Xiong Pan, Chen Quan, He Yiwei
Department of Health management center, Suining Central Hospital, Suining, 629000, China.
Department of Cardiothoracic Surgery, Suining Central Hospital, No. 127, Desheng Road, Chuanshan District, Suining, 629000, China.
J Cardiothorac Surg. 2024 Dec 20;19(1):676. doi: 10.1186/s13019-024-03143-6.
The conventional arteriovenous approach closure of patent ductus arteriosus (PDA) may be associated with more complications, especially in young infants. The objective is to explore the feasibility and clinical efficacy of interventional closure of PDA through a single venous approach under echocardiography without angiography.
112 patients (32 males and 80 females) with PDA closed by different methods in Suining Central Hospital were enrolled, including 60 cases (Group 1) with a single venous approach under echocardiography without angiography and 52 cases (Group 2) with the conventional arteriovenous approach. There were no significant differences in age and gender composition between the two groups. The success rate of operation, complete closure rate of 24 h, procedure time, X-ray fluoroscopic time, radiation dose, intraoperative contrast volume, preoperative and postoperative creatinine, preoperative and postoperative uric acid nitrogen, bed rest time, total hospital stay, and incidence of vascular complications were compared between the two groups.
There were no significant differences in the success rate of operation (100% vs. 100%) and the complete closure rate of 24 h (100% vs. 100%) between the two groups (P > 0.05). In the single venous approach group, the procedure time was (50.05 ± 4.78 min vs. 57.69 ± 6.44 min), the X-ray fluoroscopy time was (7.30 ± 0.78 min vs. 10.23 ± 1.58 min), and the radiation dose was (79.57 ± 15.18mGy vs. 219.22 ± 34.60mGy), contrast volume (0mL vs. 62.22 ± 22.69 ml), bed rest time (4.03 ± 0.99 h vs. 12.25 ± 1.73 h), total hospital stay (3.30 ± 0.52 days vs. 3.39 ± 0.49 days) and the incidence of vascular complications (0% vs. 13.9%) were significantly lower than those in the traditional angiography group (P < 0.05). There were no significant changes in creatinine (51.86 ± 12.75 umol/L vs. 53.09 ± 10.27 umol/L) and urea nitrogen (4.84.81 ± 1.21 mmol vs. 4.98 ± 0.93 mmol/L) before and after operation in single venous group (P > 0.05). Compared with preoperative creatinine level (68.23 ± 8.66umol vs. 59.23 ± 22.12umol) and urea nitrogen level (5.98 ± 1.13 mmol/L vs. 5.16 ± 1.49 mmol/L) in the traditional angiography group after operation (24 h), they were significantly increased (P < 0.05).
Compared with the conventional arteriovenous approach, the single venous approach has the outstanding advantage of reducing vascular complications, contrast volume, radiation dose, and procedure time. Compared with the conventional arteriovenous approach, on the basis of obtaining the same efficacy, the PDA occlusion of the single venous approach under echocardiography without angiography has the outstanding advantages of simplified operation, less X-ray radiation, no contrast agent injury, short bed rest time, and fewer vascular complications. It is a green and safe surgical method worth promoting for PDA patients with suitable anatomical conditions.
传统的动脉导管未闭（PDA）动静脉途径封堵术可能会伴随更多并发症，尤其是在低龄婴儿中。目的是探讨在超声心动图引导下经单一静脉途径且无需血管造影进行PDA封堵术的可行性及临床疗效。
纳入遂宁市中心医院采用不同方法封堵PDA的112例患者（男32例，女80例），其中60例（第1组）采用超声心动图引导下经单一静脉途径且无需血管造影，52例（第2组）采用传统动静脉途径。两组患者的年龄和性别构成无显著差异。比较两组的手术成功率、24小时完全封堵率、手术时间、X线透视时间、辐射剂量、术中造影剂用量、术前及术后肌酐、术前及术后尿酸氮、卧床休息时间、总住院时间及血管并发症发生率。
两组的手术成功率（100%对100%）和24小时完全封堵率（100%对100%）无显著差异（P＞0.05）。在单一静脉途径组，手术时间（50.05±4.78分钟对57.69±6.44分钟）、X线透视时间（7.30±0.78分钟对10.23±1.58分钟）、辐射剂量（79.57±15.18毫戈瑞对219.22±34.60毫戈瑞）、造影剂用量（0毫升对62.22±22.69毫升）、卧床休息时间（4.03±0.99小时对12.25±1.73小时）、总住院时间（3.30±0.52天对3.39±0.49天）及血管并发症发生率（0%对13.9%）均显著低于传统血管造影组（P＜0.05）。单一静脉组术前及术后肌酐（51.86±12.75微摩尔/升对53.09±10.27微摩尔/升）和尿素氮（4.84.81±1.21毫摩尔对4.98±0.93毫摩尔/升）无显著变化（P＞0.05）。与传统血管造影组术后（24小时）的术前肌酐水平（68.23±8.66微摩尔对59.23±22.12微摩尔）和尿素氮水平（5.98±1.13毫摩尔/升对5.16±1.49毫摩尔/升）相比，显著升高（P＜0.05）。
与传统动静脉途径相比，单一静脉途径在减少血管并发症、造影剂用量、辐射剂量及手术时间方面具有突出优势。与传统动静脉途径相比，在获得相同疗效的基础上，超声心动图引导下经单一静脉途径且无需血管造影的PDA封堵术具有操作简化、X线辐射少、无造影剂损伤、卧床休息时间短及血管并发症少等突出优势。对于具有合适解剖条件的PDA患者，这是一种值得推广的绿色安全手术方法。
