Post Procedural Left Pulmonary Artery Stenosis and Aortic Coarctation Following Transcatheter Closure of Ductus Arteriosus in Infants and Associated Outcomes
DOI:
https://doi.org/10.51253/pafmj.v75iSUPPL-3.12675Keywords:
Aortic coarctation, Complications, Left pulmonary artery stenosis, Patent ductus arteriosus, Transcatheter closureAbstract
Objective: To determine the frequency of Left Pulmonary Artery (LPA) stenosis and aortic coarctation following transcatheter closure of ductus arteriosus and to assess the post-procedural outcomes.
Study Design: Quasi- Experimental study.
Place and Duration of Study: Armed Forces Institute of Cardiology/ National Institute of Heart Diseases, Rawalpindi, Aug 2023 to Jan 2024.
Methodology: Forty Seven patients of both gender who underwent Patent Ductus Arteriosus (PDA) closure and weight having < 10kg were included.All patients were admitted one day prior to the procedure, base line laboratory tests including complete blood count, C-reactive protein, chest x-ray, echocardiography and ECG were performed.Patients were kept in post cath ward/HDU for observations and monitoring for any complications. Patients were called up on day 1, day 7, 1st month, 3rd month and 6th month for follow-up.
Results: Out of 47 patients, 18(38.3%) were males and 29(61.1%) were females with mean age 7.67±3.77 months. After PDA closure, 12(25.5%) patients developed coarctation across descending aorta, 3(6.3%) patients developed LPA stenosis which improved with time and none patient had significant coarctation or LPA stenosis at 6 month follow up. PDA type, size, device type and weight of participants were significantly associated with coarctation of aorta and LPA stenosis (p<0.05).
Conclusion: Transcatheter PDA device closure is an effective and safe treatment in small infants, although there is small risk of aortic coarctation, left pulmonary artery stenosis and Left ventricular dysfunction that resolved in majority of patient without any further intervention over time.
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References
Ali SI, Khan OY, Naveed N, Ahmad H, Patel N, Arif A. Congenital septal defects in Karachi, Pakistan: an update of mutational screening by high-resolution melting (HRM) analysis of MTHFR C677T. Hum Genomics 2024 ;18(1):6.
https://doi.org/10.1186/s40246-023-00566-5
Khan AM, Ullah Z, Ilyas S, Wazir HD, Rehman Y, Hussain I, et al. The outcome of trans-catheter closure of patent ductus arteriosus: a single-center experience. Cureus 2022;14(1).
https://doi.org/10.7759/cureus.21577
Sathanandam S, McNamara P, Pedra C, Toyoshima K, Malekzadeh-Milani S, Patkai J,et al. A global perspective on PDA management in the extremely premature: shifting trend toward transcatheter closure. Catheter Cardiovasc Interv 2023;2(4):100968.
https://doi.org/10.1016/j.jscai.2023.100968
Pierpont ME, Brueckner M, Chung WK, Garg V, Lacro RV, McGuire AL, et al. Genetic basis for congenital heart disease: revisited: a scientific statement from the American Heart Association. Circ. 2018;138(21):e653-711.
https://doi.org/10.1161/CIR.0000000000000606
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al., 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;73(12):e81-192.
https://doi.org/10.1161/CIR.0000000000000603
Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. J Pediatr. 2010;125(5):1020-1030.
https://doi.org/10.1542/peds.2009-3506
Abu-Shaweesh JM, Almidani E. PDA: Does it matter?. Int J Pediatr Adolesc Med 2020;7(1):11-14.
https://doi.org/10.1016/j.ijpam.2019.12.001
Noori S. Pros and cons of patent ductus arteriosus ligation: hemodynamic changes and other morbidities after patent ductus arteriosus ligation. Semin Perinatol 2012;36(2):139-145.
https://doi.org/10.1053/j.semperi.2011.09.024
Chen ZY, Wu LM, Luo YK, Lin CG, Peng YF, Zhen XC, et al,. Comparison of long-term clinical outcome between transcatheter Amplatzer occlusion and surgical closure of isolated patent ductus Arteriosus. Chin Med J 2009;122(10):1123-1127. https://doi.org/10.3760/cma.j.issn
Tomasulo CE, Gillespie MJ, Munson D, Demkin T, O'Byrne ML, Dori Y,et al. Incidence and fate of device related left pulmonary artery stenosis and aortic coarctation in small infants undergoing transcatheter patent ductus arteriosus closure. Catheter Cardiovasc Interv 2020;96(4):889-897.
https://doi.org/10.1002/ccd.28942
Schwartz MC, Nykanen D, Winner LH, Perez J, McMahan M, Munro HM, et al., Transcatheter patent ductus arteriosus occlusion in small infants. Congenit Heart Dis 2016;11(6):647-655.https://doi.org/10.1111/chd.12360
Zahn EM, Peck D, Phillips A, Nevin P, Basaker K, Simmons C et al., Transcatheter closure of patent ductus arteriosus in extremely premature newborns: early results and midterm follow-up. JACC Cardiovasc Interv 2016;9(23):2429-2437.
https://doi.org/10.1016/j.jcin.2016.09.019
MalekzadehMilani S, Akhavi A, Douchin S, Dauphin C, Chalard A, Mauran P,et al. Percutaneous closure of patent ductus arteriosus in premature infants: a French national survey. Catheter Cardiovasc Interv. 2020;95(1):71-77.
https://doi.org/10.1002/ccd.28502
Chien YH, Wang HH, Lin MT, Lin HC, Lu CW, Chiu SN,et al. Device deformation and left pulmonary artery obstruction after transcatheter patent ductus arteriosus closure in preterm infants. Int J Cardiol Heart Vasc 2020;312:50-5.
https://doi.org/10.1016/j.ijcard.2020.02.065
Rafique S, Imtiaz S, Akhtar K, Mehmood A, Ara A, Wahab A, et al. Anatomical Characteristics of Patent Ductus Arteriosus and Choice of Transcatheter Occluder Devices. Pak Armed Forces Med J. 2024;74(1):62-67.
https://doi.org/10.51253/pafmj.v74iSUPPL-1.11562
Sathanandam SK, Gutfinger D, O'Brien L, Forbes TJ, Gillespie MJ, Berman DP et al. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients≥ 700 grams. Catheter Cardiovasc Interv 2020;96(6):1266-1276.
https://doi.org/10.1002/ccd.28973
Backes CH, Cheatham SL, Deyo GM, Leopold S, Ball MK, Smith CV et al. Percutaneous patent ductus arteriosus (PDA) closure in very preterm infants: feasibility and complications. J Am Heart Assoc2016;5(2):e002923.
https://doi.org/10.1161/JAHA.115.002923
Zahn EM, Peck D, Phillips A, Nevin P, Basaker K, Simmons C et al. Transcatheter closure of patent ductus arteriosus in extremely premature newborns: early results and midterm follow-up. JACC Cardiovasc Interv 2016;9(23):2429-2437.
https://doi.org/10.1016/j.jcin.2016.09.019
Talat S, Sheikh AM, Sattar H, Kanwal A, Akbar T. The transient effects of trans-catheter patent ductus arteriosus closure on left ventricular systolic function. Pak Postgrad Med J 2023;34(02):88-92.https://doi.org/10.51642/ppmj.v34i02.576
Bischoff AR, Stanford AH, Aldoss O, Rios DR, McLennan DI, Mohammad Nijres B et al. Left ventricular function before and after percutaneous patent ductus arteriosus closure in preterm infants. Pediatr Res 2023;94(1):213-221.
https://doi.org/10.1038/s41390-022-02372-6
Greyling A, Jiyana S, Nxele MF, Makrexeni Z, Pepeta L. Ductal closure in infants under 6 kg including premature infants using AmplatzerTM duct occluder type two additional sizes: a single-centre experience in South Africa. Cardiovasc. J. Afr 2020;31(1):33-39.
https://doi.org/10.5830/CVJA-2019-044
Epçaçan S, Bulut MO, Yücel İK, Çelebi A. A beneficial technique for preventing the device protrusion to the aorta during percutaneous patent ductus arteriosus closure:"Balloon-assisted device releasing technique". Cardiol Young 2019;29(11):1380-
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