Device Closure Of Patent Ductus Arteriosus Research Articles

Congenital heart disease cardiac catheterization at Uganda Heart Institute, a 12-year retrospective study of immediate outcomes

BackgroundCardiac catheterization is an invasive diagnostic and treatment tool for congenital heart disease (CHD) with potential complications.ObjectiveTo describe the immediate outcomes of patients who underwent cardiac catheterization for CHD at the Uganda Heart Institute (UHI).MethodsThe study was a retrospective chart review of 857 patients who underwent cardiac catheterization for CHD at UHI from 1st February 2012 to 30th June 2023. Precardiac catheterization clinical data, procedure details, and post-procedure data were recorded. The statistical software SPSS was used for data analysis.ResultsWe studied 857 patients who underwent cardiac catheterization for CHD at UHI. Females comprised 62.8% (n = 528). The age range was 3 days to 64 years, with a mean of 5.1 years (SD 7.4). Advanced heart failure was present in 24(2.8%) of the study participants. The most common procedures were patent ductus arteriosus device closure (n = 500, 58.3%), diagnostic catheterization (n = 194, 22.5%), and balloon pulmonary valvuloplasty (n = 114, 13.0%). PDA device closure had 89.4% optimal results while BPV had 75.9% optimal performance outcome.Adverse events occurred in 52 out of 857 study participants (6.1%). Clinically meaningful adverse events (CMAES) occurred in 3.9%, (n = 33), high severity adverse events in 2.9% (n = 25) and mortality in 1.5% (n = 13).Advanced heart failure at the time of cardiac catheterization, was significantly associated with clinically meaningful adverse events (OR 52 p-value < 0.001) and mortality (OR 564, p value < 0.001).ConclusionMany patients with CHD have benefited from the cardiac catheterization program at UHI with high optimal procedure outcome results. Patients with advanced heart failure at the time of cardiac catheterization have less favorable outcomes emphasizing the need for early detection and early intervention.

Left Pulmonary Artery Stenting for Left Pulmonary Artery Stenosis Following Patent Ductus Arteriosus Device Closure: Case Series and Review of the Literature

Percutaneous device occlusion is currently the standard of care for most cases of patent ductus arteriosus (PDA). Albeit infrequent, device‐related left pulmonary artery (LPA) stenosis is a known complication of this procedure, occasionally requiring stent placement to relieve the obstruction. We present a series of four patients who required left pulmonary stenting after ductus arteriosus device closure. A review of the current evidence is presented.

Pattern of transcatheter interventional procedure have done in Cath lab and their immediate outcome: one year experience at Bangladesh Shishu hospital and institute

Background: Congenital heart disease (CHD) is defined by structural and functional malformations of the heart. If CHD not managed through appropriate interventions, it affects quality of life of the individual and potential premature death. Objectives were assessing the frequency and pattern of interventional procedure done in Cath lab of paediatric cardiology department, Bangladesh Shishu Hospital and Institute and their immediate outcome. Methods: It was a cross sectional retrospective study. Total 56 patients of ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), pulmonary stenosis (PS), aortic stenosis (AS), coarctation of aorta, pulmonary atresia, TGA from January 2019 to December 2019 who underwent trans-catheter interventional procedure by author at Cath lab of paediatric cardiology department, Bangladesh Shishu Hospital and Institute were enrolled in this study. Results: Among 56 patients, PDA device closure done in 19, balloon pulmonary valvuloplasty (BPV) in 13 patients, device closure of ASD in 3 patients, device closure of VSD in 2 patients and balloon aortic valvuloplasty (BAV) in 1 patient. Two patients died; one is pulmonary atresia with PDA dependent pulmonary circulation following ductal stenting another is d-TGA intact IVS with PFO following BAS. One PDA device embolized and retrieved surgically from main and right pulmonary artery. Mean fluoroscopy time=17.29 and mean total procedure time=38.52 min. Conclusions: Trans-catheter interventional procedure for PS, coarctation of aorta, PDA, ASD, VSD, AS, d-TGA, Pulmonary atresia is a safe and some procedure such as BAS for d- TGA, BPV for critical PS, Ductal stenting for pulmonary atresia, Balloon angioplasty for severe coarctation of aorta with LV dysfunction is lifesaving with a low adverse event rate.

Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants.

There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. The decision to treat requires a thorough understanding of the clinical status of the patient, clinical evaluation of PDA, echocardiographic diagnosis, and hemodynamic impact of ductal shunt on the pulmonary and systemic circulation. In this article, updated evidence on the efficacy and adverse effects of pharmacological treatment options and expectant management are presented, while highlighting the long-term benefits of PDA treatment remains equivocal and controversial. The authors propose a schematic targeted PDA treatment approach based on gestational and chronological age for practical clinical use, and they emphasize important future directions including advancement in PDA device closure techniques, diagnostic echo-parameters, hemodynamic evaluation to assess the impact on other organs, and understanding the long-term outcomes.

Transcatheter Device Closure of Postsurgical Residual Left to Right Shunt Lesions in Children during the Immediate Postoperative Period

Objectives Postoperative residual shunts in the form of ventricular septal defects (VSD) and patent ductus arteriosus (PDA), if hemodynamically significant, can lead to symptoms of left ventricular volume overload and delayed recovery. The standard management is redo surgery, which can lead to significant morbidity and mortality. Device closure of such defects offers an alternative management strategy in selected cases. This study aims to examine the utility of device closure of residual left-to-right shunts in the pediatric age group in the immediate postoperative period. Method A retrospective analysis of hospital records was done from March 2018 to December 2022 to analyze the device closure in postoperative residual shunts. The success rate, complications, hospital length of stay, and midterm follow-up were analyzed. Results A total of four postoperative patients underwent VSD device closure and one patient underwent PDA device closure. The median age at transcatheter procedure was 6 years (range 3–10 years). The median time interval between the surgical procedure and the device closure procedure was 4 days (range 2–15 days). The indication for device closure was left ventricular volume overload in three patients and two patients had persistent pleural effusion. Qp:Qs was more than 1.5:1 in all five patients. The amplatzer duct occluder I (ADO-I) device was used in four patients and the ADO-II in one patient. There was no residual shunt post-deployment, with no major complication. The mean follow-up period was 2 years and all the patients had no residual shunt. Conclusion This case series, with its limitation of only five cases, has shown that device closure of hemodynamically significant residual postoperative left-to-right shunt lesions is an effective alternative strategy to redo surgery in older children. Further study is required with a larger sample size, and a longer follow-up is needed to evaluate its long-term safety and efficacy.

Abstract 15296: Incidence and Predictive Factors for Left Ventricular Dysfunction After Transcatheter Device Closure of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Background: Left ventricular (LV) dysfunction is a known complication after ligation or device closure of patent ductus arteriosus (PDA). Recently, an increasing number of premature and extremely low birth weight (ELBW) infants undergo transcatheter device closure of PDAs. Afterload sensitivity of the immature myocardium may be expected to result in important changes in LV ejection fraction (EF) post-procedure. Aim: To evaluate incidence and magnitude of LV dysfunction after device closure of PDA in ELBW infants. Methods: Subjects undergoing PDA device closure from 2020-2022 who were ELBW (&lt;1 kg) and extremely premature (gestational age &lt;29 weeks) at birth were included. A single cardiologist reviewed each pre- and post-intervention echocardiogram and calculated LVEF. Mildly depressed function was defined as an LVEF &lt;53%, moderately depressed as LVEF &lt;40% and severely depressed as LVEF &lt;30%. Results: There were 62 subjects who met inclusion criteria. Mean gestational age and birth weight were 24.8 weeks and 646 g, respectively. Mean age and weight at intervention were 7.9 weeks and 1718 g, respectively. All patients had normal LVEF pre-procedure (mean LVEF 68%) with a significant decline post-procedure to 60% (p&lt;0.001) (Figure). Post-procedure, 80.6% of subjects maintained normal LVEF. Of 12 subjects who developed depressed function, 83% (n=10) had mildly depressed function and 17% (n=2) had moderately depressed function. There was no significant difference in post-procedure LV dysfunction in relation to pre-procedural PDA size, left atrial dilation, or LV dilation on univariate analysis. All subjects recovered function without additional inotropic support with a median time to observed normal LVEF of 5 days. Conclusions: LV dysfunction develops in 19% of ELBW infants undergoing PDA device occlusion, is usually mild in severity, and normalizes in all subjects. The size of PDA or degree of left heart dilation does not predict LV dysfunction in this population.

Transport and Anaesthesia Consideration for Transcatheter Patent Ductus Arteriosus Closure in Premature Infants.

Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications.

Off-label use of KONAR-MF™ occluder for transcatheter closure of patent ductus arteriosus in unusual circumstances.

Transcatheter patent ductus arteriosus (PDA) closure with unusual morphology associated with multiple constrictions or unusual circumstances such as interruption of inferior vena cava (IVC) is still challenging. This study evaluates the use of KONAR-MF™ (Lifetech Scientific Co Ltd., Shenzhen) for transcatheter closure of PDA in such situations. Between January 2021 and October 2021, 24 patients from three different tertiary care centers underwent PDA device closure using the KONAR-MF™ device and are included in the study. Patient demographics, echocardiographic assessment, procedural details including the approach, device details, complications, and follow-up data were recorded. The median age and weight of the cohort were 2 years (0.5-41) and 10 kg (5-98), respectively. The indications for using KONAR-MF™ were (a) unusual morphology of PDA in 14, long tubular PDA in 8, and long tubular with multiple constrictions in 6 patients and (b) unusual circumstances such as interrupted IVC in 6 and inability to cross PDA antegradely in 4 due to dilated main pulmonary artery. The procedure was successful in all the patients and no procedure-related complications were noted in this cohort. Median follow-up of 9 months (range: 5-18) showed no residual shunt and only one patient had flow acceleration across the left pulmonary artery (peak Doppler gradient 16 mmHg). KONAR-MF™ device can be used safely and effectively for transcatheter closure of PDA with unusual anatomy or in unusual circumstances.

Comparison of venous approach and conventional approach in children undergoing percutaneous patent ductus arteriosus closure

BackgroundThe standard method for the closure of PDA is the conventional method, where both arterial and venous access are obtained. Patent ductus arteriosus can be closed successfully via venous-only approach. ObjectivesTo compare the outcomes of the venous approach and combined arterial and venous approach (conventional approach) among children undergoing percutaneous patent ductus arteriosus device closure at Sahid Gangalal National heart center, Kathmandu, Nepal. MethodsA total of 248 children <15 years of age with a diagnosis of PDA were included in this retrospective observational study. Echocardiography was used for the selection of patients. We compared the venous approach and combined arterial and venous approach (conventional approach) of PDA device closure in these patients. ResultsA total of 248 children with age groups of 6 months to 14 years were enrolled during the study period. The venous-only approach (group B) was used in 96 patients, and the conventional approach (group A) was used in 152 patients. Baseline characteristics, clinical characteristics, and clinical outcomes in terms of success rate, complications, procedure time, fluoroscopic time, and contrast used were compared between the two groups.The rate of successful closure in group A and group B patient groups were 96.7 % and 100 %, respectively. The mean procedure time was significantly lesser in group B as compared to group A (25 ± 6.6 min in group B vs. 52 ± 10.4 min in group B, p value ≤ 0.001). The mean fluoroscopy time was also significantly lesser in group B as compared to group A (5 min ± 1.728 in group B vs. 6.5 min ± 2.3 in group A, p-value <0.001). Similarly, the total amount of contrast used was also significantly lesser in group B as compared to group A (24.2 ml ± 11.8 in group B vs. 30ml ± 14.45, p value = 0.001). The complication rate was 11.2 % (n = 17) in group A vs 11 % (n = 11) in group B patient groups. ConclusionThe venous-only approach can be used as a method of closing PDA as it has lesser procedure time, fluoroscopic time, and lesser amount of contrast used. However, proper patient selection is important prior to performing device closure.

Patent Ductus Arteriosus Device Closure with AMPLATZER Duct Occluder-II in a Low Birth Weight Preterm Neonate- First Experience in Pakistan

We report a successful closure of large patent ductus arteriosus (PDA) in a low-birth weight preterm neonate using an ADO IIdevice for the first time in AFIC/NIHD Rawalpindi. A hemodynamically significant PDA in a preterm neonate carries anincreased risk of morbidity, including chronic lung disease, necrotizing enterocolitis and renal impairment. After the failure ofmedical therapy, successful, timely and safe transcatheter closure of PDA using appropriate equipment is a milestone inmanaging PDA in preterm neonates.

Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies

ABSTRACT Introduction With the advent of improved neonatal care, increasingly vulnerable higher-risk patients with complex congenital heart anomalies are presenting for intervention. This group of patients will always have a higher risk of an adverse event during a procedure but by recognizing this risk and with the introduction of risk scoring systems and thus the development of novel lower risk procedures, the rate of adverse events can be reduced. Area covered This article reviews risk scoring systems for congenital catheterization and demonstrates how they can be used to reduce the rate of adverse events. Then, novel low risk strategies are discussed for low-weight infants e.g. patent ductus arteriosus (PDA) stent insertion; premature infants e.g. PDA device closure; and transcatheter pulmonary valve replacement. Finally, how risk is assessed and managed within the inherent bias of an institution is discussed. Expert opinion There has been a remarkable improvement in the rate of adverse events in congenital cardiac interventions, but now, as the benchmark of mortality rate is switched to morbidity and quality of life, continued innovation into lower risk strategies and understanding the inherent bias when assessing risk will be key to continuing this improvement.

Safety and Short-Term Outcomes for Infants < 2.5kg Undergoing PDA Device Closure: A C3PO Registry Study.

To evaluate short-term procedural outcomes and safety for infants < 2.5kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0kg (range 0.7-2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems (p = 0.017) and cases with multiple devices attempted (p = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.

Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device

BackgroundHemolysis after Patent ductus arteriosus (PDA) device closure is rare. Although in most cases, hemolysis settles on its own; however, in some cases it may not settle spontaneously and may require additional procedures like putting additional coils, gel foam or thrombin instillation, balloon occlusion, or removing it surgically. We report a case of adult PDA device closure who persisted with hemolysis and was managed by transcatheter retrieval.Case presentationA 52-year-old gentleman presented to us with a diagnosis of large PDA with operable hemodynamics. Descending thoracic aortic Angio showed a large 11 mm PDA. Transcatheter device closure was done in the same sitting with a 16 × 14 Amplatzer Ductal Occluder I(ADO) device,;however, after device release, the aortic end of the device was not fully formed and there was residual flow. The next morning patient started with gross hematuria with persistent residual flow. We tried to manage with conservative means including hydration, and blood transfusion; however, residual flow persisted for 10 days and his hemoglobin dropped from 13 gm/dl preprocedural to 7 gm/dl, creatinine increased from 0.5 mg/dl to 1.9 mg/dl, bilirubin increased to 3.5 mg/dl & urine showed hemoglobinuria. As the patient continued to deteriorate it was planned to retrieve the device by transcatheter approach. 10 French amplatzer sheath was parked in the pulmonary artery near the ductus. We tried with a combination of multiple catheters and Gooseneck snare (10 mm) and finally, we successfully retrieved with a combination of Multipurpose (MP) catheter and 10 mm Gooseneck snare. After that, we closed the defect successfully with a double disk device (muscular Ventricular septal defect 14 mm Amplatzer). The patient’s hematuria settled and was discharged after 2 days with normal hemoglobin and creatinine.ConclusionsPatent ductus arteriosus ADO 1 device should not be released if the aortic end of the disk is not fully formed Patient should be carefully monitored for hemolysis if evidence of residual shunt and given supportive treatment. If conservative treatment fails, residual flow needs to be eliminated. Transcatheter retrieval although technically challenging is a feasible treatment. A muscular VSD device is a good alternative to the usual PDA device to close PDA, especially in adults.

Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal

BackgroundCongenital heart diseases have significant effect on the growth and development of a child. Timely intervention helps a child to grow and develop to full potential. Cardiac interventionists have not long ago developed methods to cure conditions via transcatheter methods like device closures for shunt lesions. These interventions have been hugely accepted and applied all over the world. ObjectivesThe aim of this study was to determine the outcome of Transcatheter device closure in Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) in terms of improvement in echocardiographic parameters and nutritional well-being. It also outlined the immediate and long term complications of Transcatheter device closure of the shunt lesions. MethodologyA prospective study was carried out among 129 pediatric patients who underwent Transcatheter device closure of shunt lesions at Shahid Gangalal National Heart Centre from March 2019 to March 2021. Simple convenient, consecutive non-probability sampling method was used for the study.Independent sample t-test was applied to see the correlation and significance of continuous variables and Linear regression was used to find out relation between weight gain and device closure. ResultsAmong 129 pediatric patients having either ASD, PDA or VSD without other comorbidities who underwent transcatheter device closure at Shahid Gangalal National Heart Centre, there was 1 mortality (0.7 %), 3 device embolization (2.3 %), 11 (8.5 %) tiny residual leaks, 6 (4.6 %) femoral artery thrombosis, 19 (14.7 %) Left ventricular systolic dysfunction, 4 (3.1 %) new onset arrhythmia, 13(10.0 %) new onset trivial AR and 2 (1.5 %) mild obstruction to surrounding structures. There were no long term complications observed during the study period. Pulmonary artery pressures improved in most along with normalization of chamber dilatation. There was significant improvement in weight of children at the end of one year follow up (P < 0.001), however among individual shunt lesion, only patients undergoing PDA device closure demonstrated significant weight gain. ConclusionTranscatheter device closure is a promising, safe and effective means of treatment for ASD, PDA and VSD. It has significant bearing in weight gain as well as general well-being of children. Judicious selection of cases, proficient expertise and availability of suitable infrastructures are paramount for successful outcome.

Radiation Dose Exposure to Patients During Transcatheter Patent Ductus Arteriosus Closure via the Arterial Route

Objective This study aims to evaluate the radiation dose for transcatheter patent ductus arteriosus (PDA) viathe arterial route and compare it with previously published benchmarks. Background Exposure to radiation in the catheterization lab can cause skin injury and cancer in the long run, especially in pediatric patients with complex heart conditions, which necessitate serial catheterizations. Therefore, measuring the patient radiation dose and establishing a benchmark for each cardiac interventional procedure is essential. Material and methods In this prospective study, 34 patients with transcatheter patent ductus arteriosus closure via an arterial route were included. Patients who had silent PDAs, no left heart dilatation and PDA size of less than 2mm had PDA closed via an arterial route. All the study group patients received an Amplatzer duct occluder II-additional size device (St. Jude Medical Corp, St. Paul, MN) using biplane flat-panel fluoroscopy equipment adjusted in accordance with the pediatric parameters. Patients' dose area product, air kerma and fluoroscopytime were recorded in the catheterization lab and finally compared with internationally published reference data. Results Of 73 patients who had transcatheter patent ductus arteriosus closure between April 2021 to December 2021, 34patients who had a PDA closure via an arterial route were enrolled. The median age and weight were 11.5 (4-168) months and 10.5 (6-31) kg. Twenty-one (61.8%) were males, and 13 (38.2%) were males. The median radiation dose parameters were as follows: air kerma 11 (3-42) milliGray, dose area product 131 (33-443) microGray per m2, median dose area product indexed to weight 12 (1-48) microGray m2 per kg, fluoroscopy time 2 (2-4) min and frame rate 15 (7.5-15) frames per second. Due to many factors, our radiation dose parameters were less than internationally published reference values for transcatheter PDA closure. Conclusion Patient selection, detailed pre-catheterization echocardiography and procedure planning are essential for accomplishing device closure of PDA with a significant reduction in radiation dose. Hemodynamic assessment in the catheterization lab is unnecessary for most PDA patients. Additionally, a next-generation imaging platform equipped with flat-panel detectors and adjusted for pediatric settings and a fluoro recording option can be used to reduce radiation exposure.

A prospective study of various anesthetic techniques in patients with acyanotic congenital heart diseases undergoing device closure.

Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure. In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S-FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15. GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S-FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen. In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.

Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed During Infancy.

Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure during infancy. Chart review was performed on patients who had a PDA closure at not more than 1year of age between January1, 2002 and June1, 2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE at least 3months after procedure, or had a velocity greater than 2.0m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE at least 3months after device placement. Time points included the first TTE after the procedure, first TTE at least 3months after procedure, and the most recent TTE. Total of 147 infants met the inclusion criteria. Age and weight at initial procedure were 141 ± 217days and 4.2 ± 2.8kg. There was no significant difference in DAo velocity between initial and most recent TTE. LPA velocity and left ventricular diastolic Z score significantly decreased between initial and most recent TTE. Seventy-eight patients had repeat echocardiograms more than 1year after PDA procedure with no change in clinical management. No patient underwent an intervention on the LPA or DAo for stenosis. In patients who underwent an uncomplicated PDA closure during infancy, TTE parameters either stayed stable or improved over time. These findings need to be corroborated in larger studies with longer follow-up. If verified, the long-term TTE guidelines may need to be simplified for this patient population.

Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy.

IntroductionGuidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure after infancy.MethodsChart review was performed on patients who had a PDA closure ≥ 1 year of age between 1/1/2002 and 6/1/2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE ≥ 6 months after procedure, had a residual PDA or velocity > 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE ≥ 6 months after device placement. Time points included the initial TTE after the procedure, first TTE ≥ 6 months after procedure, and the most recent TTE.ResultsA total of 189 patients met the study criteria. The median age and weight at initial procedure were 2.7 (1.0–64.7) years and 12.5 (3.4–69.2) kg. Most recent TTE was performed 2.0 (0.4–17.0) years after PDA closure. There were no significant differences in fractional shortening (36.4 ± 5.0% vs. 36.9 ± 5.6%) or LPA velocity (1.1 ± 0.4 m/s vs. 1.1 ± 0.4 m/s) from initial to most recent TTE, respectively. Left ventricular internal diastolic diameter Z-score significantly decreased (1.4 ± 1.8 vs. − 0.01 ± 1.2, p < 0.01) and DAo peak velocity significantly increased (1.2 ± 0.3 m/s vs. 1.3 ± 0.3 m/s, p = 0.02) from initial to most recent TTE, respectively. No patient died or underwent an intervention on the LPA or DAo for stenosis. Seventy-five patients had a total of 208 repeat TTE > 1 year after PDA procedure with no change in clinical management.ConclusionsIn patients who underwent an uncomplicated PDA closure after infancy, TTE parameters improved or stayed within normal limits on the most recent TTE. Repeat lifetime TTEs after 1-year post-device placement in this population may not necessarily be needed if there are no clinical concerns.

Myocardial injury and inflammatory response in percutaneous device closures of pediatric patent ductus arteriosus

BackgroundThe percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic inflammatory markers’ levels after PDA in children are not fully reported.MethodsWe have conducted a retrospective analysis of the medical records of 385 pediatric patients in our hospital from January 2017 to December 2019. The patients were distributed into five groups. The first four (A, B, C and D) included patients divided by the type of the surgical closure methods, namely ligation, clamping, ligation-combined suturing and ligation-combined clamping, respectively. The fifth group E comprised of percutaneous device PDA patients. All recorded medical and trial data from the five groups were statistically studied.ResultsNo serious complications in the patients regardless of the classification group were reported. Our results suggested that there were no considerable differences between the groups at the baseline (with all P > 0.05). Group E demonstrated a significantly smaller operative time (42.39 ± 3.88, min) and length of hospital stay (LOS) (4.49 ± 0.50, day), less intraoperative blood loss (7.12 ± 2.09, ml) while on the other hand, a higher total hospital cost (24,001.35 ± 1152.80, RMB) than the other four groups (with all P < 0.001). Interestingly, the comparison of the inflammatory factors such as white blood cells (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), as well as the myocardial injury markers (CKMB and troponin I) did not show a significant increase (P > 0.05) among the four groups. On the contrary, when the aforementioned factors and markers of all the surgical groups were compared to those in group E, we observed significantly higher speed and magnitude of changes in group E than those in groups A, B, C, and D (with all P < 0.001).ConclusionAlthough the percutaneous device closure of PDA is more comforting and drives fast recuperation in comparison to conventional surgery, it provokes myocardial injury and overall inflammation. Timely substantial and aggressive intervention measures such as the use of antibiotics before operation and active glucocorticoids to suppress inflammation and nourish the myocardium need be applied if the myocardial and inflammatory markers are eminent.

Feasibility, Safety, and Short-Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High-Frequency Jet Ventilation.

BackgroundProlonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure.Methods and ResultsThis is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes.ConclusionsTranscatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.