Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Closure: A Prospective Trial at High Altitude.

Abstract

Objective: To explore the clinical efficacy and safety of interventional closure of patent ductus arteriosus (PDA) via femoral venous puncture under echocardiography guidance at high altitude.

Methods: From December 2022 to July 2023, 36 patients with PDA at high altitude were prospectively enrolled and underwent closure either under echocardiography guidance or fluoroscopy guidance. Baseline, procedural, and outcome characteristics were compared in intention-to-treat analysis.

Results: The characteristics of patients and PDA were comparable between the two groups. The success rate of occlusion was 100% in both groups. Compared with the traditional fluoroscopy group, the echocardiography group showed a significant reduction in Air Kerma (112.13 ± 77.51 Gy vs. 247.27 ± 123.81 Gy, p = 0.001), Dose Area Product (24.3 [13.6-31.3] Gy·cm² vs. 41.5 [26.9-63.5] Gy·cm², p = 0.015) and intraoperative contrast dose (0 vs. 1.74 ± 1.02 mL/kg, p < 0.001). In the fluoroscopy group, a significant rise in creatinine (60.47 ± 14.02 umol/L vs. 40.93 ± 14.94 umol/L, p < 0.001) and urea nitrogen levels (6.03 ± 1.12 mmol/L vs. 4.80 ± 0.81 mmol/L, p < 0.001) at 24 h postoperatively were detected compared to preoperative levels, whereas no such changes were detected in the echocardiography group. Except for one patient in the fluoroscopy group lost to 1-year follow-up, no adverse events were reported in either group.

Conclusion: At high altitude, echocardiography-guided percutaneous PDA closure offers comparable efficacy to traditional methods, with minimal X-ray exposure and no contrast-induced kidney injury.

Clinical trial registration: The trial is registered at http://www.chictr.org.cn (ChiCTR2400090901).