Shi Xiaoqing, Hua Yimin, Li Yifei
Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2020 Nov 20;99(47):e22528. doi: 10.1097/MD.0000000000022528.
Surgical closure of patent ductus arteriosus (PDA) has been considered the only way to rescue preterm neonates following nonsteroidal anti-inflammatory drugs closure failure. However, PDA closure by catheter-based interventions has become another therapeutic choice. The aim of this report was to investigate the timing and treatment methods for hemodynamically significant PDA (hsPDA) in preterm neonates.
We retrospectively studied 4 ventilator-dependent preterm neonate cases with hsPDA who had an urgent need of PDA closure and who attended our hospital between October 2016 and March 2018. We assessed the efficacy and safety of transcatheter closure of the hsPDA, and evaluated the dependence of the infants on mechanical ventilation.
The 4 infants with hsPDA underwent successful transcatheter closures. Two infants were weaned from the ventilatory support within 24 hours after the closure. Those 2 preterm neonates demonstrated normal growth and development during the postoperative follow-up. However, the other 2 infants still needed ventilatory support beyond 48 hours post procedure. One of them presented a bronchial stenosis, underwent a bronchial stent placement by bronchoscopy 10 days after the PDA closure, and was only then finally withdrawn from the ventilatory support. The other infant had a severe bronchomalacia and was only weaned from the ventilator 36 days post PDA closure.
Transcatheter closure could be an acceptable alternative to surgical ligation when medication treatment fails to close hsPDAs in ventilator-dependent preterm neonates. This intervention should be considered to minimize mechanical ventilation duration, reduce the incidence of bronchopulmonary dysplasia, and improve the prognoses of these infants.
对于非甾体类抗炎药关闭动脉导管未闭（PDA）失败后的早产新生儿，手术闭合PDA一直被认为是唯一的挽救方法。然而，基于导管的介入性PDA闭合术已成为另一种治疗选择。本报告旨在探讨早产新生儿血流动力学显著的PDA（hsPDA）的治疗时机和方法。
我们回顾性研究了2016年10月至2018年3月间在我院就诊的4例依赖呼吸机的hsPDA早产新生儿病例，这些患儿急需闭合PDA。我们评估了经导管闭合hsPDA的有效性和安全性，并评估了婴儿对机械通气的依赖情况。
4例hsPDA婴儿均成功进行了经导管闭合术。2例婴儿在闭合术后24小时内脱机。这2例早产新生儿在术后随访期间生长发育正常。然而，另外2例婴儿在术后48小时后仍需要通气支持。其中1例出现支气管狭窄，在PDA闭合术后10天通过支气管镜置入支气管支架，随后才最终脱机。另1例婴儿有严重支气管软化，在PDA闭合术后36天才脱机。
对于依赖呼吸机的早产新生儿，如果药物治疗无法闭合hsPDA，经导管闭合术可作为手术结扎的一种可接受的替代方法。应考虑采用这种干预措施以缩短机械通气时间，降低支气管肺发育不良的发生率，并改善这些婴儿的预后。
