Abstract:

Objective　To analyze the application value of ultrasound in the closure of left axillary patent ductus arteriosus (PDA) guided by transesophageal ultrasound. Methods　A total of 42 cases of children with PDA in Children's Hospital Affiliated to Zhengzhou University from January 2020 to January 2022 were retrospectively analyzed. There were 19 males and 23 females, aged (2.62±0.58) years. All of them were examined by transesophageal ultrasound to determine whether the closure of left axillary PDA could be performed or not. The surgical conditions, ultrasound guidance conditions, results, and ultrasound follow-up were analyzed. Results　All of the 42 children did not use X ray, and the closure of left axillary PDA was completed under the transesophageal echocardiography. The occluders were well shaped. There were no complications such as cardiovascular perforation in the children. All of the 42 children successfully completed PDA closure under echocardiography, and the occluder models were XJFD0406-XJFD1618. After the release of the closure umbrella during the operation in 23 cases, the different degrees of leakage were immediately detected by transesophageal ultrasound during the operation, with the largest width of the inner root bundle of the pulmonary artery of 1.9 mm and the fastest leakage velocity of 2.4 m/s. The left pulmonary artery blood flow did not increase rapidly. The flow velocity of some descending aorta increased slightly, and the flow velocity of descending aorta were all down to normal during the follow-up. In the 23 cases of children with leakage during the operation, they underwent chest ultrasound review on the first day after surgery, and 9 cases of children still had leakage. Among the 42 children, 4 cases had a small amount of pericardial effusion. During the follow-up 3 months after operation, 8 cases of leakage disappeared successively, but 1 case of residual leakage remained. At 6 months of follow-up, none of the children had any residual leakage or residual shunt. Conclusion　In the closure of small incision left axillary PDA guided by transesophageal ultrasound alone, transesophageal ultrasound can accurately evaluate the operation condition and ultrasound guidance condition, with small operation incision, good curative effect, and fast recovery, so it has become the first choice for the treatment of PDA at present.

Key words:

Patent ductus arteriosus, Transesophageal ultrasound, Closure of left axillary patent ductus arteriosus

摘要：

目的　分析经食道超声引导下左腋下动脉导管未闭（PDA）封堵术中超声应用价值。方法　本文为回顾性分析。选取2020年1月至2022年1月郑州大学附属儿童医院PDA患儿42例，男19例，女23例，年龄（2.62±0.58）岁。均采用经食道超声检查，明确是否能进行左腋下PDA封堵术，统计手术情况、超声引导情况、结果及超声随访。结果　42例患儿均未使用X线，完全在经食道超声心动图下完成经左腋下PDA封堵术；封堵器均塑形良好；患儿均无心血管穿孔等并发症；42例患儿均成功在超声心动图下完成PDA封堵术，封堵器型号XJFD0406-XJFD1618；23例术中释放封堵伞之后，术中经食道超声即刻监测到不同程度的渗漏，最宽1例肺动脉内根部束宽1.9 mm，渗漏流速最快1例流速2.4 m/s；左肺动脉血流未见增快；部分降主动脉流速稍增快，在随访过程中，降主动脉流速均降至正常；术中23例渗漏患儿，在术后第1天经胸超声复查，仍有9例渗漏；本组42例患儿中，4例出现少量心包积液；在术后3个月随访中，8例患儿渗漏先后消失，仍有1例残余渗漏；术后6个月随访时，所有患儿均无残余渗漏或残余分流。结论　在单纯经食道超声引导下左腋下小切口PDA封堵术中，经食道超声能对手术情况、超声引导情况进行准确评估，且该手术切口小、疗效好、恢复快，目前已经成为治疗PDA的首选方案。

关键词:

动脉导管未闭, 经食道超声, 左腋下动脉导管未闭封堵术