Fate of the Left Pulmonary Artery and Thoracic Aorta After Transcatheter Patent Ductus Arteriosus Closure in Extremely Low Birthweight Infants
Dor Markush, MD, Cedars-Sinai Medical Center, Los Angeles, CA
Dor Markush, MD1, Surbhi Gupta, MD2, Jennifer C Tsing, MA1, Nicole C Berndsen, MSN, NP-C1, Geena Radville3, Ruchira Garg, MD1, Evan M. Zahn, MD, MSCAI1 and Myriam Almeida-Jones, MD1, (1)Cedars-Sinai Medical Center, Los Angeles, CA, (2)University of California, Los Angeles, Los Angeles, CA, (3)University of Texas at Austin, Austin, TX
Keywords: Occlusion Devices and Structural Heart Disease (SHD)
Background
:
Transcatheter patent ductus arteriosus closure (TCPC) is an emerging treatment for extremely low birthweight (ELBW) infants. Left pulmonary artery (LPA) and descending aorta (DAO) obstruction are described device-related complications, however data on long term outcomes is lacking.
Methods
:
A retrospective analysis of ELBW infants who underwent successful TCPC from 05/2013-12/2018 was performed. 2-D echocardiography and Doppler imaging was obtained before, during, 24 hrs post-procedure, and in long-term follow-up with a focus on LPA and DAO stenosis.
Results
:
A total of 45 ELBW neonates underwent successful TCPC at a median procedural weight of 1150 g (755 - 2510 g). Thirty two infants (71%) underwent TCPC with an AVPII and 12 (27%) with the Piccolo device. One patient, who had a pre-procedural diagnosis of coarctation of the aorta, required aortic stent placement 3 days after TCPC. One patient, who had a concerning LPA flow pattern immediately after device implant, developed early progressive LPA stenosis requiring stent placement 3 months post-procedure. Both had Doppler velocities > 2.5 m/sec on post-procedure echocardiogram, the highest recorded values for LPA and DAO in our cohort. In the remaining infants, including 6 (13%) who had increased post-procedure Doppler velocities (ranging 2.0 - 2.4 m/sec), none developed LPA or DAO obstruction, and all had progressive improvement and normalization of flow velocities over time (median last follow-up 26.1 mo (0.5 - 75 mo).
Conclusions
:
TCPC can be performed safely in ELBW infants with a low incidence of LPA and DAO obstruction. Patients who develop significant LPA or DAO obstruction present early and may be successfully treated with stent therapy. In the absence of significant progressive vascular obstruction in the early post-procedure period, mild increases in LPA and DAO flow velocities < 2.5 m/sec improve spontaneously and normalize in long-term follow-up.