| Objectives:To observe the law of changes in left ventricular structure and function in 24 hours and long-term follow-up of transcatheter catheterization closure of patent ductus arteriosus(PDA),and to explore the causes of this law.Methods:Collecting 784 cases from 1998.1.1 to 2017.1.31 in Pediatric Cardiology of Shandong Provincial Hospital who have received transcatheter interventional therapy of PDA,and 754 were included as subjects,their data information include:sex、age、weight、Preoperative complications、Postoperative complications、diameter of PDA、Aortic width、width of Pulmonary artery、preoperative and postoperative data:shunt of PDA、Left ventricular diameter、Left atrial diameter、Left ventricular ejection fraction、Pulmonary artery systolic pressure、Mitral and aortic regurgitation.Analyzing effects of various factors on the postoperative 24-hour recovery of left ventricle with the help of SPSS18.0,and 122 patients were followed up for a long time to observe the long-term left ventricular recovery regulation.Results:1.All patients were successfully closured,include male 257(32.78%),the median age and weight were 3.21 years old(range 0.2-65)and 15Kg(range 4.4-95).2.Before operation therapy,710 cases(90.56%710/784)with LA increased,729 cases LV increased(92.99%729/784),678 cases with both LA and LV increased(86,48%678/784);LV increased more than LA(0.73±0.59 vs 0.62±0.44cm P=0.00).3.When 24 hours after surgery compared with preoperative,593 cases of LA significantly reduced,81 cases unchanged;629 cases of LA significantly reduced,65 cases unchanged;LA、LV、the difference between LA and reference、the difference between LV and reference all reduced dramatically((2.71±0.36vs2.40±0.48 P=0.004.29±0.99vs3.89±0.87 P=0.00 0.63±0.44vs0.35±0.35 P=0.00 0.74±0.60vs0.39±0.44 P=0·00).4.When left ventricle compared with atrium,the difference between LV and reference was greater than the difference between LA and reference after 24 hours of the intervention(0.39±0.44vs0.34±0.34 P=0.00);Preoperative and postoperative LV difference and ratio were all greater than LA(0.35±0.33vs0.28±0.33 P=0.001.144±0.16 vs 1.10±0.09 P=0.00).5.Grouping according to the preoperative difference between LA and reference,the difference in LA improved group was greater than the other(0.66±0.45vs0.39±0.30 P=0.00),but no difference in left ventricle;Grouping according to the preoperative difference between LV and reference,the difference in LA and LV improved group was greater than the other(0.76±0.60vs0.59±0.50 P=0.000.77±0.60vs0.40±0.48 P=0.00).6.Female with higher recovery rate in LV(X2=6.22 P=0.013);but no difference in LA(X2=0.627 P=0.429)7.The factor of age affect the recovery degree in LA(X2=6.521 P=0.011)and the perative increased degree of LV(F=6.793 P=0.00).8.The Aortic end width and Pulmonary artery end width are larger in LA improved group than worsen group(0.69±0.30&0.48±0.19 P=0.001,0.37±0.22&0.32±0.18 P=0.019).9.Comparing the group which combined with original heart disease or not,it showed no differences between preoperative and postoperative cavity diameter(0.32±0.42vs0.28±0.32P=0.555)and ratio(1.14±0.15vs1.13±0.16 P=0.719),but different in LV(0.23±0.34vs0.36±0.33 P=0.009,1.06±0.08vs1.11±0.09 P=0.002).10.24 hours after Interventional therapy,PASP decreased dramatically(54.54±20.98&37.78±17.34 P=0.00),but there was no significant changes in LVEF between preoperative and postoperative follow-up studies(P>0.05).11.Long-term follow-up study,96.92(118/122)cases with their structure return to normal within 6months;85 patients(10.84%85/784)had transient short-term complications,and no long-term complications occured.Conclusions:1.The transcatheter interventional therapy of PDA is safe and an efficient,with high success rate of surgery,less complications,can be used as the first choice for PDA treatment.2.we can see obvious recovery within 24 hour but LVEF did not show difference.3.Before therapy,it has difference in the increased degree of LA and LV,and they all recover fast and then slowly.The majority of patients had a r chamber size return to normal within 6months.4.The degree of increase in cardiac cavity plays a major role on the recovery of postoperative left ventricular structure,the increased degree of LA and LV affect the LA recovery,but LV recovery is only influenced by its own.5.Age,sex,the structural characteristics of the catheter itself,and whether the combination of heart disease influence the recovery.6.postoperative residual shunt,increased valve regurgitation with time gradually ease. |
PDF Full Text Request