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Echocardiographic Prediction of Left Ventricular Dysfunction After Transcatheter Patent Ductus Arteriosus Closure in
Miao Hou1, Weiguo Qian1, Bo Wang1
1Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China.
Insights
Transcatheter patent ductus arteriosus (PDA) closure temporarily impairs left ventricular (LV) systolic function in children. However, LV function fully recovers within three months, with pre-closure echocardiography parameters predicting potential dysfunction.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Surgery
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect in children.
- Transcatheter closure is a standard treatment for PDA.
- The impact of PDA closure on left ventricular (LV) systolic function requires further evaluation.
Purpose of the Study:
- To assess changes in LV systolic function post-transcatheter PDA closure in pediatric patients.
- To identify echocardiographic predictors of LV dysfunction following PDA closure.
Main Methods:
- 191 pediatric patients with PDA underwent transcatheter closure.
- Echocardiography measured various cardiac dimensions and LV systolic function parameters (LVEF, FS) pre-closure, within 24 hours post-closure, and at 3-month follow-up.
- Ratios of PDAd/AOd and LAd/AOd were calculated.
Main Results:
- LV systolic function parameters (LVEF, FS) and dimensions (LAd, LVESD, LVEDD) significantly decreased within 24 hours post-closure but recovered to baseline by 3 months.
- Patients with post-closure LV systolic dysfunction had higher pre-closure LAd, LVEF, PDAd/AOd, and LAd/AOd.
- Pre-closure LVEF ≤ 66.5%, PDAd/AOd ≥ 0.28, and LAd/AOd ≥ 1.54 predicted post-closure LV systolic dysfunction.
Conclusions:
- Transcatheter PDA closure leads to transient LV systolic dysfunction in children.
- Complete recovery of LV systolic function is observed within 3 months post-procedure.
- Pre-closure LVEF, PDAd/AOd, and LAd/AOd are valuable predictors for identifying children at risk of post-closure LV systolic dysfunction.
Abstract:
Objectives: To evaluate the change of left ventricular (LV) systolic function after transcatheter patent ductus arteriosus (PDA) closure in children, and to identify whether echocardiography parameters could be the predictors of LV dysfunction post-PDA closure if present. Methods: This study enrolled 191 pediatric PDA patients, and all of them underwent successful transcatheter PDA closure between January 2016 and December 2018. The patent ductus arteriosus diameter (PDAd), aortic root diameter (AOd), left atrial diameter (LAd), right ventricular outflow tract dimension (RVOT), LV end-diastolic dimension (LVEDD), and LV end-systolic dimension (LVESD) were all measured by echocardiography at pre-closure, post-closure (within 24 h after the procedure), and follow-up (3 months after the procedure). The ratio of PDAd to AOd (PDAd/AOd), the ratio of LAd to AOd (LAd/AOd), the left ventricular ejection fraction (LVEF), and the fractional shortening (FS) were calculated. Results: The LAd, LVESD, LVEDD, FS, and LVEF decreased significantly in the 24 h after closure, compared to pre-closure levels. However, all echocardiography parameters recovered to pre-closure levels at 3 months after PDA closure in all patients. Moreover, the pre-closure LAd, LVEF, PDAd/AOd, and LAd/AOd were higher in the patients with post-closure LV systolic dysfunction than in those without post-closure LV systolic dysfunction. Furthermore, the pre-closure LVEF, PDAd/AOd, and LAd/AOd were correlated with the post-closure LVEF, and pre-closure LVEF ≤ 66.5%, PDAd/AOd ≥ 0.28, and LAd/AOd ≥ 1.54 predict the post-closure LV systolic dysfunction. Conclusion: Transcatheter closure of PDA causes a significant deterioration in LV systolic function early after PDA closure, which recovered completely within 3 months of post-closure in children. Pre-closure LVEF, PDAd/AOd, and LAd/AOd can be the predictors of post-closure left ventricular systolic dysfunction.
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