Zhang Kaijun, Yang Le, Zhang Rensen, Ma Jingdong, Cheng Min, Yang Penghui, Xiang Ping, Li Mi, Zhou Xue
Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China,
National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Key Laboratory of Children's Important Organ Development and Diseases of Chongqing Municipal Health Commission, Chongqing, China,
Cardiology. 2025;150(2):212-220. doi: 10.1159/000540685. Epub 2024 Aug 1.
Muscular ventricular septal defect occluders (MVSDOs) have been attempted as an option in low-weight patients with patent ductus arteriosus (PDA). However, few studies have assessed the safety of transcatheter patent ductus arteriosus closure (TCPC) using MVSDO. Therefore, we compared the outcomes in low-weight patients who used MVSDO and mushroom-shaped occluder (MSO).
Medical records of children under 10 kg (n = 417) who underwent TCPC from 2015 to 2021 at a Chinese health center were reviewed. They were divided into MSO (n = 372) and MVSDO (n = 45) groups. A 1:1 propensity score matching (PSM) was done considering gender, height, weight, body surface area (BSA), PDA diameter, and BSA-corrected PDA diameter.
All 45 children in the MVSDO group (mean weight: 5.92 ± 1.32 kg) achieved successful immediate occlusion. One case in the MVSDO group experienced device migration within 24 h requiring unplanned surgery. MVSDO significantly ameliorated pulmonary artery hypertension. After PSM, each group comprised 41 children. The MVSDO group had a smaller effect on platelet counts (MVSDO vs. MSO = 259.85 ± 114.82 vs. 356.12 ± 134.37, p < 0.001), a reduced incidence of thrombocytopenia (MVSDO vs. MSO = 2/41 vs. 7/41, p = 0.001), and a higher rate of residual shunting (MVSDO vs. MSO = 16/41 vs. 5/41, p = 0.005), compared with the MSO group. Thrombocytopenia resolved during hospitalization and micro-shunts disappeared by 6 months. No pulmonary artery or descending aortic secondary stenosis was observed in 1-year follow-up.
MVSDO used in low-weight children is feasible, with high success and satisfactory postoperative and short-term follow-up outcomes, including lower thrombocytopenia incidence, compared to MSO. Further long-term studies with larger samples are recommended.
Muscular ventricular septal defect occluders (MVSDOs) have been attempted as an option in low-weight patients with patent ductus arteriosus (PDA). However, few studies have assessed the safety of transcatheter patent ductus arteriosus closure (TCPC) using MVSDO. Therefore, we compared the outcomes in low-weight patients who used MVSDO and mushroom-shaped occluder (MSO).
Medical records of children under 10 kg (n = 417) who underwent TCPC from 2015 to 2021 at a Chinese health center were reviewed. They were divided into MSO (n = 372) and MVSDO (n = 45) groups. A 1:1 propensity score matching (PSM) was done considering gender, height, weight, body surface area (BSA), PDA diameter, and BSA-corrected PDA diameter.
All 45 children in the MVSDO group (mean weight: 5.92 ± 1.32 kg) achieved successful immediate occlusion. One case in the MVSDO group experienced device migration within 24 h requiring unplanned surgery. MVSDO significantly ameliorated pulmonary artery hypertension. After PSM, each group comprised 41 children. The MVSDO group had a smaller effect on platelet counts (MVSDO vs. MSO = 259.85 ± 114.82 vs. 356.12 ± 134.37, p < 0.001), a reduced incidence of thrombocytopenia (MVSDO vs. MSO = 2/41 vs. 7/41, p = 0.001), and a higher rate of residual shunting (MVSDO vs. MSO = 16/41 vs. 5/41, p = 0.005), compared with the MSO group. Thrombocytopenia resolved during hospitalization and micro-shunts disappeared by 6 months. No pulmonary artery or descending aortic secondary stenosis was observed in 1-year follow-up.
MVSDO used in low-weight children is feasible, with high success and satisfactory postoperative and short-term follow-up outcomes, including lower thrombocytopenia incidence, compared to MSO. Further long-term studies with larger samples are recommended.
对于体重较轻的动脉导管未闭（PDA）患者，已尝试使用肌部室间隔缺损封堵器（MVSDO）作为一种选择。然而，很少有研究评估使用MVSDO进行经导管动脉导管未闭封堵术（TCPC）的安全性。因此，我们比较了使用MVSDO和蘑菇形封堵器（MSO）的低体重患者的治疗结果。
回顾了2015年至2021年在中国一家健康中心接受TCPC的10kg以下儿童（n = 417）的病历。他们被分为MSO组（n = 372）和MVSDO组（n = 45）。根据性别、身高、体重、体表面积（BSA）、PDA直径和BSA校正的PDA直径进行1:1倾向评分匹配（PSM）。
MVSDO组的所有45名儿童（平均体重：5.92±1.32kg）均立即成功封堵。MVSDO组有1例在24小时内发生封堵器移位，需要进行非计划手术。MVSDO显著改善了肺动脉高压。PSM后，每组各有41名儿童。与MSO组相比，MVSDO组对血小板计数的影响较小（MVSDO组 vs. MSO组 = 259.85±114.82 vs. 356.12±134.37，p < 0.001），血小板减少症的发生率降低（MVSDO组 vs. MSO组 = 2/41 vs. 7/41，p = 0.001），残余分流率较高（MVSDO组 vs. MSO组 = 16/41 vs. 5/41，p = 0.005）。血小板减少症在住院期间得到缓解，微分流在6个月时消失。在1年的随访中未观察到肺动脉或降主动脉继发性狭窄。
与MSO相比，在低体重儿童中使用MVSDO是可行的，成功率高，术后及短期随访结果令人满意，包括血小板减少症发生率较低。建议进行更大样本的进一步长期研究。
对于体重较轻的动脉导管未闭（PDA）患者，已尝试使用肌部室间隔缺损封堵器（MVSDO）作为一种选择。然而，很少有研究评估使用MVSDO进行经导管动脉导管未闭封堵术（TCPC）的安全性。因此，我们比较了使用MVSDO和蘑菇形封堵器（MSO）的低体重患者的治疗结果。
回顾了2015年至2021年在中国一家健康中心接受TCPC的10kg以下儿童（n = 417）的病历。他们被分为MSO组（n = 372）和MVSDO组（n = 45）。根据性别、身高、体重、体表面积（BSA）、PDA直径和BSA校正的PDA直径进行1:1倾向评分匹配（PSM）。
MVSDO组的所有45名儿童（平均体重：5.92±1.32kg）均立即成功封堵。MVSDO组有1例在24小时内发生封堵器移位，需要进行非计划手术。MVSDO显著改善了肺动脉高压。PSM后，每组各有41名儿童。与MSO组相比，MVSDO组对血小板计数的影响较小（MVSDO组 vs. MSO组 = 259.85±114.82 vs. 356.12±134.37，p < 0.001），血小板减少症的发生率降低（MVSDO组 vs. MSO组 = 2/41 vs. 7/41，p = 0.001），残余分流率较高（MVSDO组 vs. MSO组 = 16/41 vs. 5/41，p = 0.005）。血小板减少症在住院期间得到缓解，微分流在6个月时消失。在1年的随访中未观察到肺动脉或降主动脉继发性狭窄。
与MSO相比，在低体重儿童中使用MVSDO是可行的，成功率高，术后及短期随访结果令人满意，包括血小板减少症发生率较低。建议进行更大样本的进一步长期研究。
