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 Oct 1;96(4):889-897. doi: 10.1002/ccd.28942. Epub 2020 Apr 27.

Abstract

Objectives: To evaluate short- and middle-term outcomes after transcatheter patent ductus arteriosus (TC-PDA) closure in small infants, specifically device-related left pulmonary artery (LPA) stenosis and aortic coarctation, risk factors, and changes over time.

Background: Recent studies have demonstrated successful transcatheter PDA (TC-PDA) closure in small infants. LPA stenosis and aortic coarctation have been seen after TC-PDA, but it is not clear whether device-related LPA/aortic obstruction persists.

Methods: A single-center retrospective study of infants ≤4 kg who underwent TC-PDA closure from February 1, 2007 to September 1, 2018 was performed, evaluating the incidence and risk factors for LPA stenosis and coarctation.

Results: Forty-four patients underwent successful TC-PDA with Amplatzer Vascular Plug II (AVPII; n = 30), Amplatzer Duct Occluder II-Additional Sizes (n = 10), Amplatzer Duct Occluder I (n = 3), and coil-filled AVPI (n = 1) devices, all via an antegrade approach. Median birthweight and procedural weight were 890 g (range: 490-3,250) and 2.8 kg (range: 1.2-4.0), respectively. Median follow-up was 0.7 years (range: 2 days-7 years). Thirty-eight patients had post-procedure echocardiograms assessing LPA/aortic obstruction. Of those, 17 had LPA flow acceleration/stenosis (≥1.5 m/s), which improved or resolved in all patients with available follow-up; 3 developed mild coarctation (>2 m/s), which improved in the two with more than short-term follow-up; 4 developed mild flow acceleration (1.5-2 m/s) in the descending aorta, which resolved in three and increased in one (2.4 m/s). Flow acceleration in the LPA was associated with younger procedural age, larger PDA minimal diameter, and placement of a device other than the AVPII. There was no device-related mortality or need for reintervention.

Conclusion: TC-PDA in small infants is effective, without significant complications. Device-related LPA/aortic obstruction can improve with time/growth.

Keywords: catheterization; congenital heart disease; percutaneous; premature.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aortic Coarctation / diagnostic imaging
  • Aortic Coarctation / epidemiology*
  • Birth Weight
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation
  • Ductus Arteriosus, Patent / diagnostic imaging
  • Ductus Arteriosus, Patent / therapy*
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Risk Factors
  • Septal Occluder Device / adverse effects*
  • Stenosis, Pulmonary Artery / diagnostic imaging
  • Stenosis, Pulmonary Artery / epidemiology*
  • Time Factors
  • Treatment Outcome