Abstract: Objective To evaluate the clinical efficacy of minimally invasive perpulmonary and percutaneous closure of the patent ductus arteriosus(PDA)in infants. Methods A retrospective analysis was performed on 145 infants diagnosed with a large PDA≥4.0 mm in diameter. Data on PDA size, left ventricular end-diastolic diameter and operation-related parameters were collected for each patient. Based on the different interventional approaches, the infants were divided into two groups: the DSA-guided percutaneous closure group(n=95)and the Echo-guided perpulmonary closure group(n=50). The clinical efficacy of both groups was evaluated. Results Both groups achieved a high success rate of 100% in the Echo-guided perpulmonary closure group and 100% in the percutaneous approach. In the DSA-guided perpulmonary closure group for the patients aged from 7 to 12 months, the mean minimum diameter of PDA at the pulmonary end was(5.80±1.29)mm(range, 4.00-10.00 mm), the mean maximum diameter of PDA at the aortic end was(8.14±2.16)mm(range, 5.20-15.00 mm), and the size of the implanted device was(8.12±1.65)mm(range, 6.00-12.00 mm). Similarly, in the DSA-guided percutaneous closure group, the mean minimum and maximum diameters of PDA were(5.14±0.94)mm(range, 4.00-9.50 mm)and(6.66±1.25)mm(range, 4.00-12.70 mm), respectively. The implanted device size was(7.83±1.93)mm(range, 6.00-10.00 mm). The above data and the postoperative pulmonary artery systolic pressure(PASP)of both groups were lower than before surgery(P<0.05). In the Echo-guided perpulmonary closure group for the patients aged from 0 to 6 months, the mean minimum diameter of PDA at the pulmonary end was(5.14±1.51)mm(range, 4.00-10.00 mm), and the mean maximum diameter of PDA at the aortic end was(6.68±1.80)mm(range, 4.00-10.00 mm). Similarly, in the DSA-guided percutaneous closure group, the mean minimum and maximum diameters of PDA were(5.11±1.24)mm(range, 4.00-8.40 mm)and(5.92±0.63)mm(range, 5.00-7.00 mm), respectively. The implant device size was(7.63±1.67)mm(range, 6.00-12.00 mm)and(6.83±1.34)mm(range, 6.00-10.00 mm)in the two groups, respectively; there were no statistical differences between the two groups. The follow-up results showed that there were no complications such as device dislodgement, arrhythmia, or residual shunt. Conclusion Both the perpulmonary and percutaneous approaches for the closure of large PDA devices in infants are safe and effective. The perpulmonary approach is particularly suitable for low-birth-weight and preterm infants, especially in cases with limited accessibility and peripheral vascular challenges.

Key words: Patent ductus arteriosus, Perpulmonary, percutaneous closure, Congenital heart disease