Related Experiment Video
Updated: Sep 6, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy
Rachel Reo1, Erin Van Pelt1, Casey Lovelace1
1Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Lifelong echocardiograms after uncomplicated patent ductus arteriosus (PDA) device closure in children may not be necessary. Follow-up transthoracic echocardiograms (TTE) showed stable cardiac function, suggesting repeat testing might be omitted if no clinical concerns arise.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Devices
Background:
- Current guidelines recommend lifelong transthoracic echocardiograms (TTE) following patent ductus arteriosus (PDA) device closure.
- The clinical utility of routine lifelong TTE follow-up after uncomplicated PDA device closure in patients treated after infancy requires evaluation.
Purpose of the Study:
- To assess the necessity of routine lifelong follow-up TTE in patients who underwent uncomplicated PDA device closure after infancy.
- To determine if TTE parameters remain stable or improve post-procedure in this specific patient group.
Main Methods:
- Retrospective chart review of 189 patients who underwent PDA closure ≥ 1 year of age.
- Exclusion criteria included other congenital heart disease or inadequate follow-up TTE.
- Analysis focused on TTE parameters at initial, 6-month, and most recent follow-up points.
Main Results:
- No significant changes in fractional shortening or left pulmonary artery (LPA) velocity were observed between initial and most recent TTE.
- Left ventricular internal diastolic diameter Z-score decreased significantly, while descending aorta (DAo) peak velocity increased slightly.
- No deaths or interventions for LPA or DAo stenosis occurred; 75 patients had repeat TTEs >1 year post-procedure without clinical management changes.
Conclusions:
- Transthoracic echocardiogram parameters generally stabilize or improve within normal limits after uncomplicated PDA closure in patients treated after infancy.
- Routine lifelong TTE follow-up beyond 1 year post-device placement may not be essential for this population if no clinical concerns are present.
Introduction:
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 after infancy.
Methods:
Chart 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.
Results:
A 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.
Conclusions:
In 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.
