Effect of Trans-catheter closure of the Ductus Arteriosus in Preterm Infants

Effect of Trans-catheter closure of the Ductus Arteriosus in Preterm Infants

Purpose: Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants with hemodynamic consequences of systemic hypo-perfusion and later pulmonary hypertension. Management of pulmonary hypertension in the presence of a large PDA with left to right shunting is challenging. We soug...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2019-08, Vol.144, p.1
Main Authors: Philip, Ranjit, Sathanandam, Shyam, Waller, Benjamin
Format: Article
Language:eng
Subjects:
Age
Blood pressure
Catheterization
Catheters
Diagnostic systems
Extubation
Gestational age
Heart
Hemodynamics
Hypertension
Infants
Lungs
Medical instruments
Newborn babies
Occlusion
Perfusion
Premature babies
Pulmonary hypertension
Respiratory therapy
Systolic pressure
Ventricle
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Summary:Purpose: Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants with hemodynamic consequences of systemic hypo-perfusion and later pulmonary hypertension. Management of pulmonary hypertension in the presence of a large PDA with left to right shunting is challenging. We sought to assess the effect of the PDA and its trans-catheter device closure on the pulmonary vascular bed in preterm infants. Methods: A review of 100 consecutive children who underwent trans-catheter device closure of PDA was performed. Preterm infants who had a diagnostic right heart catheterization were chosen. Hemodynamic measures including Qp:Qs, pulmonary systolic pressure as a percentage to systemic pressure(PAP%) and pulmonary vascular resistance(PVR, expressed as wood units.m2) were measured at baseline, with 100%Fio2 and 20ppmiNO(condition2) and after test occlusion of the PDA(condition3). Respiratory severity scores (RSS) were also assessed. Results: There were 33 preterm infants, of which 17 were ≤ 2.5Kg, 12 were ventilator dependent. The Median gestational age of this sub-group was 27 weeks (23-32 weeks). The median age and weight at the time of the procedure were 6 weeks (4 - 16 weeks) and 1.6 Kg (1.06 – 2.5 Kg) respectively. The mean baseline Qp:Qs was 2.2:1 which increased to 4:1 with condition2 and down to 1 with condition3 as expected. The mean PAP% was 78%, which decreased to 42% with condition 2 &3 as did the PVR (baseline: 4.1, condition2: 1.9, condition3: 2.1). The median days for extubation were 17. The predictors for prolonged (>30-days post procedure) elevation of RSS (Score≥1) were: closure performed at >8-weeks of age and, SPAP ≥50% of the SBP (OR=2.86, 95%CI: 1.5-4.2, p=0.05 and OR=5.4, 95%CI: 2.2-9.4, p
ISSN:0031-4005
1098-4275