Aggarwal Sanjeev, Kadiu Gilda, Natarajan Girija
Division of Neonatology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, USA.
Discipline of Pediatrics, Central Michigan University, Mount Pleasant, MI, USA.
Pediatr Cardiol. 2025 Jun 19. doi: 10.1007/s00246-025-03894-6.
A large non-restricted left-to-right shunt across a patent ductus arteriosus (PDA) with the resultant volume and pressure load may impact right ventricle (RV) function. We aimed to compare RV function on echocardiogram before and soon after transcatheter closure of PDA in preterm neonates.
This single-center retrospective study included preterm infants ≤ 2 kg who underwent PDA transcatheter closure. Echocardiograms before and within 24 h after transcatheter closure were analyzed by a single reader for i) Tricuspid Annular Plane systolic excursion (TAPSE), ii) RV Velocity Time Integral (VTI) outflow, iii) RV Fractional area change (FAC), iv) Systolic-to-diastolic time (SD) ratio from the tricuspid valve regurgitation, and v) Stroke distance, the product of VTI and heart rate. Paired t test was used to compare parameters before and after device closure.
Our cohort (n = 97), 54.6% of whom were males, had a mean (Standard Deviation) gestational age of 24.9 (1.9) weeks and birth weight of 742 (244) grams. The median (IQR) age at procedure was 29 (21-45) days. We found evidence of RV dysfunction (abnormal TAPSE in 14%, FAC in 66.5% and SD in 100%) at baseline with significant improvement 24 h after device closure in RV VTI, FAC, SD, stroke distance, and myocardial performance index.
Among preterm infants with a PDA, transcatheter closure was associated with significant short-term improvement in RV systolic function. These data provide novel intriguing insights into the potential benefit of unloading of the RV through device closure in this population.
未闭动脉导管（PDA）存在大量非限制性左向右分流，由此产生的容量和压力负荷可能会影响右心室（RV）功能。我们旨在比较早产儿经导管封堵PDA前后超声心动图上的右心室功能。
这项单中心回顾性研究纳入了体重≤2kg且接受PDA经导管封堵术的早产儿。由一名阅片者分析经导管封堵术前及术后24小时内的超声心动图，指标包括：i）三尖瓣环平面收缩期位移（TAPSE）；ii）右心室流出道速度时间积分（VTI）；iii）右心室面积变化分数（FAC）；iv）三尖瓣反流的收缩期与舒张期时间（SD）比值；v）行程距离，即VTI与心率的乘积。采用配对t检验比较封堵器械前后的参数。
我们的队列（n = 97）中，54.6%为男性，平均（标准差）胎龄为24.9（1.9）周，出生体重为742（244）克。手术时的中位（IQR）年龄为29（21-45）天。我们发现基线时存在右心室功能障碍的证据（14%的TAPSE异常，66.5%的FAC异常，100%的SD异常），封堵器械后24小时，右心室VTI、FAC、SD、行程距离和心肌性能指数有显著改善。
在患有PDA的早产儿中，经导管封堵与右心室收缩功能的显著短期改善相关。这些数据为通过器械封堵减轻该人群右心室负荷的潜在益处提供了新的有趣见解。
