Effect of Transcatheter Closure of the Ductus Arteriosus on Right Ventricular Function in Preterm Neonates.

Abstract

Background: A large non-restricted left-to-right shunt across a patent ductus arteriosus (PDA) with the resultant volume and pressure load may impact right ventricle (RV) function. We aimed to compare RV function on echocardiogram before and soon after transcatheter closure of PDA in preterm neonates.

Method: This single-center retrospective study included preterm infants ≤ 2 kg who underwent PDA transcatheter closure. Echocardiograms before and within 24 h after transcatheter closure were analyzed by a single reader for i) Tricuspid Annular Plane systolic excursion (TAPSE), ii) RV Velocity Time Integral (VTI) outflow, iii) RV Fractional area change (FAC), iv) Systolic-to-diastolic time (SD) ratio from the tricuspid valve regurgitation, and v) Stroke distance, the product of VTI and heart rate. Paired t test was used to compare parameters before and after device closure.

Results: Our cohort (n = 97), 54.6% of whom were males, had a mean (Standard Deviation) gestational age of 24.9 (1.9) weeks and birth weight of 742 (244) grams. The median (IQR) age at procedure was 29 (21-45) days. We found evidence of RV dysfunction (abnormal TAPSE in 14%, FAC in 66.5% and SD in 100%) at baseline with significant improvement 24 h after device closure in RV VTI, FAC, SD, stroke distance, and myocardial performance index.

Conclusion: Among preterm infants with a PDA, transcatheter closure was associated with significant short-term improvement in RV systolic function. These data provide novel intriguing insights into the potential benefit of unloading of the RV through device closure in this population.