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Prediction of left ventricular dysfunction after device closure of patent ductus arteriosus: proposal for a new
Viralam S Kiran1, Ashish Tiwari
1Department of Paediatric Cardiology, Narayana Institute of Cardiovascular Sciences, Narayana Health City, Bangalore, India.
Insights
Indexed patent ductus arteriosus (PDA) size effectively predicts left ventricular (LV) dysfunction after device closure. This simple measurement aids in risk stratification and patient management for PDA interventions.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Left ventricular (LV) dysfunction is a concern in patients undergoing percutaneous patent ductus arteriosus (PDA) device closure.
- Predicting and managing LV dysfunction is crucial for patient outcomes and risk stratification.
Purpose of the Study:
- To determine the incidence and correlates of LV dysfunction in patients after PDA device closure.
- To propose an indexed parameter for predicting LV dysfunction post-procedure.
Main Methods:
- Retrospective analysis of 447 patients who underwent PDA device closure.
- PDA diameter was measured and indexed to body surface area.
- LV function was assessed using echocardiography post-procedure.
Main Results:
- LV dysfunction occurred in 22.8% of patients post-PDA device closure.
- A significant correlation was found between indexed PDA size and the incidence of LV dysfunction (p<0.05).
- Higher indexed PDA sizes corresponded to a markedly increased risk of LV dysfunction.
Conclusions:
- Indexed PDA size is a reliable predictor of post-procedural LV dysfunction.
- The proposed indexed PDA size classification offers a cost-effective tool for risk stratification and management in PDA device closure.
- Early identification of patients at risk for LV dysfunction can improve clinical management and counseling.
Aims:
The aims of this study were to determine the incidence and correlates of left ventricular (LV) dysfunction amongst percutaneous patent ductus arteriosus (PDA) device closure patients, and to propose an indexed parameter for predicting LV dysfunction.
Methods And Results:
In a retrospective cross-sectional analysis of 30 months duration, 447 patients who underwent PDA device closure were studied. The diameter of the PDA at the pulmonary artery end was measured in the angiograms in all patients and was indexed for their body surface area. The indexed PDA size was categorised into group A (1-2.9 mm/m², 35/447), B (3-5.9 mm/m², 254/447), C (6-8.9 mm/m², 66/447) and D (>9 mm/m², 35/447). Systolic LV function was evaluated using echocardiography at frequent intervals. Overall, 62.63% of the patients were female (280/447). At baseline, all 447 patients had normal LV function. LV dysfunction was seen in 102/447 (22.8%) patients with 2.8% in category A (1/35), 10.6% in category B (27/254), 34.1% in category C (42/123) and 91.4% in category D (32/35) after PDA device closure. Correlation of indexed PDA size and LV dysfunction was statistically significant (p<0.05).
Conclusions:
Accurate prediction of LV dysfunction is important in risk stratification, ICU management and counselling in PDA device closures. Indexed PDA size correlates well with post-procedural LV dysfunction. The authors propose a new classification of PDA utilising this accurate, reproducible and easy to perform parameter, which does not involve any extra cost, for risk stratification and early management in device closure of PDA.
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