Correlation of Ductal size with Left Ventricular Systolic Function Changes by Echocardiography in Children after Transcatheter Closure of Patent Ductus Arteriosus in a Tertiary Care Hospital

Abstract

Background: Transcatheter closure of Patent Ductus Arteriosus (PDA) is considered an excellent treatment option for children requiring PDA closure due to its low morbidity and mortality rates. Theoretically, after PDA closure, there should be a gradual improvement in left ventricular volume overload and remodeling. However, numerous studies have shown that there is a temporary decline in left ventricular function immediately following PDA closure. Objectives: To see the correlation of ductal size with changes in left ventricular systolic function by echocardiography in children undergoing transcatheter closure of PDA. Materials and methods: It was a cross sectional study. All pediatric inpatients ≥6 months of age, diagnosed as a case of PDA and planned for device closure were enrolled in the study. M-Mode, 2D, Color Doppler and 2D speckle tracking echocardiography was done by GE Echo machine Model VividS70N using probes 5MHz (5s) and 6MHz(6s). Electrocardiogram (ECG ) gated echo was done at base line (prior to closure of PDA), after 24 hour post closure and after 1 month post closure, in order to evaluate the immediate and short term changes in left ventricular systolic function from the baseline, using the following parameters: Left Ventricular Ejection Fraction (LVEF) and Left Ventricular Fractional Shortening (LVFS). The total sample size was 35. Data were collected on a pre-tested questionnaire. Data analysis was carried out by using the SPSS version 22.0 windows software. Continuous data were expressed as mean ±SD and analyzed by paired t-test. Categorical data were expressed as frequency and percentages. Correlation was seen using Pearson’s correlation. P-value < 0.05 was considered statistically significant. Results: The mean age of the study subjects was 46.69 ± 41.8 months with mean body surface area of 0.56 ±0.25m² (0.32-1.3). Females were predominant with 74.3% and males were 25.7%. The mean PDA size was 3.35 ± 0.77mm and the LA: Aorta ratio was 1.45 ± 0.24. The LVEF, LVFS were reduced from 70.11±3.81 to 57.34±5.0, 39.28±3.14 to 32.0±4.54 respectively 24hours after device closure. This reduction of LVEF, LVFS were statistically significant (p<0.01). At 1 month post device follow up all the parameters returned to near baseline level. PDA size was found to be negatively correlated with early changes in left ventricular functions i.e. larger the PDA size, greater is the reduction in LV function post PDA device. Conclusions: Transcatheter closure of PDA can lead to transient reduction in left ventricular systolic function which improves gradually after a month; however, close monitoring is required. Larger the PDA size, greater is the reduction in LV function. As such moderate to large PDAs should be followed up more cautiously and immediate timely intervention is needed, if severe deterioration is found.