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Mitra S, Bischoff AR, Sathanandam S, Lakshminrusimha S, McNamara PJ. Procedural closure of the patent ductus arteriosus in preterm infants: a clinical practice guideline. J Perinatol 2024:10.1038/s41372-024-02052-9. [PMID: 38997403 DOI: 10.1038/s41372-024-02052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
IMPORTANCE Transcatheter closure of the patent ductus arteriosus (PDA) is being increasingly adopted as an alternative to surgical PDA closure in preterm infants. OBJECTIVE To develop rigorous clinical practice guideline recommendations on procedural PDA closure in preterm infants. METHODS The principles of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision (EtD) framework were used to develop the guideline recommendations. An e-Delphi survey of 45 experts was conducted and recommendations that reached ≥75% agreement were accepted as consensus. MAIN RECOMMENDATIONS Procedural PDA closure may be considered in extremely preterm infants (<28 weeks gestational age) requiring invasive mechanical ventilation >10 postnatal days and confirmed to have a large hemodynamically significant PDA, at centers with high local rates of death and/or bronchopulmonary dysplasia (conditional recommendation). If sufficient institutional expertise is available and patient characteristics are suitable, transcatheter PDA closure may be considered as the preferred approach over PDA ligation (conditional recommendation).
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Affiliation(s)
- Souvik Mitra
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Adrianne R Bischoff
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, USA
| | - Shyam Sathanandam
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, USA.
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Koo J, Torres N, Katheria A. Early Echocardiographic Predictors of Eventual Need for Patent Ductus Arteriosus Treatment: A Retrospective Study. Am J Perinatol 2024. [PMID: 38237629 DOI: 10.1055/a-2249-1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with end-organ injury including intraventricular hemorrhage. Early treatment may reduce morbidities but may result in overtreatment. This study aimed to examine the association between commonly obtained echocardiographic markers within the first 12 hours of life and eventual treatment of an hsPDA. STUDY DESIGN Patients with <32 weeks' gestational age had blinded echocardiograms done within the first 12 hours of life as part of research protocols. Subsequent treatment of the patent ductus arteriosus (PDA) was determined by the clinical team independent of echocardiogram results. t-tests and chi-square tests were done for continuous data and categorical outcomes. A receiver operating curve was created to optimize cutoff values. RESULTS Among 199 neonates studied (mean time of echocardiogram 6.7 h after birth), those needing PDA treatment had higher left ventricular output (LVO), right ventricular output (RVO), and superior vena cava (SVC) flow (p-values 0.007, 0.044, and 0.012, respectively). Cutoffs for predicting PDA treatment were LVO > 204 mL/kg/min (63% sensitivity, 66% specificity), RVO > 221 mL/kg/min or SVC flow > 99 mL/kg/min (sensitivities 70 and 43%, specificities 48 and 73%, respectively). CONCLUSION Preterm neonates with higher markers of cardiac output in the first 12 hours of birth later required PDA treatment. These data are the first to use standard cardiac output measures in the first 12 hours of life to predict the need for future PDA treatment. Further prospective studies will need to be performed to corroborate these associations between echocardiographic markers and clinical outcomes/morbidities. KEY POINTS · Early diagnosis of hsPDA may prevent severe morbidity and death.. · There are echocardiographic markers beyond duct size and flow direction that may aid early diagnosis.. · Cardiac output markers within the first 12 hours of life may predict need for treatment of hsPDA..
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Affiliation(s)
- Jenny Koo
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California
| | - Nohemi Torres
- Department of Pediatric Cardiology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
| | - Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California
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Van Pelt E, Reo R, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed During Infancy. Cardiol Ther 2022; 11:523-530. [PMID: 36074260 PMCID: PMC9652175 DOI: 10.1007/s40119-022-00278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure during infancy. METHODS Chart review was performed on patients who had a PDA closure at not more than 1 year of age between January 1, 2002 and June 1, 2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE at least 3 months after procedure, or had a velocity greater than 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE at least 3 months after device placement. Time points included the first TTE after the procedure, first TTE at least 3 months after procedure, and the most recent TTE. RESULTS Total of 147 infants met the inclusion criteria. Age and weight at initial procedure were 141 ± 217 days and 4.2 ± 2.8 kg. There was no significant difference in DAo velocity between initial and most recent TTE. LPA velocity and left ventricular diastolic Z score significantly decreased between initial and most recent TTE. Seventy-eight patients had repeat echocardiograms more than 1 year after PDA procedure with no change in clinical management. No patient underwent an intervention on the LPA or DAo for stenosis. CONCLUSION In patients who underwent an uncomplicated PDA closure during infancy, TTE parameters either stayed stable or improved over time. These findings need to be corroborated in larger studies with longer follow-up. If verified, the long-term TTE guidelines may need to be simplified for this patient population.
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Affiliation(s)
- Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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Reo R, Van Pelt E, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy. Cardiol Ther 2022; 11:445-452. [PMID: 35780440 PMCID: PMC9381662 DOI: 10.1007/s40119-022-00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure after infancy. Methods Chart review was performed on patients who had a PDA closure ≥ 1 year of age between 1/1/2002 and 6/1/2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE ≥ 6 months after procedure, had a residual PDA or velocity > 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE ≥ 6 months after device placement. Time points included the initial TTE after the procedure, first TTE ≥ 6 months after procedure, and the most recent TTE. Results A total of 189 patients met the study criteria. The median age and weight at initial procedure were 2.7 (1.0–64.7) years and 12.5 (3.4–69.2) kg. Most recent TTE was performed 2.0 (0.4–17.0) years after PDA closure. There were no significant differences in fractional shortening (36.4 ± 5.0% vs. 36.9 ± 5.6%) or LPA velocity (1.1 ± 0.4 m/s vs. 1.1 ± 0.4 m/s) from initial to most recent TTE, respectively. Left ventricular internal diastolic diameter Z-score significantly decreased (1.4 ± 1.8 vs. − 0.01 ± 1.2, p < 0.01) and DAo peak velocity significantly increased (1.2 ± 0.3 m/s vs. 1.3 ± 0.3 m/s, p = 0.02) from initial to most recent TTE, respectively. No patient died or underwent an intervention on the LPA or DAo for stenosis. Seventy-five patients had a total of 208 repeat TTE > 1 year after PDA procedure with no change in clinical management. Conclusions In patients who underwent an uncomplicated PDA closure after infancy, TTE parameters improved or stayed within normal limits on the most recent TTE. Repeat lifetime TTEs after 1-year post-device placement in this population may not necessarily be needed if there are no clinical concerns.
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Affiliation(s)
- Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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Méot M, Haddad RN, Patkai J, Abu Zahira I, Di Marzio A, Szezepanski I, Bajolle F, Kermorvant E, Lapillonne A, Bonnet D, Malekzadeh-Milani S. Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121138. [PMID: 34943334 PMCID: PMC8700662 DOI: 10.3390/children8121138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.
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Affiliation(s)
- Mathilde Méot
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
- Correspondence: ; Tel.: +33-144494357
| | - Raymond N. Haddad
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Juliana Patkai
- Neonatology Department, Port-Royal Hospital, 75014 Paris, France;
| | - Ibrahim Abu Zahira
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Anna Di Marzio
- Anesthesiology, Hôpital Necker-Enfants Malades, 75015 Paris, France;
| | - Isabelle Szezepanski
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Fanny Bajolle
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Elsa Kermorvant
- Neonatology Department, Hôpital Necker-Enfants Malades, 75015 Paris, France; (E.K.); (A.L.)
- UFR de Médecine, Université de Paris, Site Cordeliers, 75006 Paris, France
| | - Alexandre Lapillonne
- Neonatology Department, Hôpital Necker-Enfants Malades, 75015 Paris, France; (E.K.); (A.L.)
- UFR de Médecine, Université de Paris, Site Cordeliers, 75006 Paris, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
- UFR de Médecine, Université de Paris, Site Cordeliers, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
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Meot M, Gaudin R, Szezepanski I, Bajolle F, Bonnet D, Malekzadeh-Milani S. Transcatheter patent arterial duct closure in premature infants: A new technique to ease access to the patent arterial duct, with particular benefit for the tricuspid valve. Arch Cardiovasc Dis 2021; 114:482-489. [PMID: 34312100 DOI: 10.1016/j.acvd.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 06/01/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature infants at Hôpital Necker Enfants Malades, we have changed our technique several times to advance the guidewire through the right heart to avoid tricuspid valve damage. AIM To describe the technique we have been using since May 2019, to report our results with a particular focus on tricuspid leaks and to analyse the potential mechanisms of tricuspid lesion development with previous methods. METHODS All premature infants weighing<2kg who underwent transcatheter PAD closure with this new technique were included. Demographic data, procedural data, outcome and procedural complications were reviewed, with particular attention to the occurrence of tricuspid regurgitation. RESULTS Between May 2019 and May 2020, 33 patients were included. Median gestational age was 25 weeks. Median birth weight and procedural weight were 690g (range 490-1065g; interquartile range [IQR] 620-785g) and 1160g (range 900-1900g; IQR 1030-1300g), respectively. Median age at procedure was 35 (IQR 30-46) days. PAD anatomy was evaluated on transthoracic echocardiography only. The median duct diameter was 3 (IQR 2.5-3.2) mm at the pulmonary end. Success rate was 100% (defined as successful closure without residual shunt). One patient had a renal vein thrombosis, which fully resolved with low-molecular-weight heparin anticoagulation. No tricuspid regurgitation or stenosis of the left pulmonary artery or the aorta was seen. One patient died of a superior caval vein obstruction with bilateral chylothorax related to a central catheter thrombosis 56 days after the procedure, unrelated to the catheter procedure. CONCLUSION In this prospective study, we describe a new technique to avoid tricuspid valve damage and facilitate delivery of the PAD device.
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Affiliation(s)
- Mathilde Meot
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France.
| | - Régis Gaudin
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Isabelle Szezepanski
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Fanny Bajolle
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
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