Simpson Megan K, Bhombal Shazia, Hamrick Shannon E, Hash Sarah, Adamson Marissa, He Zhulin, Hogan Keenan, Huang Hui, Jergel Andrew, Kim Dennis W, LeFevre Ashley S, Mills Marcos, Saini Ashish, Ligon R Allen
Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA.
Division of Neonatology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2220 N Druid Hills Rd NE, Atlanta, GA, 30329, USA.
Pediatr Cardiol. 2025 Jan 15. doi: 10.1007/s00246-025-03771-2.
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.
评估接受经导管动脉导管未闭封堵术(TCPC)的早产儿动脉导管未闭(PDA)的形态变化。我们提出F型导管与较低的矫正胎龄(CGA)及改善的TCPC结局相关。对2020年11月至2023年11月在一家大型机构接受TCPC的早产儿进行回顾性研究。两名独立的心脏病专家对血管造影进行盲法评估,将PDA分类为已发表的6种形态之一。比较构成F型和非F型导管的两组TCPC患者的手术特征和结局;设定统计学显著性为p值<0.05。104例TCPC新生儿符合纳入标准;这些新生儿被分类为F型导管形态(n = 44)和非F型导管形态(n = 60)。F型导管形态的患者与非裔美国人种族相关(p = 0.007),手术/实际年龄较低(p < 0.001),体重较低(p = 0.002),CGA较低(p < 0.001)。F型组的手术时间明显更短(41分钟对57分钟;p < 0.01)。TCPC失败(n = 2)和器械栓塞(n = 2)事件均发生在非F型导管形态的患者中。CGA截止<34周是F型导管的良好预测指标(敏感性0.93,特异性0.67)。实际年龄和CGA较小与F型导管形态相关。在该机构,F型导管与较短的TCPC手术时间相关,且并发症发生率较低。这些数据可能促使考虑更早转诊进行TCPC。然而,确定早产儿理想的TCPC时机是多因素的,需要多学科评估团队。