| BackgroundPatent Ductus Arteriosus is one of the common congenital heart diseases in childhood.Transcatheter closure is the first choice for children who meet the indications for interventional procedures,and it has a short surgery time and high surgery success rate,but the incidence of complications is not low,predominantly minor complications.Studies on interventional treatment of patent ductus arteriosus in various centers lack statistical descriptions of related complications in large samples and summaries of regression,and there is a lack of uniform strategies for mediumlong term management of children after intervention.ObjectiveBy constructing a large sample database of interventional treatment for children with unclosed arteries,we analyze the occurrence and treatment of complications related to transcatheter closure of patent ductus arteriosus to improve operators’awareness of related complications,reduce the occurrence of complications,and improve the prognosis of children.MethodsThe information of children who were hospitalized in the Department of Pediatric Cardiology of Shandong Provincial Hospital and received PDA transcatheter closure from December 1998 to December 2022 was collected and uploaded to the"Pediatric Cardiology Epidemiology Survey and Precision Treatment Platform",The information of 1,228 children who met the inclusion and exclusion criteria of this study.We summarize the occurrence and outcome of complications related to PDA interventional occlusion and to analyze the possible risk factors.Results1.1228 children who met the inclusion and exclusion criteria of this study,with a median age of 33 months(range 3 months-216 months),preoperative ultrasound showing a PDA diameter of 1.0mm～12.5 mm and intraoperative contrast showing a PDA diameter of 0.4 mm～12 mm.1222 cases were successfully occluded and 6 cases failed,with a procedural success rate of 99.51%.519 of these children were followed up from 1 month to 15 years after surgery,the overall follow-up rate was 42.26%.A total of 62 coils(three children had two coils implanted due to the large diameter of the PDA,and one child had a second coil implanted due to postoperative residual fractionation leading to hemolysis),27 vascular plugs,1022 Amplatzer duct occluder,100 Amplatzer duct occluder Ⅱ,4 angle-forming blockers,4 eccentric blockers,4 myocardial 4 ventricular septal defect occluders,2 symmetric ventricular septal defect occluders,and 1 gelatin sponge.2.There are 363 children had different degrees of complications after PDA transcatheter closure,including 6 cases of blocker dislodgement,1 case of blocker displacement,146 cases of residual shunt,1 case of postoperative hemolysis,27 cases of thrombocytopenia,10 cases of vascular injury,9 cases of arrhythmia,2 cases of arterial stenosis,244 cases of new valve regurgitation(88 cases of new aortic regurgitation,156 cases of new tricuspid regurgitation(88 new aortic regurgitation and 156 new tricuspid regurgitation),4 cases of aggravated regurgitation(1 aggravated aortic regurgitation and 3 aggravated tricuspid regurgitation),and 5 cases of tricuspid tendon rupture were found in all regurgitations.According to the classification of the risk level of complications,there were 6 cases of severe complications,55 cases of major complications,and the rest were minor complications.According to the time of complication,447 cases were classified as perioperative complications and 3 cases as short-term complications.As of the follow-up cutoff date,no intermediate or distant complications related to the interventional operation had been confirmed.3.The outcome of complications and follow-up:Among the 6 cases of blocker dislodgement,1 case was removed by cardiac surgery,and the other 5 cases were successfully removed by interventional means,and all children were safely discharged except 1 child who died after rescue.The descending aortic pressure difference was maintained at about 30 mmHg,and the postoperative growth and development were acceptable.In the residual shunt group,66 children were followed up,except for one child with severe mitral regurgitation who underwent mitral valvuloplasty and ligation of PDA at 6 months after surgery.Among the 27 cases of thrombocytopenia,there were no cases of severe visceral hemorrhage,26 of which improved after medical management.1 child with severe persistent thrombocytopenia underwent another intervention 70 days after the first operation and failed to block the residual shunt with a spring coil,but the rate of residual shunt slowed down after the operation and no further thrombocytopenia occurred.One case of pseudoaneurysm + lower limb thrombosis improved after local compression bandage+heparin anticoagulation;one case of arteriovenous fistula was treated with vascular surgery to remove the arteriovenous fistula+vein repair+autologous artery reconstruction;among the two cases of simple pseudoaneurysm,one case improved after local compression bandage,and one case did not improve after local compression bandage because of the large size of the aneurysm.Among the 9 arrhythmias,1 case was discharged from the hospital and the rest recovered to normal within 6 months after surgery.2 cases of arterial stenosis did not have the blocker removed,and the aortic pressure difference in 1 case was reduced to 10 mmHg and in 1 case was maintained at 30 mmHg during the postoperative follow-up.Of the 5 cases with moderate to severe tricuspid regurgitation due to tricuspid tendon rupture,1 case had reduced tricuspid regurgitation during follow-up and currently maintains mild to moderate regurgitation,while the remaining 4 cases had no reduction in tricuspid regurgitation after surgery and all underwent tricuspid valvuloplasty.The remaining 4 cases had no postoperative reduction in tricuspid regurgitation and underwent tricuspid valvuloplasty.4.A follow-up study was performed on 66 children with residual shunts on 24-hour postoperative review of cardiac ultrasound.The rate of complete occlusion at the 1-month postoperative review was 66.7%,the rate of complete occlusion at 3 months postoperative was 86.3%,and the rate of complete occlusion at 6 months postoperative was 96.9%.5.The 1221 children with PDA who were safely discharged after the procedure were divided into a thrombocytopenia group and a non-thrombocytopenia group,and statistical analysis of the relevant information of the two groups showed statistically significant differences between the two groups in age,weight,PDA diameter,PDA diameter to aortic diameter ratio,and occurrence of residual shunts,except for gender and preoperative platelet count.Further multifactorial binary logistic regression analysis was performed,and the results showed that large PDA diameter and residual shunt were independent risk factors for the occurrence of thrombocytopenia after PDA interventional occlusion.Conclusion1.Transcatheter closure is a safe and effective treatment for PDA with high procedural success rate,low incidence of serious or major complications,and short postoperative hospital stay.2 The common complications after PDA interventional occlusion include blocker dislodgement,blocker displacement,hemolysis,thrombocytopenia,vascular injury,tricuspid tendon rupture,arrhythmia,arterial stenosis,etc.The related complications mainly appear within 1 week after surgery,especially in the first 3 days after surgery.Early detection and proper management of these serious complications and major complications can greatly reduce the mortality rate of related complications and improve the long-term prognosis of the children.3.Unlike residual leak after PDA surgical ligation,residual shunts after PDA interventional occlusion mostly resolve on their own within 6 months after the procedure.However,if the residual shunt is complicated by hemolysis,thrombocytopenia,or infective endocarditis,and medical treatment is ineffective,the residual shunt should be actively managed by interventional means or surgical procedures.4.The large diameter of PDA and residual shunt are risk factors for the development of thrombocytopenia after interventional occlusion,and postoperative infection,hypersensitivity reaction and hematoma formation may be involved in the"second strike" of thrombocytopenia. |
PDF Full Text Request