Patent Ductus Arteriosus Morphology Changes in Preterm Neonates Undergoing Transcatheter Device Closure.

Journal: Pediatric Cardiology
Published:
Abstract

Evaluate patent ductus arteriosus (PDA) morphology changes in the preterm neonate undergoing transcatheter PDA closure (TCPC). We propose the type F ductus is associated with lower corrected gestational age (CGA) and improved TCPC outcomes. Retrospective review of premature neonates undergoing TCPC at a large volume institution from November 2020 to November 2023. Two independent cardiologists blindly reviewed angiograms to classify the PDA as one of the 6 published morphologies. Procedural characteristics and outcomes were compared for two cohorts of TCPC patients constituting the type F and the non-type F ductus; statistical significance set at p-value < 0.05. 104 TCPC neonates met inclusion criteria; these were categorized as type F (n = 44) and non-type F (n = 60) ductal morphology. Patients with type F ductal morphology was associated with African American race (p = 0.007), lower procedural/chronological age (p < 0.001), weight (p = 0.002), and CGA (p < 0.001). Procedural length was significantly shorter in the type F group (41 vs 57 min; p < 0.01). Unsuccessful TCPC (n = 2) and device embolization (n = 2) events all occurred in patients with a non-type F ductal morphology. The CGA cut off < 34 weeks represents a good predictor of having a type F ductus (sensitivity 0.93, specificity 0.67). Younger chronological and CGA are associated with type F ductal morphology. At this institution, a type F ductus was associated with a shorter TCPC procedure time and demonstrated a lower complication rate. This data may prompt consideration of earlier TCPC referral. However, determining ideal TCPC timing in premature neonates is multifactorial and requires a multidisciplinary review team.

Authors
Megan Simpson, Shazia Bhombal, Shannon Hamrick, Sarah Hash, Marissa Adamson, Zhulin He, Keenan Hogan, Hui Huang, Andrew Jergel, Dennis Kim, Ashley Lefevre, Marcos Mills, Ashish Saini, R Ligon
Relevant Conditions

Patent Ductus Arteriosus