Clinical Study Of 232 Pediatric Patients With Patent Ductus Arteriosus Undergoing Transcatheter Closure

Objective: A retrospective study was conducted on clinical data of 232 pediatric patients with patent ductus arteriosus(PDA)undergoing transcatheter closure,so as to analyze that the clinical features of pediatric patients,the safety and effectiveness of the transcatheter closure and anesthesia.Method and methodology: 232 cases aged below 14 were admitted,diagnosed as PDA and conducted with transcatheter closure in The First Affiliated Hospital of Guangxi Medical University during January2011 to December 2016.Clinical data such as the general data,clinical manifestations,electrocardiogram(ECG),transthoracic echocardiography(TTE),cardiac catheterization,transcatheter closure and anesthesia was collected.According to ages,232 cases were divided into 3 groups-the infant group(1month old,1 year old),the young children group(1 year old,3 years old)and the child group(3 years old,14 years old).The clinical features,occlusion and anesthesia related clinical data were analyzed.Results:(1)43.10% of patients had recurrent respiratory tract infection while 15.52% were accompanied with other diseases like respiratory tract infection.The cardio-thoracic ratio was 0.57±0.05.The cardio-thoracicproportion of 84.91% were above 0.50.According to ECG,43.97% had left ventricular enlargement.(2)48.71% were accompanied with pulmonary arterial hypertension.The mPAP of 10.34% was above 55 mmHg.The mPAP and operation time of infant group and young children group were significantly higher than that of child group(all P<0.05).However,there was no significant difference between the infant group and young children group(P>0.05).(3)The acute successful rate of the operation was 100%.PDA occluder of 1 case fell off and should be taken out by conducing surgical procedures.The puncturing site of 1 case was with hematoma.(4)As the preoperative ASA grading was concerned,72.85% were grade II and 25.80% were grade III.95.26% were conducted with general anesthesia while 4.74% were local anaesthesia.Among patients with general anesthesia,91.86% were narcotized with ketamine and propofol and 8.14% were narcotized with fentanyl and propofol.(5)Under conditions of geneal anesthesia,4 cases(1.81%)with ASA scoring III selected the artificial airway and mechanical ventilation while 217 cases(98.19%)selected natural airway and autonomous respiration.During the operation,4 cases(1.84%)were transformed to artificial airway.(6)After the operation,25 cases(10.78%)were obviously irritable and should be calmed down with diazepam.No obvious respiratory depression happened.77(34.68%)cases were high in temperature(≥37.5℃),among which 59 cases(76.62%)should be treated through anti-inflection therapy.There was statistically significance(all P<0.05)in the proportion of fever between the infant group(66.67%),the young children group(48.84%)and the child group(11.45%).Conclusions:(1)Nearly half patients were accompanied with recurrent respiratory tract infection symptoms and the majority had left ventricular enlargement.(2)Nearly half patients were accompanied with pulmonary arterialhypertension while 10.34% were severe pulmonary hypertension patients.The mPAP for infants and young children were significantly higher than that for children.(3)The success rate of PDA transcatheter closure was high with favorable effects and lower occurrence rate of severe complications.However,the operation time for infants and young children were significantly longer than that for children.(4)The majority patients selected general anesthesia,among which 91.86% employed ketamine and propofol while 8.14% employed fentanyl and propofol.(5)Most patients with low age,underweight,poor cardiac function and preoperative respiratory tract infection adopted artificial airway and mechanical ventilation.Most patients with better conditions of preoperative status adopted natural airway and autonomous ventilation method and the proportion of transforming to artificial airway was relatively low.(6)Common adverse events after the operation were irritability and fever.The irritable patients can be calmed down after the administration of diazepam without significant respiratory depression.Rates of fever after the operation was 34.68%and most of them should be enforced with anti-infection therapy.The younger the patients’ ages,the greater the chance of fever.