Abstract
Transcatheter patent ductus arteriosus closure (TCPC) is an emerging treatment for low birth weight extremely premature neonates (EPNs). Left pulmonary artery (LPA) and descending aorta (DAO) obstruction are described device-related complications, however, data on mid- and long-term vascular outcomes are lacking. A retrospective analysis of EPNs who underwent successful TCPC at our institution from 03/2013 to 12/2018 was performed. Two-dimensional echocardiography and spectral Doppler velocities from various time points before and after TCPC were used to identify LPA and DAO flow disturbances. A total of 44 EPNs underwent successful TCPC at a median (range) procedural weight of 1150 g (755–2500 g). Thirty-two (73%) patients were closed with the AVP II and 12 (27%) with the Amplatzer Piccolo device. LPA and DAO velocities on average remained within normal limits and improved spontaneously in long-term follow up (26.1 months, range 1–75 months). One patient, who had concerning LPA flow characteristics immediately after device implant (peak velocity 2.6 m/s) developed progressive LPA stenosis requiring stent placement 3 months post-procedure. In the remaining infants, including 7 (16%) who developed LPA and 3 (7%) who developed DAO flow disturbances (range 2–2.4 m/s), all had progressive normalization of flow velocities over time. TCPC can be performed safely in EPNs with a low incidence of LPA and DAO obstruction. In the absence of significant progressive vascular obstruction in the early post-procedure period, mild increases in LPA and DAO flow velocities tend to improve spontaneously and normalize in long-term follow-up.
Highlights
Closure of the patent ductus arteriosus (PDA) is often delayed in extremely premature neonates (EPNs), with a higher risk for developing a hemodynamically significant PDA associated with lower gestational age [1]
As Transcatheter patent ductus arteriosus closure (TCPC) in EPNs is a newly described procedure, a paucity of data exists on mid- and long-term outcomes related to vascular stenosis
If stenosis persisted despite these maneuvers, the device was removed, the procedure aborted, and the patient converted to surgical ligation
Summary
Closure of the patent ductus arteriosus (PDA) is often delayed in extremely premature neonates (EPNs), with a higher risk for developing a hemodynamically significant PDA (hsPDA) associated with lower gestational age [1]. [7,8,9,10,11], this has led investigators to develop alternative strategies for managing hsPDA in EPNs. Transcatheter patent ductus arteriosus closure (TCPC) is the treatment of choice for PDA closure in infants ≥ 6 kg, older children, and adults [12, 13]. As TCPC in EPNs is a newly described procedure, a paucity of data exists on mid- and long-term outcomes related to vascular stenosis. The aim of our study was to describe LPA and DAO echo-derived flow patterns in EPNs following TCPC, and to characterize the early and long-term risk for development of LPA and/ or DAO obstruction
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
