Echocardiographic Short-Term Follow up of Children after Transcatheter Closure of Patent Ductus Arteriosus

Abstract

Background: Patent ductus arteriosus constitutes 5-10% of all the congenital heart diseases. Volume overloading of the left side of the heart, risks of endocarditis, aneurysm of patent ductus arteriosus (PDA), and pulmonary vascular disease are indications for closure of the defect. Purpose: Evaluation of the efficacy and safety of PDA device closure in the paediatric age group patients. Methods: This prospective observational study included 26 children with a mean age of 30.2 ± 27.6 months and a mean weight of 12.8 ± 6.6 kg. Echocardiographic follow up was done at 24 hour, 1 week and 3 months post-intervention. Evaluation included assessment of residual shunt, left ventricle dimensions, left atrium/aorta ratio and velocity along descending aorta and left pulmonary artery. Results: Three different devices were used; the Amplatzer duct occluder (ADO-I) and its delivery system, PFM Nit-Occlud and Nit-Occlud PDA-R. All the patients were discharged safely from hospital after 24 hours of admission. Complete ductus closure was achieved in 77% of cases by 24 hours post-intervention, and in 96.15 % after three months. The left ventricular end diastolic diameter (LVEDd) Z score decreased from 2.13±2.37 pre-intervention, to 0.65±1.8 after 3 months (p <0.001). Although the LV showed decrease in systolic function (FS), all the patients showed improvement in symptoms. No significant obstruction along the descending aorta or left pulmonary artery was reported. No complications like thrombus formation, blood loss or infective endocarditis, in any case, were reported. Conclusion: Trans-catheter closure of PDA is effective and safe with rapid reversal of the left sided overload. Similar studies with long term follow up are needed for further evaluation of the LV systolic function pattern.