Patent Ductus Arteriosus Morphology Changes in Preterm Neonates Undergoing Transcatheter Device Closure

Evaluate patent ductus arteriosus (PDA) morphology changes in the preterm neonate undergoing transcatheter PDA closure (TCPC). We propose the type F ductus is associated with lower corrected gestational age (CGA) and improved TCPC outcomes. Retrospective review of premature neonates undergoing TCPC at a large volume institution from November 2020 to November 2023. Two independent cardiologists blindly reviewed angiograms to classify the PDA as one of the 6 published morphologies. Procedural characteristics and outcomes were compared for two cohorts of TCPC patients constituting the type F and the non-type F ductus; statistical significance set at p-value < 0.05. 104 TCPC neonates met inclusion criteria; these were categorized as type F (n = 44) and non-type F (n = 60) ductal morphology. Patients with type F ductal morphology was associated with African American race (p = 0.007), lower procedural/chronological age (p < 0.001), weight (p = 0.002), and CGA (p < 0.001). Procedural length was significantly shorter in the type F group (41 vs 57 min; p < 0.01). Unsuccessful TCPC (n = 2) and device embolization (n = 2) events all occurred in patients with a non-type F ductal morphology. The CGA cut off < 34 weeks represents a good predictor of having a type F ductus (sensitivity 0.93, specificity 0.67). Younger chronological and CGA are associated with type F ductal morphology. At this institution, a type F ductus was associated with a shorter TCPC procedure time and demonstrated a lower complication rate. This data may prompt consideration of earlier TCPC referral. However, determining ideal TCPC timing in premature neonates is multifactorial and requires a multidisciplinary review team.