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Distensibility of the ductus arteriosus in neonates and young infants undergoing transcatheter closure
Kota Nagasawa1, Jun Muneuchi2, Yuichiro Sugitani1
1Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan.
Insights
Younger, smaller infants have more flexible patent ductus arteriosus (PDA), increasing the risk of device migration during transcatheter closure. This distensibility is a key factor in procedural complications.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Device migration is a significant complication during transcatheter closure of patent ductus arteriosus (PDA) in neonates and infants.
- The inherent distensibility of the ductus arteriosus in this population may contribute to device migration.
Purpose of the Study:
- To investigate the relationship between ductal distensibility and device migration in neonates and infants undergoing PDA transcatheter closure.
- To identify factors contributing to device migration during PDA closure procedures.
Main Methods:
- Retrospective review of angiographic findings in 41 neonates and infants who underwent transcatheter PDA closure.
- Measurement of ductal diameters (pulmonary artery side, center, aortic side) before closure and device center diameter after closure.
- Calculation of the distensibility index (post-closure device diameter / pre-closure central ductal diameter).
Main Results:
- The distensibility index was significantly correlated with younger age (r=-0.49, P=0.001) and lower weight (r=-0.53, P<0.001).
- Four out of 41 subjects experienced device instability or migration, leading to procedure declination.
- Younger and lower-weight infants demonstrated a more distensible PDA.
Conclusions:
- The distensibility of the patent ductus arteriosus in neonates and young infants is a significant risk factor for device migration during transcatheter closure.
- Understanding ductal distensibility can help predict and potentially mitigate the risk of device migration in pediatric PDA interventions.
Abstract:
Device migration is one of serious complications in neonates and infants undergoing transcatheter closure of the patent ductus arteriosus (PDA). We hypothesize that neonates and young infants possess the distensibility of the ductus, which may be related to device migration. We retrospectively reviewed angiographic findings in 41 neonates and infants who underwent transcatheter closure of PDA. We measured diameters of the ductus at the pulmonary (PA) side, the center, and the aortic (AO) side before PDA closure, and the device center diameter after device closure. The distensibility index was defined as the ratio of the device center diameter after device deployment to the diameter at the center of the ductus before PDA closure. Age and weight at the procedure were 168 (117-260) days and 5.3 (4.3-6.9) kg, respectively. Thirty-seven subjects accomplished the successful device closure, and four subjects were declined because of the device instability or migration. Implanted devices included Amplatzer Duct Occluders in 33 subjects and Amplatzer Vascular Plug-2 in 8 subjects. The PDA diameters at PA side, at the center, AO side, and the device center diameter were 3.2 (2.2-4.3) mm, 4.7 (3.6-5.7) mm, 7.7 (6.3-9.4) mm, and 5.8 (4.2-6.9) mm, respectively. The PDA diameter before closure was not correlated age and weight. The distensibility index was 1.28 (1.06-1.64), which was significantly correlated to age (r = - 0.49, P = 0.001) and weight (r = - 0.53, P < 0.001). Infants with the younger age and the lower weight have the more distensible PDA, which may be a risk for device migration.
