Application of single venous approach under echocardiographic without angiography in closure of Patent Ductus Arteriosus

Abstract

Background: The conventional arteriovenous approach closure of patent ductus arteriosus（PDA）may be associated with more complications especially in young infants. The objective is to explore the feasibility and clinical efficacy of interventional closure of PDA through single venous approach under echocardiographic without angiography. Methods: 112 patients (32 males and 80 females) with PDA closed by different methods in Suining Central Hospital were enrolled, including 60 cases with single venous approach under echocardiographic without angiography and 52 cases with conventional arteriovenous approach. There were no significant differences in age and gender composition between the two groups. The success rate of operation, complete closure rate of 24 hours,Procedure time, X-ray fluoroscopic time, radiation dose, intraoperative contrast volume, preoperative and postoperative creatinine, preoperative and postoperative uric acid nitrogen, bed rest time, total hospital stay and incidence of vascular complications were compared between the two groups. Results: There were no significant differences in the success rate of operation (100% vs 100%) and the complete closure rate of 24 hours (100% vs 100%) between the two groups (P>0.05). In the single venous approach group, the Procedure time was (50.05±4.78min vs 57.69±6.44min), the X-ray fluoroscopy time was (7.30±0.78min vs 10.23±1.58min), and the radiation dose was (79.57±15.18mGy vs 219.22±34.60mGy), contrast volume (0mL vs 62.22±22.69ml), bed rest time (4.03±0.99h vs 12.25±1.73h), total hospital stay (3.30±0.52 days vs 3.39±0.49 days) and the incidence of vascular complications (0% vs 13.9%) were significantly lower than those in the traditional angiography group (P<0.05). There were no significant changes in creatinine (51.86±12.75umol/L vs 53.09±10.27umol/L) and urea nitrogen (4.81±1.21mmol/L vs 4.98±0.93mmol/L) before and after operation in single venous group (P>0.05). Compared with preoperative creatinine level (68.23±8.66umol vs 59.23±22.12umol) and urea nitrogen level (5.98±1.13mmol/L vs 5.16±1.49mmol/L) in traditional angiography group after operation (24 hours) were significantly increased (P < 0.05). Conclusions: Compared with the conventional arteriovenous approach, the single venous approach has the outstanding advantage of reducing vascular complications, contrast volume, radiation dose,procedure time .Compared with the conventional arteriovenous approach, on the basis of obtaining the same efficacy, the PDA occlusion of the single venous approach under echocardiographic without angiography has the outstanding advantages of simplified operation, less X-ray radiation, no contrast agent injury, short bed rest time, and fewer vascular complications.It is a green and safe surgical method worth promoting for PDA patients with suitable anatomical conditions.