Transcatheter closure of patent ductus arteriosus with mitral regurgitation in children: Clinical outcome and improvement of mitral regurgitation after procedure with echocardiogram follow-up

Abstract

Background: Patent ductus arteriosus (PDA) is a prevalent pediatric heart condition, often causing heart failure and pulmonary hypertension. Mitral regurgitation, a common occurrence, may be improved by CMRI after PDA closure, suggesting improved follow-up. Objectives: The purpose of this retrospective study is to evaluate the clinical outcomes and follow-up echocardiogram results following transcatheter PDA closure in these patients, with the view of proposing an effective treatment strategy. On other words, the goal is to improve the follow-up of children with PDA and mitral regurgitation five years after PDA closure in which the issue of long-term follow-up of these children still needs to be assessed. Methods: The Queen Alia Heart Institute conducted retrospective study that examined the outcomes and follow-up of children with open PDA with only mitral regurgitation (MR) who underwent closure, outcomes, and follow-up by echocardiography from January 2018 to March 2022. The patient cohort included 46 children who were discussed in heart team meetings and were candidates for catheterization for device closure due to no resolution of the shunts proposed for transcatheter closure of PDA with color Doppler echocardiography. Transcatheter closure was performed with general anesthesia or conscious sedation, and continuous hemodynamic monitoring was performed for at least 30 minutes to ensure stabilization. The study also reviewed the management and outcomes of children with isolated MR and no intervention for PDA. Current intervention techniques for transcatheter closure in patients diagnosed with PDA and MR are divided into four main strategies: Lesson-Severn wire-controlled occlusion, Sideris muscular device implantation, inter-procedural MR availability assessment before device deployment, and secondary transcatheter or interventional strategy due to remaining MR. Advances in treatment have allowed patients to receive intervention at younger ages and benefit from a reduced dose of radiation. Results: A study comparing children with and without PDA and MDI showed significant improvements in post-intervention EROA, RV volume, RVEF, LVEDVi, and LVFS compared to pre-intervention values. The subgroup analysis revealed that after PDA closure, MR drainage volume decreased, while ventricular volume and function were compensated. The study also found that the improvement and EROA reduction might be related to sex rather than age. The results showed no statistical difference in hospitalization rates between the two groups, but the DuctAngio group had a higher proportion of patients with symptoms and poor health. The study also found that patients with MR showed better patient experience, highlighting the potential improvements in pediatric cardiology. Conclusions: The study found that transcatheter closure of significant PDA with MR improved MR in most patients rapidly and at midterm follow-up, with immediate symptomatic improvement and cardiac remodeling, without long-term MR progression.