Background

Transthoracic echocardiography (TTE) is increasingly utilized for guiding transcatheter closure of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objectives of this study were to compare PDA size measurements by TTE with angiographic measurements and to describe TTE techniques used in guiding transcatheter PDA closure (TCPC) in ELBW infants.

Methods

One hundred twenty-five consecutive ELBW infants (gestational age < 27 weeks, birth weight < 1 kg) who underwent TCPC before 8 weeks of age under TTE guidance were included. Patent ductus arteriosus sizes were measured from the procedural TTE and angiograms retrospectively by blinded observers. The TTE PDA diameters at the aortic (ED1) and pulmonary end (ED2) were compared with the corresponding angiographic diameters (CD1 and CD2). The TTE PDA lengths, obtained by two techniques (EL1, a straight line between ED1 and ED2; and EL2, a curvilinear line along the PDA), were compared with the PDA length by angiography (CL). Transthoracic echocardiography was used to guide accurate device positioning within the PDA.

Results

The procedure weight was 600-1,460 g. The TTE and angiographic PDA diameters were comparable (mean ED1 vs CD1 = 4.5 ± 0.68 vs 4.4 ± 0.85 mm, P = .26; and mean ED2 vs CD2 = 3.1 ± 0.72 vs 3.2 ± 0.94 mm, P = .14). The angiographic length was underestimated by EL1 by 2.6 ± 1.6 mm (P < .0001), while EL2 estimated it better (mean EL2 vs CL = 11.0 ± 1.83 vs 10.8 ± 2.15 mm; P = .40). Transcatheter PDA closure was successful in 100% of the cases using TTE guidance. There were no intraprocedural complications.

Conclusions

Transthoracic echocardiography guidance during TCPC in ELBW infants eliminates the need for aortograms via femoral arterial access, preventing the complications associated with it. Transthoracic echocardiography PDA measurements are comparable to angiographic measurements, thereby assisting in appropriate device size selection.

中文翻译：

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超低出生体重婴儿动脉导管未闭的超声心动图与血管造影测量以及回波引导对经导管闭合的效用

背景

经胸超声心动图 (TTE) 越来越多地用于指导极低出生体重 (ELBW) 婴儿的动脉导管未闭 (PDA) 经导管闭合。本研究的目的是比较 TTE 测量的 PDA 大小与血管造影测量，并描述用于指导 ELBW 婴儿经导管 PDA 闭合 (TCPC) 的 TTE 技术。

方法

纳入了 125 名在 TTE 指导下在 8 周龄前接受 TCPC 的连续 ELBW 婴儿（胎龄 < 27 周，出生体重 < 1 kg）。动脉导管未闭的大小是由盲法观察者从手术 TTE 和血管造影照片中回顾性测量的。将主动脉 (ED1) 和肺末端 (ED2) 的 TTE PDA 直径与相应的血管造影直径 (CD1 和 CD2) 进行比较。通过两种技术（EL1，ED1 和 ED2 之间的直线；EL2，沿 PDA 的曲线）获得的 TTE PDA 长度与通过血管造影术 (CL) 获得的 PDA 长度进行比较。经胸超声心动图用于指导 PDA 内的准确设备定位。

结果

手术重量为 600-1,460 克。TTE 和血管造影 PDA 直径具有可比性（平均 ED1 对 CD1 = 4.5 ± 0.68 对 4.4 ± 0.85 毫米，P  = .26；平均 ED2 对 CD2 = 3.1 ± 0.72 对 3.2 ± 0.94 毫米，P  = .14）。EL1 低估了血管造影长度 2.6 ± 1.6 mm ( P  < .0001)，而 EL2 估计得更好（平均 EL2 vs CL = 11.0 ± 1.83 vs 10.8 ± 2.15 mm；P  = .40）。使用 TTE 指导的经导管 PDA 闭合在 100% 的病例中成功。没有术中并发症。

结论

ELBW 婴儿 TCPC 期间的经胸超声心动图指导消除了通过股动脉通路进行主动脉造影的需要，防止了与之相关的并发症。经胸超声心动图 PDA 测量值与血管造影测量值相当，因此有助于选择合适的设备尺寸。