ObjectiveTo evaluate the efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with transthoracic echocardiography (TTE).MethodsFrom February 2016 to November 2018, 98 patients of pure PDA were selected, including 43 patients of funnel type and 55 patients of tube type. There were 38 males and 60 females at age of 2-48 (9.8±10.4) years. All patients underwent TTE-guided retrograde closure of the PDA through the femoral artery to establish a femoral-abdominal aorta-thoracic aorta-ductus arteriosus-aorta-right ventricle trajectory.Under the guidance of TTE, a suitable closure umbrella was placed through the femoral artery. One month, 3 months, 6 months, 12 months after the surgery, the patients received out-patient clinical follow-up.ResultsNinety eight patients were successfully occluded by TTE. The occluder was replaced many times in an adult PDA patient, but finally it was successfully plugged. The operation time was 33.2±5.8 min. The lumbar diameter was 12±6 mm. And the postoperative murmur disappeared. Ultrasound showed no shunt between the aorta and the pulmonary artery, and the postoperative hospital stay was 3-4 days. No shunt signal was found in 1, 3, 6, 12 months follow-up. Left atrial anteroposterior diameter (25.8±6.1 mm vs. 30.6±8.4 mm) and left ventricular end diastolic diameter (38.5±9.1 mm vs. 45.2±11.5 mm) were significantly smaller (P < 0.05).ConclusionTTE-guided transcatheter closure of PDA via femoral artery is a safe and effective method to avoid the damage of X-ray and contrast medium. The prospect of clinical application is good.
ObjectiveTo compare the efficacy of percutaneous closure guided by transthoracic echocardiography or angiography in the treatment of patent ductus arteriosus (PDA).MethodsLiterature databases such as CNKI, VIP, Wanfang Database, PubMed, Cochrane Library were searched for collecting published literatures on percutaneous closure for PDA guided by transthoracic echocardiography and angiography, retrieval time limit was up to April 2019. Two evaluators independently screened the literature, extracted the data and evaluated the quality according to inclusion and exclusion criteria. The collected data were analyzed by RevMan 5.3 software.ResultsEight studies were included finally, with a total sample size of 681 cases. Meta-analysis showed that there was no statistical difference in the operative success rate between the echocardiography group and the angiography group (RR=0.99, 95%CI 0.97- 1.01, P=0.40). Postoperative complications were less in the echocardiography group than those in the angiography group (RR=0.26, 95%CI 0.11-0.59, P=0.001).The operation time (P<0.000 01), amount of intraoperative radiation (P<0.000 01), exposure time (P<0.000 01), hospitalization days (P<0.000 01) and hospitalization costs (P<0.000 01) in the echocardiography group were less or shorter than those in the angiography group, and the difference was statistically different.ConclusionCompared with angiography-guided, transthoracic echocardiography-guided percutaneous closure for PDA is a safe and effective method with less trauma, lower cost, and can replace angiography as one of the guiding methods for PDA.