Follow-up After Percutaneous Patent Ductus Arteriosus Occlusion in Lower Weight Infants

Overview

Journal J Pediatr

Specialty Pediatrics

Date 2019 Jul 3

PMID 31262530

Citations 9

Authors

Erin Nealon

Brian K Rivera

Clifford L Cua

Molly K Ball

Corey Stiver

Brian A Boe

Jonathan L Slaughter

Joanne Chisolm

Charles V Smith

Jennifer N Cooper

Aimee K Armstrong

Darren P Berman

Carl H Backes

Affiliations

Soon will be listed here.

Abstract

Objectives: To describe longer term outcomes for infants <6 kg undergoing percutaneous occlusion of the patent ductus arteriosus (PDA).

Study Design: This was a retrospective cohort study of infants <6 kg who underwent isolated percutaneous closure of the PDA at a single, tertiary center (2003-2017). Cardiopulmonary outcomes and device-related complications (eg, left pulmonary artery obstruction) were examined for differences across weight thresholds (very low weight, <3 kg; low weight, 3-<6 kg). We assessed composite measures of respiratory status during and beyond the initial hospitalization using linear mixed effects models.

Results: In this cohort of lower weight infants, 92 of 106 percutaneous occlusion procedures were successful. Median age and weight at procedure were 3.0 months (range, 0.5-11.1 months) and 3.7 kg (range, 1.4-5.9 kg), respectively. Among infants with pulmonary artery obstruction on initial postprocedural echocardiograms (n = 20 [22%]), obstruction persisted through hospital discharge in 3 infants. No measured variables were associated with device-related complications. Rates of oxygenation failure (28% vs 8%; P < .01) and decreased left ventricular systolic function (29% vs 5%; P < .01) were higher among very low weight than low weight infants. Pulmonary scores decreased (indicating improved respiratory status) following percutaneous PDA closure.

Conclusions: Percutaneous PDA occlusion among lower weight infants is associated with potential longer term improvements in respiratory health. Risks of device-related complications and adverse cardiopulmonary outcomes, particularly among very low weight infants, underscore the need for continued device modification. Before widespread use, clinical trials comparing percutaneous occlusion vs alternative treatments are needed.

Citing Articles

Who Still Gets Ligated? Reasons for Persistence of Surgical Ligation of the Patent Ductus Arteriosus Following Availability of Transcatheter Device Occlusion for Premature Neonates.

Hoffmann J, Khazal Z, Apers W, Sharma P, Weismann C, Kaganov K J Cardiovasc Dev Dis. 2024; 11(5).

PMID: 38786954 PMC: 11122133. DOI: 10.3390/jcdd11050132.

The effect of bethanechol on tracheobronchomalacia in preterm infants with bronchopulmonary dysplasia: a retrospective cohort study.

Pugh C, Akmyradov C, Courtney S, Agarwal A, Chandler A, Matlock D J Perinatol. 2023; 44(2):288-293.

PMID: 37848605 DOI: 10.1038/s41372-023-01799-x.

Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy.

Reo R, Van Pelt E, Lovelace C, Eshelman A, Beckman B, Chisolm J Cardiol Ther. 2022; 11(3):445-452.

PMID: 35780440 PMC: 9381662. DOI: 10.1007/s40119-022-00272-8.

Percutaneous Closure of Patent Ductus Arteriosus.

Barcroft M, McKee C, Berman D, Taylor R, Rivera B, Smith C Clin Perinatol. 2022; 49(1):149-166.

PMID: 35209997 PMC: 8887783. DOI: 10.1016/j.clp.2021.11.009.

Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children's Hospitals.

Kuntz M, Staffa S, Graham D, Faraoni D, Levy P, DiNardo J J Am Heart Assoc. 2021; 11(1):e022776.

PMID: 34970919 PMC: 9075185. DOI: 10.1161/JAHA.121.022776.

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