Clinical Application Of Transcatheter Closure Of Patent Ductus Arteriosus Under Transthoracic Echocardiography

Objective:The research was aimed at discussing whether the patent ductus arteriosus occlusion guided by transthoracic echocardiography could be used as an improved patent ductus arteriosus occlusion to shorten the operation time and the quantity of X-ray that the patient contact with surgeon.And it is hoped to promote the operation method.Methods:65 PDA patients from the first affiliated hospital of Kunming Medical University that were eliminated the other cardiovascular malformation were selected during Sep.2015 to Sep.2017,and they were randomly divided into observation group(36 patients)and control group(29 patients).In the control group,the traditional patent ductus arteriosus occlusion technique was applied which namely X-ray and aortic angiography.Before operation,the PDA of the patients in observation group were measured through Transthoracic Echocardiography(TTE)near the sternum,supraclavicular fossa and left high section for many times,and the average minimum inner diameter was obtained as the basis of choosing plugging device.And then the patent ductus arteriosus occlusion guided by TTE was performed.The comparisons between the cases of two groups:(1)General information of two group of patients:such as the ratio of male and females,average age,average weight,PDA diameter,blood oxygen saturation,etc;(2)The correlation between TTE and cardiac catheterization in quantitative measurement of PDA diameter;(3)The operation time,the amount of radiation,the dosage of the contrast agent,the total length of hospital stay and the total hospitalization expenses of the two treatment regimens;(4)Operation success rate,instant complete blocking rate and long term complete closure rate;(5)Preoperative and postoperative pulmonary arterial pressure and differential pressure;(6)Surgery complications(including thrombus and hematoma,false aneurysm and arteriovenous fistula,heart valve damge,arrhythmia,infective endocarditis,shift of the closure or fall off,mechanical hemolysis,the puncture point infection,femoral artery dissection,etc.)Results:1.There was no significant difference in age,weight,PDA diameter and blood oxygen saturation between two groups(P>0.05).2.The differences in the time of operation,the amount of radiation exposure,the amount of contrast agent and the total hospitalization cost were statistically significant between two groups(P<0.05),and there was no statistic significance in total hospital stay(P>0.05).3.There was no statistically significant difference between the two groups in the operation success rate,the instant complete blocking rate,and the long-term complete blocking rate(P>0.05).4.Before and after operation,there was no statistically significant difference between pulmonary artery pressure and differential pressure(P>0.05).5.There was statistic significance in the incidence of surgical complications(P<0.05).Conclusions:1.Compared with the traditional PDA occlusion,there was no significant difference in success rate of operation,instant complete plugging rate and the forward seal ration between PDA occlusion guided by TTE and the traditional one,which also suggested that there is no obvious difference between their treatment effect.2.PDA occlusion guide by TTE had less hospitalization cost,operation time,radiation exposure,fewer complications,and saved more medical resources.It is less harmful to the health of patients.