Immediate and Short-term Changes in Left Ventricular Function in Children Undergoing Percutaneous Closure of Patent Ductus Arteriosus by Echocardiography and Tissue Doppler

Abstract

Background: Patent ductus arteriosus accounts for 5-10% of all congenital heart diseases. Left-to-right shunting through the PDA results in pulmonary over-circulation and left heart volume overload. Transcatheter closure is the method of choice for PDA closure when suitable. Some previous studies have described an immediate deterioration of left ventricular functions after percutaneous closure of PDA, which is reversible and improves after few months. Purpose: This study aimed to determine the immediate and short-term changes in the left ventricular function in children with patent ductus arteriosus after percutaneous closure using 2D echocardiography and tissue doppler imaging. Patients and Methods: Thirty children with isolated PDA were treated by trans-catheter closure were studied. The LV dimensions, volumes and systolic function were assessed by two-dimensional echocardiography and tissue Doppler imaging before the PDA closure, on day 1 and after one month. Results: The median age of the patients was 4.25 years and mean BSA was 0.73 ± 0.31 m², with the mean PDA diameter of 2.53 ± 0.60 mm. The LVEDD, LVESD, left atrium diameter, ejection fraction and LVEDV reduced significantly immediately after PDA closure (p < 0.001). After 1 month, LVEDD, LVESD and LAD continued to decrease, while ejection fraction improved significantly. All tissue Doppler velocities showed a significant decrease immediately after closure with significant increase of MPI (p < 0.001) and then were improved within 1 month. Conclusion: percutaneous closure of PDA was associated with reversible significant decrease in the left ventricular systolic and diastolic functions, which recovered after one month.

Time period after transcatheter PDA closure with changes in left ventricular function and nutritional status

“…8,29,30 In addition to monitoring for complications, some studies also assessed changes in LVF parameters and body weight, but most monitoring was not done for a full year after closure. 11,14,31,32 We monitored both LVF parameters and nutritional status, according to the WHO or CDC growth charts depending on patient age. 15 A Nigeria study reported that 92% of CHD patients had malnutrition and 90% of those had severe malnutrition.…”

“…Other studies usually only assessed changes in LVF parameters or nutritional status, not both. 11,14,32 The weakness of our study was the small sample size, due to the large number of patients excluded due to patient non-compliance to clinic visits for evaluation of LVF parameters, as well as incomplete medical record nutritional status data. As such, further study is needed with a larger sample size, and assessment of other possible confounding variables to better elucidate relationships between variables.…”