"Key anatomical structure detection method" and "working length marking method" enhance the safety and efficacy of echocardiography-guided percutaneous closure of patent ductus arteriosus: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Ning ¹ , WANG Shouzheng ¹ , OUYANG Wenbin ¹ , LI Ziping ¹ , DONG Jie ¹ , LIU Zizheng ¹ , DONG Jing ¹ , ZHANG Fengwen ¹ ,  PAN Xiangbin ^1,2

1. Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Cardiovascular Diseases, Beijing, 100037, P. R. China;
2. Department of Structural Heart Disease, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen Medical Academy of Research and Translation (SMART), Shenzhen, 518057, Guangdong, P. R. China;

Corresponding?author：

PAN Xiangbin, Email: panxiangbin@fuwaihospital.org

Keywords：

Patent ductus arteriosus; echocardiography-guided; closure; echocardiography; key anatomical structure detection method; working length marking method; congenital heart disease; interventional therapy

DOI：

10.7507/1007-4848.202511012

Video：

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Objective To evaluate the impact of the "key anatomical structure detection method" and "working length marking method" on the safety and efficacy of echocardiography-guided percutaneous closure of patent ductus arteriosus (PDA). Methods Patients who underwent echocardiography-guided percutaneous PDA closure at Fuwai Hospital, Chinese Academy of Medical Sciences, with complete clinical data, between January 2016 and December 2021, were retrospectively analyzed. Patients were divided into a study group (procedure performed using both "key anatomical structure detection method" and "working length marking method") and a control group (procedures performed without these methods). Propensity score matching (PSM) was applied for 1∶1 matching between the two groups. The primary endpoint was procedure success at 30 days after procedure. Secondary endpoints included intraoperative echocardiography localization success, major and minor complication at 6 months after procedure, and days of hospital stay. Results A total of 273 patients were included, among which 141 were in the study group and 132 in the control group. Before PSM, all patients achieved procedure success. After PSM, 77 matched pairs (154 patients) were analyzed. The study group demonstrated a significantly higher intraoperative echocardiography localization success rate (98.70% vs. 50.64%, P<0.001) and shorter hospitalization duration at (4.10±1.98) d vs. (5.01±2.16) d (P=0.007). The 6-month minor complication rate was lower in the study group (0.00% vs. 6.49%, P=0.058). All patients were successfully discharged, with no cases of device embolization, infective endocarditis, or death observed during follow-up.Conclusion "Key anatomical structure detection method" and "working length marking method" are effective echocardiography-guided adjunctive methods that enhance the safety and efficacy of PDA closure. These approaches deserve further validation in prospective multicenter studies in the future.

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7.	Smith-Bindman R, Alber SA, Kwan ML, et al. Medical imaging and pediatric and adolescent hematologic cancer risk. N Engl J Med, 2025, 393(13): 1269-1278.
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1. Eilers LF, Kyle WB, Allen HD, et al. Patent ductus arteriosus. Pediatr Rev, 2021, 42(11): 632-634.
2. Porstmann W, Wierny L, Warnke H. Closure of persistent ductus arteriosus without thoracotomy. Ger Med Mon, 1967, 12(6): 259-261.
3. Meadows J, Landzberg MJ. Advances in transcatheter interventions in adults with congenital heart disease. Prog Cardiovasc Dis, 2011, 53(4): 265-273.
4. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
5. Barry OM, Bouhout I, Turner ME, et al. Transcatheter cardiac interventions in the newborn JACC focus seminar. J Am Coll Cardiol, 2022, 79(22): 2270-2283.
6. Cohen S, Liu A, Gurvitz M, et al. Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease. Circulation, 2018, 137(13): 1334-1345.
7. Smith-Bindman R, Alber SA, Kwan ML, et al. Medical imaging and pediatric and adolescent hematologic cancer risk. N Engl J Med, 2025, 393(13): 1269-1278.
8. Elmaraezy A, Morra ME, Mohammed AT, et al. Risk of cataract among interventional cardiologists and catheterization lab staff: A systematic review and meta-analysis. Catheter Cardiovasc Interv, 2017, 90(1): 1-9.
9. Akebi T, Matsugaki R, Ono T. Relationship between wearing a lead apron and work-related musculoskeletal disorders: a questionnaire survey of Japanese radiological technologists. Acta Med Okayama, 2022, 76(5): 541-545.
10. Wang SY, Meyer DH, Schumacher B. Inheritance of paternal DNA damage by histone-mediated repair restriction. Nature, 2023, 613(7943): 365-374.
11. Smith-Bindman R, Chu PW, Firdaus HA, et al. Projected lifetime cancer risks from current computed tomography imaging. JAMA Intern Med, 2025, 185(6): 710-719.
12. 段福建, 龔俊松, 康文英, 等. 全超聲引導用于經導管二尖瓣緣對緣手術的應用研究. 臨床心血管病雜志, 2023, 39(8): 576-578.Duan FJ, Gong JS, Kang WY, et al. Application of full ultrasound guidance in transcatheter mitral valve edge-to-edge repair. Chin J Clin Cardiol, 2023, 39(8): 576-578.
13. 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): 359-361.Pan XB. Exploration and development prospects of ultrasound-guided percutaneous interventional therapy for structural heart disease. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(5): 359-361.
14. 國家衛生健康委員會國家結構性心臟病介入質量控制中心, 國家心血管病中心結構性心臟病介入質量控制中心, 中華醫學會心血管病學分會先心病經皮介入治療指南工作組, 等. 常見先天性心臟病經皮介入治療指南(2021版). 中華醫學雜志, 2021, 101(38): 3054-3076.National Structural Heart Disease Intervention Quality Control Center of the National Health Commission, National Center for Cardiovascular Diseases, Quality Control Center for Structural Heart Disease Intervention, Chinese Medical Association, Branch of Cardiovascular Diseases, Working Group on Guidelines for Percutaneous Interventional Therapy of Congenital Heart Disease, et al. Guidelines for percutaneous interventional therapy of common congenital heart disease (2021 edition). Chin Med J, 2021, 101(38): 3054-3076.
15. IEEE Standards Association. IEEE Standard for a Unified Terminology and Framework for Percutaneous and Non-Fluoroscopic (PAN) Technology in Cardiovascular Diseases: IEEE Std 3182-2024[S]. 2024-12-31 [2025-12-31]. Available from: IEEE Xplore Digital Library.
16. Prakoso R, Ariani R, Kurniawati Y, et al. Expanding role of absolute zero fluoroscopy atrial septal defect closure: a single-center experience. Front Cardiovasc Med, 2025, 12: 1430555.
17. Dong J, Liu Z, Dong J, et al. Embracing a new era of echocardiography-guided percutaneous and non-fluoroscopical procedure for structure heart disease. Med Rev (2021), 2025, 5(2): 174-176.
18. 中國醫師協會兒科醫師分會兒童心血管學組, 中華醫學會兒科學分會心血管學組, 中華兒科雜志編輯委員會. 兒童常見先天性心臟病介入治療指南(2025). 中華兒科雜志, 2025, 63(6): 577-592.Pediatric Cardiology Group of Pediatrician Branch of Chinese Medical Doctor Association, Chinese Medical Association, Pediatrics Branch, Cardiovascular Group, Editorial Board of Chinese Journal of Pediatrics. Guidelines for interventional therapy of common congenital heart disease in children (2025). Chin J Pediatr, 2025, 63(6): 577-592.
19. Krishnamoorthy KM, Sasikumar D, Bijulal S. Percutaneous closure of atrial septal defects under transthoracic echocardiography without fluoroscopy. J Interv Cardiol, 2016, 29(4): 439-439.
20. Kong PX, Zhao GZ, Zhang ZG, et al. Novel Panna guide wire facilitates percutaneous and nonfluoroscopic procedure for atrial septal defect closure a randomized controlled trial. Circ-cardiovasc Interv, 2020, 13(9): e009281.

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