总结儿童动脉导管未闭（PDA）介入封堵术后主动脉瓣反流（AR）的影响因素及近中期临床转归。

回顾性分析2016年1月至2019年6月青岛市妇女儿童医院心脏中心262例行经导管介入封堵术的单纯PDA患儿资料，术后新发AR患儿8例（男6例，女2例），AR较前加重者3例。评价患儿体重、体表面积（BSA）、PDA内径、封堵器直径、肺/体循环血流量比值（Qp/Qs）、手术前后主动脉收缩压差值及脉压差值对PDA封堵术后新发AR的影响。术后密切随访观察AR患儿的转归情况。

与正常患儿相比，新发AR患儿手术前后脉压差值存在显著差异（23.33 ± 8.38 mmHg vs 16.00 ± 6.08 mmHg, P < 0.01）。两组患儿年龄、体重、PDA内径、BSA、Qp/Qs及手术前后主动脉收缩压差值比较，差异无统计学意义（P > 0.05）。8例新发AR均为轻度，术后3 d～1个月恢复正常。3例患儿术后AR加重，其中2例合并主动脉瓣二叶畸形，随访6个月～1年呈轻-中度；1例患儿考虑扩张性心肌病，术后AR维持中度，随访6个月心功能不全无加重。

PDA封堵术后主动脉脉压差值是影响术后新发AR的主要因素，考虑与术后主动脉舒张期血容量增加相关，多为功能性、暂时性改变，近中期预后良好，需注意主动脉瓣畸形及左心功能不全。

To summarize the influencing factors and clinical outcome of aortic valve regurgitation (AR) in children with patent ductus arteriosus (PDA) after transcatheter closure.

In the retrospective study from January 2016 to June 2019, 8 patients (6 males, 2 females) with new AR after PDA occlusion in Qingdao Women and Children's Hospital were summarized in all 262 cases. The effects of age, weight, body surface area (BSA), diameter of PDA, diameter of occluder, ratio of pulmonary/systemic blood flow (Qp/Qs), the difference value of aorta systolic pressure and pulse pressure pre-operation and post-operation were analyzed in new AR children. The outcome of AR was closely followed up.

Compared with the normal children, there was a significant difference in the difference value of pulse pressure pre-operation and post-operation in new AR children (23.33 ± 8.38 mmHg vs 16.00 ± 6.08 mmHg, P < 0.01). Age, weight, PDA diameter, BSA, Qp/Qs and the difference value of aorta systolic before and after occlusion between thetwo groups did not have significant difference (P > 0.05). All the 8 new AR cases were mild and recovered to normal 3 d to 1 month after occlusion. AR was more severe in 3 children after occlusion than before. Two of them were complicated with bicuspid of aortic valve, and were mild to moderate during 6 months ~ 1 year follow-up. One case was suspected of dilated cardiomyopathy, and AR remained moderate without heart failure aggravation on 6 months after occlusion.

The difference value of pulse pressure after PDA occlusion is the main risk factor for the new AR. It may be related to increased diastolic aortic blood volume after operation. The new AR is mostly functional and temporary changes, with a good prognosis in the short and mid-term. It is necessary to pay moer attention to the effect of aortic valve malformation and left ventricular dysfunction.