单纯食道超声心动图引导下经腋下小切口儿童动脉导管未闭的封堵治疗

Treatment of patent ductus arteriosus in children through small axillary incision by esophageal echocardiography-guided only

目的探讨经食道超声心动图引导、左侧腋下小切口入路行儿童动脉导管未闭封堵治疗的安全性、有效性及可行性。方法本研究为回顾性研究。收集2018年3月至2021年12月首都医科大学附属北京儿童医院收治的动脉导管未闭患儿40例作为研究对象,其中男13例、女27例,年龄1.09(0.60,1.75)岁,体重9.00(7.20,10.50)kg,均行单纯食道超声心动图引导下左侧腋下小切口入路动脉导管未闭封堵术,均手术顺利,术后返回心脏重症监护室予对症治疗,必要时予强心、利尿治疗。收集所有患儿术后即刻以及术后1个月、3~6个月随诊超声心动图及心电图情况,评估治疗效果。结果40例均封堵成功,1例术后3个月复查时发现封堵器移位,患儿无明显不适,予取出封堵器及动脉导管切断缝合术,手术顺利。其余39例术后随诊超声心动图及心电图均提示封堵器位置良好,心脏各房室内径基本正常;无一例出现残余分流、心包积液、心律失常等并发症。结论单纯经食道超声心动图引导下左侧腋下小切口入路行儿童动脉导管未闭封堵术安全有效,对小年龄、低体重、伴有粗大动脉导管未闭的患儿同样适用,具有切口小、康复快、并发症少等优点。

Objective To explore the safety,effectiveness and feasibility of patent ductus arteriosus(PDA)occlusion in children under the guidance of transesophageal echocardiography(TEE)via a small left axillary incision.Methods Clinical data were retrospectively reviewed for 40 PDA children between March 2018 and December 2021.There were 13 boys and 27 girls with an age range of 1.09(0.60-1.75)years and a body weight of 9(7.20-10.50)kg.Simple esophageal heart ultrasound-guided small incision was performed in left axilla for PDA closure.Return to the intensive care unit after the operation for symptomatic treatment and,if necessary,cardiotonic and diuretic treatment.Both echocardiogram and electrocardiogram were examined immediately,Month 1 post-operation and Month 3-6 post-operation for evaluating the treatment outcomes.Results The occluder was successfully implanted in all children.At Month 3 post-operation,occluder was displaced in one child without any obvious discomfort.The occluder was removed,arterial catheter withdrawn and skin sutured.In the remainders,follow-up cardiac color Doppler ultrasound and electrocardiogram indicated that the position of occluder was excellent and internal diameter of each atrium was basically normal.There were no complications such as residual shunt,pericardial effusion or arrhythmia.Conclusion It is safe and effective to occlude PDA with a small left axillary incision under the sole guidance of esophageal echocardiography in children.Such an approach is also suitable for young and underweight children with thick PDA.It offers the advantages of minimal trauma,faster recovery and fewer complications.