Predictors for Left Ventricular Systolic Dysfunction and its Outcome after Patent Ductus Arteriosus (Pda) Closure by Device

Abstract

Objective: To evaluate the predictors of left ventricle (LV) systolic dysfunction after PDA closure by device. Back ground: LV dysfunction is very common in patients after PDA closure by device. There are certain predictors leading to it. Methods: 63 patients of isolated PDA. Patients were admitted in paediatric cardiology department of National Institute of Cardiovascular Disease Karachi, Pakistan. Baseline echocardiography was performed. Hemodynamics were done during cardiac catheterization, pulmonary blood flow/systemic blood flow (QP/QS) and pulmonary vascular resistance calculated. After successful device closure echocardiography was repeated on day 1, after one, three and six months. All subjects were divided into two groups on the basis of post closure LV ejection fraction. All the parameters which include age, gender, weight, LVEDD z-score, QP, PDA size, left ventricle end diastolic pressure and pulmonary artery pressure compared in both groups. Results: 41 patients (65.1%) developed LV systolic dysfunction. Coil was used in only 3(4.8%) patients and two of them developed dysfunction. All patients recovered within six months except two had dysfunction beyond six months. 30 patients (47.6%) patients had weight Z-score <-3 SD and 29 of them developed dysfunction. Weight, base line LVEDD Z –score, QP, LVEDP and PDA size has significant impact on LV function with p-value <0.05. Conclusion: Hemodynamic effects of PDA, changes in LV dimensions and function caused by it are reversible after transcatheter closure of PDA. Large PDA size, high QP/QS are potential risk factors leading to LV dysfunction after device closure.