Cardiac Reverse Remodeling in Adults and Pediatrics After Transcatheter Patent Ductus Arteriosus Closure: A Multicenter Echocardiographic Study

Abstract

Purpose

Whether there is a difference in cardiac reverse remodeling after transcatheter Patent ductus arteriosus (PDA) closure between adults and pediatrics, caused by the longstanding shunt in adults, is not well studied.

Methods

We studied 22 adults and 35 pediatric patients who were referred for percutaneous closure of PDA, using volumetric echocardiography and speckle tracking echocardiography (STE) before closure, immediately after, then 3 months, and 6 months after PDA closure.

Results

Left ventricular (LV) ejection fraction (EF), global longitudinal (GLS), and circumferential strains (GCS) dropped significantly immediately after the procedure, associated with a drop in LV and left atrial (LA) diameters and volumes in both groups. In adult patients, LA reservoir and conduit strains (LASr and LAScd) also dropped. Six months later, and compared to their baseline values, adult patients had significantly lower LV GCS (−19.02 ± 3.47 % vs. −20.27 ± 3.76 %), while LVEF (57.59 ± 6.96 % vs. 59.83 ± 5.70 %) and LV GLS (−19.15 ± 3.38 % vs. −19.82 ± 2.06 %) were insignificantly lower. In contrast, the pediatric patients showed that LVEF (63.56 ± 6.44% vs. 63.89 ± 5.82%), LV GLS (−23.60 ± 2.38% vs. −23.17 ± 2.88%), and LV GCS (−22.95 ± 3.01 vs. −22.86 ± 2.51%) improved to their baseline values, or even slightly higher. LA contraction strain (LASct) improved significantly in both groups after PDA closure.

Conclusion

While both groups experienced an initial drop in cardiac function post-PDA closure, pediatric patients showed quicker recovery, likely due to the longer hemodynamic effect of the PDA in adults. PDA closure positively impacted LA contraction strain in both age groups.