful closure of PDA, which took only 35.6 ± 6.4 min. The diameter of the device was 4.8 ± 2.3 mm, and the heart murmur disappeared. There was no shunt between the left pulmonary artery and the descending aortic artery, and the length of hospitalization was 3.4 ± 0.5 days. No other incisions were needed in 32 cases. No occluder was removed, and no residual shunt was found after operation; moreover, no ICU stay was needed, and the mean hospital stay was 3.4 ± 0.5 days. No residual shunt was found at the 1-, 3-month follow-up visit.
PDA closure guided by transthoracic echocardiography via femoral artery puncture is a minimally invasive procedure that avoids injuries due to radiation and contrast agents. This method has wider application prospects in pediatrics.
多年来，先天性动脉导管未闭（PDA）的经皮介入封堵术一直是在使用辐射和造影剂的情况下完成的。在本研究中，采用无辐射和造影剂的经胸超声心动图来完成小儿PDA的经皮封堵术。
32例心功能正常且无其他心内畸形的儿童（8例男性，24例女性）被诊断为PDA（20例漏斗型；12例管型），1例患者有周围性面瘫，1例患者有癫痫，1例有多处颈椎畸形。所有手术均在外科手术室（无数字减影血管造影（DSA）设备）中在基础麻醉下经股动脉途径进行。手术通过经胸超声心动图（TTE）引导，经股动脉建立导管轨道至动脉导管未闭、肺动脉和右心室。采用股动脉途径放置合适的室间隔缺损封堵器，并在封堵后通过超声心动图评估治疗效果。术后1、3个月进行门诊随访。
所有病例PDA封堵均成功，仅用时35.6±6.4分钟。封堵器直径为4.8±2.3毫米，心脏杂音消失。左肺动脉与降主动脉之间无分流，住院时间为3.4±0.5天。32例均无需其他切口。术后未取出封堵器，未发现残余分流；此外，无需入住重症监护病房，平均住院时间为3.4±0.5天。在1个月、3个月的随访中未发现残余分流。
经胸超声心动图引导下经股动脉穿刺封堵PDA是一种微创手术，可避免辐射和造影剂造成的损伤。该方法在儿科有更广阔的应用前景。
