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Comparison of transcatheter patent ductus arteriosus closure between children and adults
Jun Yasuhara1,2, Toshiki Kuno3, Takashi Kumamoto1,4
1Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.
Insights
Transcatheter patent ductus arteriosus (PDA) closure shows fewer benefits in adults than children. Early childhood closure may prevent heart failure and improve outcomes.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Data comparing transcatheter patent ductus arteriosus (PDA) closure in children versus adults is limited.
- PDA can lead to heart failure, left ventricular remodeling, and impaired cardiac function, particularly in adults.
Purpose of the Study:
- To compare the characteristics and hemodynamic effects of transcatheter PDA closure between pediatric and adult patients.
- To evaluate the long-term impact of PDA closure on left ventricular (LV) and left atrial (LA) volumes and LV function.
Main Methods:
- Analysis of 54 consecutive patients undergoing transcatheter PDA closure, divided into <18 years (children) and ≥18 years (adults) groups.
- Comparison of hemodynamic parameters, cardiac chamber dimensions, LV mass, and LV ejection fraction (LVEF) before and after PDA closure.
- Assessment of changes from baseline to 6 months post-procedure.
Main Results:
- Adults exhibited a higher incidence of heart failure, PDA calcifications, and procedural complications compared to children.
- PDA closure reduced LV end-diastolic volume index, LA diameter index, and LV mass index in children, but not in adults.
- While LVEF decreased acutely in both groups, it remained low at 6 months only in adults; adults showed significantly less improvement in LV/LA volumes and LV function compared to children.
Conclusions:
- Transcatheter PDA closure in adults is not associated with significant reductions in LV/LA volume or improvements in LV hypertrophy and function compared to children.
- Early diagnosis and transcatheter PDA closure in childhood are recommended to prevent progressive LV remodeling and heart failure, potentially offering greater clinical benefit.
Abstract:
The data comparing the characteristics and effect of transcatheter patent ductus arteriosus (PDA) closure between children and adults is scarce. We analyzed 54 consecutive patients who underwent transcatheter PDA closures. We divided the patients into 2 groups of < 18 years and ≥ 18 years and compared the hemodynamic changes before and after the PDA closure. Adults had a higher incidence of heart failure on admission, diagnoses by heart failure and incidental echocardiography, PDA calcifications, and procedural complications than children (all P < 0.05). The left ventricular end-diastolic volume index (LVEDVI), left atrial diameter index (LADI), and LV mass index (LVMI) decreased after the PDA closure in children but not in adults. The LV ejection fraction (LVEF) significantly decreased 1 day after the PDA closure in both groups but remained low at 6 months after the procedure in only adults. The percent change in the LVEDVI, LADI, LVMI, and LVEF from baseline to 6 months after the procedure was significantly lesser in adults than children (LVEDVI: - 5.2 ± 29.1% vs. - 34.9 ± 18.9%, LADI: - 7.0 ± 13.2% vs. - 22.1 ± 18.9%, LVMI: - 11.0 ± 16.5% vs. - 34.1 ± 15.7%, LVEF: - 5.9 ± 7.6% vs. 6.1 ± 9.1%, all P < 0.05). Transcatheter PDA closure was not associated with a reduction in the LV and LA volume as well as an improvement in the LV hypertrophy and LV function in adults as compared to children. We suggested that an early diagnosis and transcatheter PDA closure during childhood might provide clinical benefit before progressive LV remodeling and heart failure.
