Follow-up Study After Transcatheter Closure Of Patent Ductus Arteriosus With Pulmonary Hypertension

Objective:Congenital Heart Disease (Congenital Heart Disease, CHD), is the most common in children during heart disease. Patent ductus arteriosus (PDA), atrial septal defect (ASD), ventricular septal defect (VSD), and pulmonary stenosis (PS) was the common types. in the past, surgical treatment requires thoracic surgery, and more need cardiopulmonary bypass (CPB), general anesthesia, blood transfusion, it lead to injury, length of hospital stay, and will bring complications, leaving a surgical scar on the patient’s physical and psychological cause long-term trauma. Since the20th century, PDA occluder first carried out since the1990s, with the continuous development of interventional devices and improved interventional therapy safe, effective, simple, quick recovery stand out, and in the world set off a craze intervention. Compared with surgery, interventional treatment of congenital heart disease started late, but rapid development. Currently, about a variety of interventional treatment of congenital heart disease and the efficacy of surgical treatment of large, PDA combined PAH intervention research is also increasing, but in some aspects of the research is not the system, the study on the application of PDA occluder merge PAH, from the success rate, complication rate, residual shunt rate, preoperative and postoperative changes in pulmonary artery pressure and other aspects of analysis through3to12months of follow-up to evaluate its efficacy and safety. In order to be able to merge PDA interventional treatment of PAH indications provide more theoretical basis.Methods:Select children from January1,2009to December31,2011in the cardiology department of Shandong Provincial Hospital. There were60cases were enrolled in for the study, according to certain inclusion and exclusion criteria, the age was froml year old to18years old. All patients were routine physical examination, electrocardiogram (ECG), transthoracic echocardiography (TTE), cardiac and lateral X-ray and other tests to confirm the diagnosis. In accordance with the ratio measured at the narrowest PDA diameter4～6mm principles selected occluders, occluders are the United States mushroom umbrella AGA’s Amplatzer PDA occluder. Strict accordance with the requirements of the implementation of interventional treatment intervention. After surgery were antibiotic prophylaxis treatment for3days. After24h,1,3,6,12months echocardiography and ECG were followed to observe the occluder morphology, residual shunt and pulmonary artery pressure changes and the presence of complications.Results:60cases of children with closure operations were all successful. The pressure in all patients were immediately drop, the pressure drop value of50%or more, intraoperative20minutes no pressure rise. Up to12months the majority of patients with normal pulmonary artery pressure, heart shadow near normal shape and size. Immediate success rate96.53%, no residual shunt.preoperative pulmonary artery systolic pressure, arterial pressure, mean pressure mean were69.4±24.5mmHg、45.3±14.2mmHg、94.5±10.3mmHg, Postoperative pulmonary artery systolic pressure, diastolic pressure, mean pressure means were29.8±8.2mmHg、29.8±8.2mmHg、98.8±6.2mmHg. Preoperative and postoperative pulmonary artery systolic, diastolic and mean pressure difference was statistically significant (T=10.945, P=0.01),(T=12.603, P=0.01). Postoperative pulmonary artery systolic, diastolic and mean pressure was significantly lower than before treatment. Preoperative aortic pressure(T=12.640, P=0.12), arterial oxygen saturation (P<0.05) has no statistically different significant. Left ventricle function and Cardio/Thoracic (CT) ratio after transcatheter closure:LAD size decreased from30.7±5.0mm to21.1±3.9mm(P<0.01), LVEDD decreased from49.2±6.2mm to40.4±5.3mm (P<0.05), LVEDV decreased from114.7±38.9ml to65.3±27.1ml (P<0.01), LVESV decreased from31.7±12.8ml ml to25.2±10.9ml (P<0.05), LVSV decreased from83.6±29.4ml to53.1±24.6ml (P<0.01), LVEF decreased from68.1±2.6%to63.5±5.3%(P>0.05), LVFS decreased from36.7±5.9%to32.4±6.2%(P>0.05), The LAD, LVEDD, LVEDV, LVESV,LVSV,LVEF,LVFS and CT ratio didn’t change (P>0.05) after3months’ follow-up. The LAD,LVEDD,LVEDV,LVESV,LVSV,LVEF,LVFS and CT ratio didn’t change (P>0.05) after6months’follow-up.30minutes after transcatheter closure of descending aortic angiography showed no residual shunt in57cases,2cases of trace residual shunt, a small amount of residual shunt in1case. Residual shunt was disappeared after1month follow-up in one case.one case was still have small residual shunt after12months follow-up.Conclusion:The occluder technology in treating PDA with PAH is simple, safe, high success rate, fewer complications, in the case of strictly controlled indications has long-term efficacy,and has high safety.