经导管介入封堵治疗儿童动脉导管未闭合并二尖瓣反流疗效评价

doi:10.12372/jcp.2022.21e1493

Abstract

Abstract:

Objective To analyze the medium - and long-term efficacy of simple transcatheter closure in the treatment of children with patent ductus arteriosus (PDA) complicated with moderate and severe mitral regurgitation (MR), and to explore its safety and feasibility. Methods Clinical data of children diagnosed with PDA complicated with moderate and severe MR and treated with transcatheter closure from March 2013 to March 2019 were retrospectively analyzed. Results A total of 121 children (27 boys and 94 girls) with a median age of 19.8 (8.0-28.0) months were included. There were 94 cases with moderate MR and 27 cases with severe MR. Echocardiography showed that the diameter of PDA was (6.4±1.8) mm. There were statistically significant differences in the main pulmonary artery (MPA) diameter, left atrium (LA) diameter, left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) among different time points (preoperative, postoperative 24 h, postoperative 1, 3, 6, 12 and 24 months) (P<0.05). Compared with pre-operation, MPA diameter, LA diameter, LVEDD and LVESD were all shortened at each follow-up time point after surgery, with statistical significance (P<0.05). During the follow-up period, 120 children (93.4%) had less MR than pre-operation. There were statistically significant differences in MR areas of all children among different time points (preoperative, postoperative 24 h, postoperative 1, 3, 6, 12 and 24 months) (P<0.05). The postoperative MR area at each follow-up time point was significantly smaller than that before surgery (P<0.05), but there was no significant difference in MR area between 12 and 24 months after surgery (P>0.05). Conclusions On the premise of strictly grasping the surgical indications, simple transcatheter closure can improve MR degree and reduce left heart load in PDA combined with moderate and severe MR in children, which is safe and effective.

Key words: mitral regurgitation, patent ductus arteriosus, transcatheter closure, congenital heart disease

CHEN Yanhua, YIN Dan, ZHENG Ming, LYU Tiewei, YI Qijian, LI Mi, XIANG Ping. Efficacy evaluation on transcatheter closure of patent ductus arteriosus with mitral regurgitation in children[J].Journal of Clinical Pediatrics, 2022, 40(7): 517-521.

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References 22

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项目	术前	术后24 h	术后1月	术后3月	术后6月	术后12月	术后24月	F值	P
MPA/mm	20.3±3.8	19.5±3.7¹⁾	16.4±2.9¹⁾	15.8±2.3¹⁾	16.0±3.1¹⁾	16.0±2.1¹⁾	15.8±3.4¹⁾	41.47	<0.001
LA/mm	23.1±3.9	22.5±4.0¹⁾	19.3±3.5¹⁾	17.6±3.2¹⁾	17.6±3.0¹⁾	17.2±2.9¹⁾	16.8±2.6¹⁾	94.85	<0.001
LVEDD/mm	41.5±6.5	39.6±6.3¹⁾	33.9±6.6¹⁾	31.2±5.2¹⁾	30.8±5.0¹⁾	30.6±4.9¹⁾	30.7±4.9¹⁾	122.32	<0.001
LVESD/mm	26.5±5.3	26.6±4.9	23.3±5.2¹⁾	20.2±4.2¹⁾	19.7±4.0¹⁾	19.8±3.7¹⁾	20.2±3.8¹⁾	80.20	<0.001
LVEF/%	63.3±4.8	63.7±4.0	63.2±4.2	63.4±4.5	63.2±3.9	63.2±3.9	63.1±4.0	0.63	0.707

时间	MR面积/cm²
术前	2.9(2.5~3.7)
术后24 h	2.3(1.7~3.1)¹⁾
术后1月	1.5(1.0~2.3)¹⁾²⁾
术后3月	1.1(0.8~2.0)¹⁾²⁾³⁾
术后6月	1.0(1.0~1.8)^1)2)3)4)
术后12月	0.9(0.6~1.6)^1)2)3)4)5)
术后24月	0.9(0.6~1.5)^1)2)3)4)5)
H值	317.25
P	<0.001

Efficacy evaluation on transcatheter closure of patent ductus arteriosus with mitral regurgitation in children

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