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Published on: January 27, 2023
Echocardiographic Predictors and Incidence of Left Ventricular Dysfunction Following Transcatheter Patent Ductus
Marissa E Adamson1,2, R Allen Ligon3,4, Shannon Hamrick4,5
1Department of Pediatric Cardiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA. marissa.e.adamson@gmail.com.
Insights
Left ventricular dysfunction occurs in 19% of extremely low birth weight infants after transcatheter closure of patent ductus arteriosus (PDA). This dysfunction is typically mild and resolves in all patients, regardless of PDA size or heart dilation.
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular research
- Echocardiography in neonates
Background:
- Left ventricular (LV) dysfunction is a recognized complication following patent ductus arteriosus (PDA) ligation.
- Transcatheter closure of PDAs is increasingly performed in premature and extremely low birth weight (ELBW) infants.
- The study addresses the need to understand LV dysfunction in this vulnerable population.
Purpose of the Study:
- To determine the incidence of LV dysfunction after transcatheter PDA closure in ELBW infants.
- To identify predictors of LV dysfunction in ELBW infants undergoing transcatheter PDA closure.
- To assess the severity and recovery pattern of LV dysfunction post-procedure.
Main Methods:
- Retrospective review of ELBW infants (<1 kg) with gestational age <29 weeks undergoing transcatheter PDA closure (2020-2022).
- Single cardiologist reviewed pre- and post-intervention echocardiograms to calculate left ventricular ejection fraction (LVEF).
- Analysis included demographic data, procedural details, and echocardiographic parameters.
Main Results:
- 67 ELBW infants (mean GA 24.8 weeks, BW 648.2 g) were included.
- Mean LVEF declined significantly from 67.0% pre-procedure to 60.3% post-procedure (p<0.001).
- 19% of infants experienced LV dysfunction, though 81% maintained normal LVEF (>53%); 55% had an EF decline >5%. Dysfunction was mild and normalized within 3-30 days. PDA size and heart dilation did not predict dysfunction.
Conclusions:
- Post-transcatheter PDA closure, 19% of ELBW infants develop transient, mild LV dysfunction.
- LV dysfunction in this population is not predicted by PDA size or left heart dilation.
- All infants demonstrated recovery of LV function, highlighting the safety of the procedure.
Background:
Left ventricular (LV) dysfunction is a known complication after ligation of patent ductus arteriosus (PDA). An increasing number of premature and extremely low birth weight (ELBW) infants undergo transcatheter closure of PDAs. The aim of this study was to evaluate incidence and predictors of LV dysfunction after transcatheter PDA closure in ELBW infants.
Methods:
Subjects undergoing PDA closure from 2020 to 2022 who were ELBW (< 1 kg) and extremely premature (gestational age < 29 weeks) at birth were included. A single cardiologist reviewed each pre- and post-intervention echocardiogram and calculated LVEF.
Results:
67 subjects were included with a mean gestational age of 24.8 weeks and birth weight of 648.2 g. Mean age and weight at time of procedure were 7.9 weeks and 1722.4 g, respectively. All patients had normal LVEF pre-procedure (mean LVEF 67.0%) with a significant decline post-procedure to 60.3% (p < 0.001). Post-procedure, 81% of subjects maintained normal LVEF (> 53%). 55% of patients did have a decline in EF > 5%. There was no significant difference in post-procedure LV dysfunction in relation to pre-procedural PDA size, left atrial or LV dilation. All subjects recovered function with a variable time to observed normal LVEF of 3-30 days.
Conclusions:
LV dysfunction develops in 19% of ELBW infants undergoing PDA device occlusion, is usually mild in severity, and normalizes in all subjects. The size of PDA, degree of left heart dilation does not predict LV dysfunction in this population.
