Immediate Efficacy And Safety Of Percutaneous Transcatheter Closure Of Patent Ductus Arteriosus In Low-Weight Patients

Objective: To discuss the immediate efficacy and safety of transcatheter closure of patent ductus arteriosus in children with body weight ≤6kg.Methods: A total of 1636 children with patent ductus arteriosus underwent transcatheter closure of patent ductus arteriosus in affiliated Children’s Hospital of Chongqing Medical University from January2011 to August 2019,including 123 children with body weight ≤6kg.The general conditions,preoperative cardiac ultrasound,blood routine,urine routine,electrocardiogram;intraoperative diameter of patent ductus arteriosus,aortic pressure,pulmonary artery pressure;postoperative cardiac ultrasound,electrocardiogram,blood routine and urine routine results;the manufacturer,type,size of the occluder and the occurrence,treatment and outcome of postoperative complicationswere recorded.The results of clinical data are expressed by countand measurement data;all measurement data are expressed by mean and standard deviation,and count data are expressed by the number of cases and percentage.Chi-square test was used to determine whether there was a significant difference in the success rate of operation between children with low weight and those with weight >6kg.Rank sum test was used to compare the incidence of thrombocytopenia,hemolysis,descending aortic stenosis,left pulmonary artery stenosis,occluder displacement,residual shunt and other complications among different weight classes.Results: A total of 1636 patients underwent transcatheter closure of patent ductus arteriosus in the affiliated Children’s Hospital of Chongqing Medical University from January 2011 to August 2019.There were 123 cases of weight ≤6 kg among them,37 males and 86 females,aged 6.9 ±2.9(0.67-17)months and 5.4±0.7(2.5-6.0)kg,21 cases of premature infants,the gestational age was34.1±2.6(28-36.6)weeks.The narrowest diameter of ductus arteriosus showed by ultrasound was 5.6±1.9(1.5-10)mm.Among the children with body weight ≤ 6kg,there were 119 cases of successful operation,the success rate of operation was 96.7%,and there were 1513 cases of children whose body weight is higher than 6kg,1491 cases were successful,and the success rate of operation was 98.5%.The success rate of the two was basically the same.Among the low weight children,4 cases failed occlusion,1 case underwent occluder removal and PDA ligation because of transposition of occluder during operation,1 case gave up occlusion because of ventricular fibrillation during operation,and 1 case did not release occluder because of decreased blood pressure and heart rate during operation,1 case showed descending aortic stenosis by ultrasound one day after operation,and ultrasound still showed descending aortic stenosis up to the 3rd day after operation,and there was no significant improvement in heart failure after conservative treatment,so emergency surgery was performed to remove the occluder.Among the 119 children with successful interventional occlusion,6 cases had serious complications within 3days after operation,with an incidence of 5%,including 3 cases of severe thrombocytopenia,2 cases of hemolysisand 1 case of pericardial effusion.To analyze whether there is a statistical difference in the incidence of complications among different body weight grades in low-weight children,only the incidence of descendingaortic stenosis and left pulmonary artery stenosis in different body weight grades have statistical differences.Conclusion: Percutaneous transcatheter closure of patent ductus arteriosus is an immediately effective and safe treatment.