Uppal Lipi, Rohit Manoj Kumar, Barwad Parag, Naganur Sanjeev, Debi Uma, Kasinadhuni Ganesh, Santosh Krishna, Cr Pruthvi, Sahoo Saroj
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Egypt Heart J. 2020 Sep 29;72(1):65. doi: 10.1186/s43044-020-00100-1.
Transcatheter device closure is a safe procedure recommended in children with patent ductus arteriosus (PDA). While the standard procedure uses arterial and venous femoral access, it poses risk of vascular complications especially in young infants. Isolated venous approach has been tried in a few studies and was found to be non-inferior to the standard technique. In this prospective observational study, we have compared the two vascular approaches of PDA device closure in pediatric patients and have also studied the feasibility of this approach in young children with weight < 6 kg.
PDA device occlusion was performed with either one of the approaches-venous alone (group I) or standard approach (group II) in a total of 135 children enrolled prospectively. The baseline data, procedural outcomes, vascular complications, and radiation dose were compared between the two groups. Fifty-two and 83 children were included in group I and group II, respectively. A total of 22 children (16%) (13 in group I; 9 in group II) had weight < 6 kg. In group II, 6 children (7.2%) had vascular site complications treated with heparin infusion with two children requiring thrombolysis. Another child in group II developed intravascular hemolysis following residual shunt, requiring surgical device retrieval and closure. No significant differences were observed in mean fluoroscopic time (p = 0.472) and air kerma between the two groups (p = 0.989).
Transcatheter PDA device closure without arterial access is a feasible and safe option in children including young infants. This technique avoids the risk of vascular complications although requires careful case selection.
经导管装置封堵术是推荐用于动脉导管未闭（PDA）患儿的一种安全手术。虽然标准手术采用股动脉和股静脉入路，但存在血管并发症风险，尤其是在小婴儿中。少数研究尝试了单纯静脉入路，发现其不劣于标准技术。在这项前瞻性观察研究中，我们比较了小儿患者PDA装置封堵的两种血管入路，并研究了这种入路在体重<6 kg幼儿中的可行性。
前瞻性纳入的135例儿童中，采用单纯静脉入路（I组）或标准入路（II组）之一进行PDA装置封堵。比较两组的基线数据、手术结果、血管并发症和辐射剂量。I组和II组分别纳入52例和83例儿童。共有22例儿童（16%）（I组13例；II组9例）体重<6 kg。在II组中，6例儿童（7.2%）发生血管部位并发症，通过肝素输注治疗，2例儿童需要溶栓。II组另1例儿童在残余分流后发生血管内溶血，需要手术取出装置并进行封堵。两组间平均透视时间（p = 0.472）和气比释动能无显著差异（p = 0.989）。
对于包括小婴儿在内的儿童，不采用动脉入路的经导管PDA装置封堵术是一种可行且安全的选择。该技术避免了血管并发症风险，尽管需要仔细选择病例。
