Percutaneous closure of patent ductus arteriosus guided by transthoracic echocardiography or angiography: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YI Kang ^1,2 , HE Shao'e ^2,3 ,  YOU Tao ^1,2 , HOU Xiaodong ^1,2 , XU Jianguo ^2,4 , WANG Dan ^2,4 , GAO Jie ^2,4 , XU Xiaomin ^2,4

1. Department of Cardiovascular Surgery, The People’s Hospital of Gansu Province, Lanzhou, 730000, P.R.China;
2. International Cooperation Base of Congenital Heart Disease Diagnosis and Treatment in Gansu Province, Lanzhou, 730000, P.R.China;
3. The Second School of Clinical Medicine of Lanzhou University, Lanzhou, 730000, P.R.China;
4. The First School of Clinical Medicine of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding?author：

YOU Tao, Email: syxzwk@126.com

Keywords：

Patent ductus arteriosus; transthoracic echocardiography; angiography; meta-analysis; systematic review

DOI：

10.7507/1007-4848.201908039

Video：

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Objective To compare the efficacy of percutaneous closure guided by transthoracic echocardiography or angiography in the treatment of patent ductus arteriosus (PDA).Methods Literature 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.Results Eight 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.Conclusion Compared 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.

Citation： YI Kang, HE Shao'e, YOU Tao, HOU Xiaodong, XU Jianguo, WANG Dan, GAO Jie, XU Xiaomin. Percutaneous closure of patent ductus arteriosus guided by transthoracic echocardiography or angiography: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 199-205. doi: 10.7507/1007-4848.201908039 Copy

1.	van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol, 2011, 58(21): 2241-2247.
2.	Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics, 2010, 125(5): 1020-1030.
3.	Mo? C. Patent ductus arteriosus. Med Ultrason, 2010, 12(2): 153-156.
4.	畢桐瑤, 姜克新. 新生兒動脈導管未閉診斷與治療的研究進展. 中國當代醫藥, 2019, 26(12): 37-40.
5.	Rolland A, Shankar-Aguilera S, Diomandé D, et al. Natural evolution of patent ductus arteriosus in the extremely preterm infant. Arch Dis Child Fetal Neonatal Ed, 2015, 100(1): F55-F58.
6.	Lam JY, Lopushinsky SR, Ma IWY, et al. Treatment options for pediatric patent ductus arteriosus: systematic review and meta-analysis. Chest, 2015, 148(3): 784-793.
7.	扶劍, 潘征夏. 外科手術與介入封堵治療小兒動脈導管未閉的對照研究. 中國胸心血管外科臨床雜志, 2019, 26(7): 660-663.
8.	馮娟, 王玉林, 朱梅, 等. 經導管Amplatzer封堵器和外科手術治療動脈導管未閉對照試驗的Meta分析. 實用兒科臨床雜志, 2008, 23(23): 1809-1812.
9.	Zanjani KS, Sobhy R, El-Kaffas R, et al. Multicenter off-label use of nit-occlud coil in retrograde closure of small patent ductus arteriosus. Pediatr Cardiol, 2017, 38(4): 828-832.
10.	楊思源, 主編. 小兒心臟病學. 第 3 版. 北京: 人民衛生出版社, 2005. 5.
11.	中華醫學會心血管病學分會結構性心臟病學組, 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 中國動脈導管未閉介入治療指南 2017. 中國介入心臟病學雜志, 2017, 25(5): 241-248.
12.	陳捷, 傅立軍, 杜軍保. 《兒童常見先天性心臟病介入治療專家共識》解讀. 中國醫刊, 2015, (5): 22-24, 25.
13.	周天津, 羅亞玲, 周雪晴, 等. 介入封堵術和外科手術治療中國大陸人群動脈導管未閉的 Meta 分析. 中國介入影像與治療學, 2016, 13(3): 129-133.
14.	Wang K, Pan X, Tang Q, et al. Catheterization therapy vs surgical closure in pediatric patients with patent ductus arteriosus: a meta-analysis. Clin Cardiol, 2014, 37(3): 188-194.
15.	Yi K, You T, Ding ZH, et al. Comparison of transcatheter closure, mini-invasive closure, and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: A PRISMA-compliant network meta-analysis of randomized and observational studies. Medicine (Baltimore), 2018, 97(40): e12583.
16.	Pan XB, Ou-Yang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol, 2015, 28(4): 390-395.
17.	鄒孟軒, 歐陽文斌, 溫彬, 等. 超聲心動圖引導下行經皮動脈導管未閉封堵術的臨床研究. 中國胸心血管外科臨床雜志, 2018, 25(7): 12-16.
18.	Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol, 2013, 66(9): 982-993.
19.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10: ED000142.
20.	張偉華, 田民, 雷蕓, 等. 兩種單靜脈法與傳統Amplatzer法治療動脈導管未閉. 中國介入影像與治療學, 2007, 4(2): 101-105.
21.	朱玲, 李軒狄, 林約瑟, 等. 經胸超聲心動圖與造影指引動脈導管未閉封堵術的比較. 中華醫學會第十五次全國心血管病學大會, 2013.
22.	楊棟, 張偉華, 光雪峰, 等. 經胸超聲指導下小兒動脈導管未閉封堵術的臨床應用. 中華臨床醫師雜志(電子版), 2013, 7, (6): 2461-2464.
23.	馬業新. 經胸超聲心動圖指導動脈導管未閉封堵治療. 中國超聲醫學雜志, 2013, 29(12): 1124-1127.
24.	許偉濱. 經胸超聲心動圖與常規法封堵嬰幼兒動脈導管未閉的前瞻性研究. 廣東省遺傳學會第九屆代表大會暨學術研討會論文集, 2014: 162.
25.	林丹丹. 經胸超聲心動圖在指導 PDA 封堵術術前及術中的臨床意義. 中國實驗診斷學, 2014, 18(5): 766-768.
26.	楊帆, 劉慶春, 陳巧珠. 經胸超聲心動圖與經主動脈造影指導動脈導管未閉封堵治療的對比研究. 臨床超聲醫學雜志, 2015, 17(10): 683-686.
27.	何彪華. Clinical Application of Transcatheter Closure of Patent Ductus Arteriosus under Transthoracic Echocardiography. 昆明醫科大學, 2018.
28.	潘湘斌. 超聲引導經皮介入治療結構性心臟病的探索和發展前景. 中國胸心血管外科臨床雜志, 2018, 25(5): 7-9.
29.	Prescott S, Keim-Malpass J. Patent ductus arteriosus in the preterm infant: diagnostic and treatment options. Adv Neonatal Care, 2017, 17(1): 10-18.
30.	Kang SL, Jivanji S, Mehta C, et al. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv, 2017, 90(7): 1135-1144.
31.	Backes CH, Rivera BK, Bridge JA, et al. Percutaneous patent ductus arteriosus (PDA) closure during infancy: a meta-analysis. Pediatrics, 2017, 139(2): pii: e20162927.
32.	Johnson JN, Sathanandam S, Naik R, et al. Echocardiographic guidance for transcatheter patent ductus arteriosus closure in extremely low birth weight infants. Congenit Heart Dis, 2019, 14(1): 74-78.
33.	Almeida-Jones M, Tang NY, Reddy A, et al. Overview of transcatheter patent ductus arteriosus closure in preterm infants. Congenit Heart Dis, 2019, 14(1): 60-64.
34.	Carmo Mendes I, Heard H, Peacock K, et al. Echocardiographic Versus angiographic assessment of patent arterial duct in percutaneous closure: towards x-ray free duct occlusion? Pediatr Cardiol, 2017, 38(2): 302-307.
35.	國家衛生健康委員會, 國家心外介入質控專家組, 國家心血管病中心醫療質量控制中心心外介入專家組. 單純超聲心動圖引導經皮介入技術中國專家共識. 中國循環雜志, 2018, 33(10): 943-952.

1. van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol, 2011, 58(21): 2241-2247.
2. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics, 2010, 125(5): 1020-1030.
3. Mo? C. Patent ductus arteriosus. Med Ultrason, 2010, 12(2): 153-156.
4. 畢桐瑤, 姜克新. 新生兒動脈導管未閉診斷與治療的研究進展. 中國當代醫藥, 2019, 26(12): 37-40.
5. Rolland A, Shankar-Aguilera S, Diomandé D, et al. Natural evolution of patent ductus arteriosus in the extremely preterm infant. Arch Dis Child Fetal Neonatal Ed, 2015, 100(1): F55-F58.
6. Lam JY, Lopushinsky SR, Ma IWY, et al. Treatment options for pediatric patent ductus arteriosus: systematic review and meta-analysis. Chest, 2015, 148(3): 784-793.
7. 扶劍, 潘征夏. 外科手術與介入封堵治療小兒動脈導管未閉的對照研究. 中國胸心血管外科臨床雜志, 2019, 26(7): 660-663.
8. 馮娟, 王玉林, 朱梅, 等. 經導管Amplatzer封堵器和外科手術治療動脈導管未閉對照試驗的Meta分析. 實用兒科臨床雜志, 2008, 23(23): 1809-1812.
9. Zanjani KS, Sobhy R, El-Kaffas R, et al. Multicenter off-label use of nit-occlud coil in retrograde closure of small patent ductus arteriosus. Pediatr Cardiol, 2017, 38(4): 828-832.
10. 楊思源, 主編. 小兒心臟病學. 第 3 版. 北京: 人民衛生出版社, 2005. 5.
11. 中華醫學會心血管病學分會結構性心臟病學組, 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 中國動脈導管未閉介入治療指南 2017. 中國介入心臟病學雜志, 2017, 25(5): 241-248.
12. 陳捷, 傅立軍, 杜軍保. 《兒童常見先天性心臟病介入治療專家共識》解讀. 中國醫刊, 2015, (5): 22-24, 25.
13. 周天津, 羅亞玲, 周雪晴, 等. 介入封堵術和外科手術治療中國大陸人群動脈導管未閉的 Meta 分析. 中國介入影像與治療學, 2016, 13(3): 129-133.
14. Wang K, Pan X, Tang Q, et al. Catheterization therapy vs surgical closure in pediatric patients with patent ductus arteriosus: a meta-analysis. Clin Cardiol, 2014, 37(3): 188-194.
15. Yi K, You T, Ding ZH, et al. Comparison of transcatheter closure, mini-invasive closure, and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: A PRISMA-compliant network meta-analysis of randomized and observational studies. Medicine (Baltimore), 2018, 97(40): e12583.
16. Pan XB, Ou-Yang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol, 2015, 28(4): 390-395.
17. 鄒孟軒, 歐陽文斌, 溫彬, 等. 超聲心動圖引導下行經皮動脈導管未閉封堵術的臨床研究. 中國胸心血管外科臨床雜志, 2018, 25(7): 12-16.
18. Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol, 2013, 66(9): 982-993.
19. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10: ED000142.
20. 張偉華, 田民, 雷蕓, 等. 兩種單靜脈法與傳統Amplatzer法治療動脈導管未閉. 中國介入影像與治療學, 2007, 4(2): 101-105.
21. 朱玲, 李軒狄, 林約瑟, 等. 經胸超聲心動圖與造影指引動脈導管未閉封堵術的比較. 中華醫學會第十五次全國心血管病學大會, 2013.
22. 楊棟, 張偉華, 光雪峰, 等. 經胸超聲指導下小兒動脈導管未閉封堵術的臨床應用. 中華臨床醫師雜志(電子版), 2013, 7, (6): 2461-2464.
23. 馬業新. 經胸超聲心動圖指導動脈導管未閉封堵治療. 中國超聲醫學雜志, 2013, 29(12): 1124-1127.
24. 許偉濱. 經胸超聲心動圖與常規法封堵嬰幼兒動脈導管未閉的前瞻性研究. 廣東省遺傳學會第九屆代表大會暨學術研討會論文集, 2014: 162.
25. 林丹丹. 經胸超聲心動圖在指導 PDA 封堵術術前及術中的臨床意義. 中國實驗診斷學, 2014, 18(5): 766-768.
26. 楊帆, 劉慶春, 陳巧珠. 經胸超聲心動圖與經主動脈造影指導動脈導管未閉封堵治療的對比研究. 臨床超聲醫學雜志, 2015, 17(10): 683-686.
27. 何彪華. Clinical Application of Transcatheter Closure of Patent Ductus Arteriosus under Transthoracic Echocardiography. 昆明醫科大學, 2018.
28. 潘湘斌. 超聲引導經皮介入治療結構性心臟病的探索和發展前景. 中國胸心血管外科臨床雜志, 2018, 25(5): 7-9.
29. Prescott S, Keim-Malpass J. Patent ductus arteriosus in the preterm infant: diagnostic and treatment options. Adv Neonatal Care, 2017, 17(1): 10-18.
30. Kang SL, Jivanji S, Mehta C, et al. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv, 2017, 90(7): 1135-1144.
31. Backes CH, Rivera BK, Bridge JA, et al. Percutaneous patent ductus arteriosus (PDA) closure during infancy: a meta-analysis. Pediatrics, 2017, 139(2): pii: e20162927.
32. Johnson JN, Sathanandam S, Naik R, et al. Echocardiographic guidance for transcatheter patent ductus arteriosus closure in extremely low birth weight infants. Congenit Heart Dis, 2019, 14(1): 74-78.
33. Almeida-Jones M, Tang NY, Reddy A, et al. Overview of transcatheter patent ductus arteriosus closure in preterm infants. Congenit Heart Dis, 2019, 14(1): 60-64.
34. Carmo Mendes I, Heard H, Peacock K, et al. Echocardiographic Versus angiographic assessment of patent arterial duct in percutaneous closure: towards x-ray free duct occlusion? Pediatr Cardiol, 2017, 38(2): 302-307.
35. 國家衛生健康委員會, 國家心外介入質控專家組, 國家心血管病中心醫療質量控制中心心外介入專家組. 單純超聲心動圖引導經皮介入技術中國專家共識. 中國循環雜志, 2018, 33(10): 943-952.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Percutaneous closure of patent ductus arteriosus guided by transthoracic echocardiography or angiography: A systematic review and meta-analysis

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