Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Jian ,  PAN Zhengxia

Department of Cardiac Surgery of Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P.R.China;

Corresponding author：

PAN Zhengxia, Email: 1126149732@qq.com

Keywords：

Patent ductus arteriosus; surgery; interventional closure

DOI：

10.7507/1007-4848.201811018

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Objective To study effect of different surgical treatments for patent ductus arteriosus in children.Method A total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared.Results The operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups.Conclusions In patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.

Citation： FU Jian, PAN Zhengxia. Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 660-663. doi: 10.7507/1007-4848.201811018 Copy

1.	Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr, 2015, 169(9): 836-872.
2.	Ansary A. Management of patent ductus arteriosus. Indian Pediatrics, 2014, 51(7): 586-587.
3.	张金哲, 主编. 张金哲小儿外科学. 北京: 人民卫生出版社出版, 2013, 820-822.
4.	陈笑征, 杜忠东. 早产儿动脉导管未闭的诊断及治疗. 中国医刊, 2018, (4): 1371-1372.
5.	Benitz WE, Newborn COFA. Patent ductus arteriosus in preterm infants. Pediatrics, 2016, 137(1).
6.	Zhang B, Liang J, Zheng X, et al. Transcatheter closure of postoperative residual ventricular septal defects using Amplatzer-type perimembranous VSD occluders. J Invasive Cardiol, 2013, 25(8): 402.
7.	Jhaveri N, MoonGrady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr, 2010, 157(3): 381-387.
8.	Reese J, Waleh N, Poole SD, et al. Chronic in utero cyclooxygenase inhibition alters pge2-regulated ductus arteriosus contractile pathways and prevents postnatal closure. Pediatr Res, 2009, 66(2): 155-161.
9.	库德热提·艾比布拉. 先天性心脏病介入封堵术的临床疗效评价. 东南国防医药, 2014, 16(3): 304-305.
10.	赵晓波, 刘立新, 周薇莉, 等. 小儿常见先天性心脏病的外科治疗. 中国妇幼保健, 2014, 29(10): 1573-1574.
11.	Mosalli R, Alfaleh K. Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants. Cochrane Database Syst Rev, 2008, 1: CD006181.
12.	于波, 孔祥清, 张智伟, 等. 中国动脉导管未闭介入治疗指南 2017. 中国介入心脏病学杂志, 2017, 25(5): 241-248.
13.	Pan X, Ouyang W, Wang S, et al. Abstract 10972: Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion. Echocardiography, 2016, 33(7): 1040-1045.
14.	Mcelhinney DB, Geiger E, Blinder J, et al. NKX2.5 mutations in patients with congenital heart disease. J Am Coll Cardiol, 2003, 42(9): 1650-1655.
15.	徐建新, 周绍斌, 金洪来, 等. CT 三维成像指导动脉导管未闭介入封堵术临床价值. 介入放射学杂志, 2017, 26(3): 206-209.
16.	张伟华, 戴海龙, 尹小龙, 等. 小儿动脉导管未闭 162 例封堵治疗临床分析. 昆明医学院学报, 2010, 31(8): 62-64.
17.	Brotschi B, Hug M I, Kretschmar O, et al. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart, 2015, 101(12): 948-953.
18.	Richards J, Johnson A, Fox G, et al. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics, 2009, 124(2): 287-293.
19.	Kim EK, Kim DH, Choi CW, et al. Insufficient intimal thickening and scarcity of cell deaths may play a significant role in the pathogenesis of the persistently patent ductus arteriosus in the preterm infant. Early Hum Dev, 2009, 85(3): 181-186.
20.	陈林, 肖颖彬, 闵家新, 等. 合并心内畸形动脉导管未闭的外科治疗. 第三军医大学学报, 2000, 22(11): 1059-1061.
21.	Cooley DA. Early development of congenital heart surgery: open heart procedures. Ann Thorac Surg, 1997, 64(5): 1544-1548.

1. Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr, 2015, 169(9): 836-872.
2. Ansary A. Management of patent ductus arteriosus. Indian Pediatrics, 2014, 51(7): 586-587.
3. 张金哲, 主编. 张金哲小儿外科学. 北京: 人民卫生出版社出版, 2013, 820-822.
4. 陈笑征, 杜忠东. 早产儿动脉导管未闭的诊断及治疗. 中国医刊, 2018, (4): 1371-1372.
5. Benitz WE, Newborn COFA. Patent ductus arteriosus in preterm infants. Pediatrics, 2016, 137(1).
6. Zhang B, Liang J, Zheng X, et al. Transcatheter closure of postoperative residual ventricular septal defects using Amplatzer-type perimembranous VSD occluders. J Invasive Cardiol, 2013, 25(8): 402.
7. Jhaveri N, MoonGrady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr, 2010, 157(3): 381-387.
8. Reese J, Waleh N, Poole SD, et al. Chronic in utero cyclooxygenase inhibition alters pge2-regulated ductus arteriosus contractile pathways and prevents postnatal closure. Pediatr Res, 2009, 66(2): 155-161.
9. 库德热提·艾比布拉. 先天性心脏病介入封堵术的临床疗效评价. 东南国防医药, 2014, 16(3): 304-305.
10. 赵晓波, 刘立新, 周薇莉, 等. 小儿常见先天性心脏病的外科治疗. 中国妇幼保健, 2014, 29(10): 1573-1574.
11. Mosalli R, Alfaleh K. Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants. Cochrane Database Syst Rev, 2008, 1: CD006181.
12. 于波, 孔祥清, 张智伟, 等. 中国动脉导管未闭介入治疗指南 2017. 中国介入心脏病学杂志, 2017, 25(5): 241-248.
13. Pan X, Ouyang W, Wang S, et al. Abstract 10972: Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion. Echocardiography, 2016, 33(7): 1040-1045.
14. Mcelhinney DB, Geiger E, Blinder J, et al. NKX2.5 mutations in patients with congenital heart disease. J Am Coll Cardiol, 2003, 42(9): 1650-1655.
15. 徐建新, 周绍斌, 金洪来, 等. CT 三维成像指导动脉导管未闭介入封堵术临床价值. 介入放射学杂志, 2017, 26(3): 206-209.
16. 张伟华, 戴海龙, 尹小龙, 等. 小儿动脉导管未闭 162 例封堵治疗临床分析. 昆明医学院学报, 2010, 31(8): 62-64.
17. Brotschi B, Hug M I, Kretschmar O, et al. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart, 2015, 101(12): 948-953.
18. Richards J, Johnson A, Fox G, et al. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics, 2009, 124(2): 287-293.
19. Kim EK, Kim DH, Choi CW, et al. Insufficient intimal thickening and scarcity of cell deaths may play a significant role in the pathogenesis of the persistently patent ductus arteriosus in the preterm infant. Early Hum Dev, 2009, 85(3): 181-186.
20. 陈林, 肖颖彬, 闵家新, 等. 合并心内畸形动脉导管未闭的外科治疗. 第三军医大学学报, 2000, 22(11): 1059-1061.
21. Cooley DA. Early development of congenital heart surgery: open heart procedures. Ann Thorac Surg, 1997, 64(5): 1544-1548.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children

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