X线下联合经胸超声心动图经皮单根血管入径介入封堵治疗动脉导管未闭的临床研究

目的探究X线下联合经胸超声心动图经皮单根血管入径介入封堵治疗动脉导管未闭(PDA)的安全可行性。方法纳入2017年10月至2019年12月首都儿科研究所附属儿童医院导管室完成经典经皮介入封堵PDA治疗(造影组)和X线下联合经胸超声心动图经皮介入封堵PDA治疗(超声组)病例。两组患儿均用超声心动图和X线评估封堵效果,对比两组的手术时长、对比剂用量及射线剂量等。结果患儿年龄6个月~11岁,体重8~40 kg。超声组72例,造影组14例。所有患儿均一次封堵成功。超声组穿刺单根血管的有62例,造影组均穿刺两根血管,所有病例均无血管并发症。超声组手术时间为(52.1±22.8)min比(111.0±42.4)min,P=0.030]、射线剂量(25.4±19.0)mGy比(123.7±55.6)mGy,P<0.001]、对比剂用量(0.2±1.2)ml比(42.5±14.4)ml,P<0.001]显著低于造影组,差异均有统计学意义。结论X线下联合经胸超声心动图经皮单根血管入径介入封堵治疗PDA安全可行。

Clinical study on the percutaneous occlusion with single vascular approach of patent ductus arteriosus by X-ray combined with transthoracic echocardiography

Objective To explore the safety and feasibility of percutaneous occlusion with single vascular approach of patent ductus arteriosus(PDA)by X-ray combined with transthoracic echocardiography(TTE).Methods From October 2017 to December 2019,percutaneous occlusions were performed in 86 PDA children in catheterization laboratory of Capital Institute of Pediatrics Affi liated Children's Hospital.In echo group,occluders were determined by the results of TTE,percutaneous closure was performed via only one vessel(femoral artery or femoral vein)under X-ray and TTE.General percutaneous closure was performed in angiography group.The eff ectiveness of occlusions were evaluated by TTE and fl uoroscopy in both groups.The diff erence of procedure duration,contrast medium dose and radiation dose were analyzed between two groups.Results The children were aged 0.5-11 years and weighted 8-40 kg.There were 72 children in echo group punctured single vessel and 14 children in angiography group and all children were successfully occluded.There were 62 children in echo group punctured only one vessel while all children in angiography group punctured two vessels,no vessel complications occurred in two groups.procedure time(52.1±22.8)min vs.(111.0±42.4)min,P=0.030],radiation dose(25.4±19.0)min vs.(123.7±55.6)min,P<0.001]and contrast medium dose(0.2±1.2)ml vs.(42.5±14.4)ml,P<0.001 in echo group were signifi cant less than those in angiography group.Conclusions This study shows that percutaneous occlusion with single vascular approach of PDA by X-ray combined with TTE is feasible and safe.