Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis

Mohamed Abdel-Bary, Khaled Abdalla Abdel-Baseer, Ahmed Fathy Abdel-Latif, Mohamed Abdella Abdel-Naser, Mahmoud Nafie, Karam Mosallam Eisa, Mohamed Abdel-Bary, Khaled Abdalla Abdel-Baseer, Ahmed Fathy Abdel-Latif, Mohamed Abdella Abdel-Naser, Mahmoud Nafie, Karam Mosallam Eisa

Abstract

Objective: To identify the predictor factors of left ventricular (LV) dysfunction following patent ductus arteriosus (PDA) surgical ligation.

Background: PDA is viewed as a noticeable amongst the most widely recognized congenital heart defects in children and its closure is responsible for many hemodynamic changes that require intervention and care.

Methods: A retrospective study included fifty children with isolated PDA treated by surgical ligation from June 2015 to June 2018. The LV dimensions and systolic function were assessed by two-dimensional echocardiography pre and post PDA ligation. All cases were followed-up on the first-day, 1 month and 6 months post ligation.

Results: The mean age of cases was 15.78 ± 7.58 months and 72% were females. The mean duct size was 4.08 ± 1.25 mm. There was a marked decrease in LVEDd, LA/Ao, EF and FS in the first-day post ligation contrasted with pre ligation values. Moreover, an amazing decline in LVEDd and LA/Ao ratio was observed 1 month post ligation contrasted with the early post ligation status with asynchronous improvement of FS and EF at one and 6 months postoperatively.

Conclusion: PDA ligation is associated with a noteworthy LV systolic dysfunction within the first day post ligation; that in a significant number of patients may require anti-failure measures, prolong the hospital stay and necessitate a regular follow up and monitoring of LV function. PDA size, age, preoperative LVEDd and FS can be considered as predictor factors for suspicion of acute decrease in the LV systolic function early post PDA ligation.

Trial registration: ClinTrial.Gov NCT04018079 .

Keywords: Congenital heart disease; LA/Ao ratio; LV systolic function and dimensions; PDA ligation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
correlation between PDA size and LVED d changes (pre closure LVED d – early post closure LVED d)
Fig. 2
Fig. 2
correlation between PDA size and FS changes (pre closure FS – early post closure FS)

References

    1. Leonhardt A, Glaser A, Wegmann M, Schranz D, Seyberth H, Nüsing R. Expression of prostanoid receptors in human ductus arteriosus. Br J Pharmacol. 2003;138:655–659. doi: 10.1038/sj.bjp.0705092.
    1. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr. 2008;153:807–813. doi: 10.1016/j.jpeds.2008.05.059.
    1. Semberova Jana, Sirc Jan, Miletin Jan, Kucera Jachym, Berka Ivan, Sebkova Sylva, O’Sullivan Sinead, Franklin Orla, Stranak Zbynek. Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g. Pediatrics. 2017;140(2):e20164258. doi: 10.1542/peds.2016-4258.
    1. Schneider DJ. The patent ductus arteriosus in term infants, children, and adults. Semin Perinatol. 2012;36:146–153. doi: 10.1053/j.semperi.2011.09.025.
    1. Sehgal A, McNamara PJ. International perspective on management of a patent ductus arteriosus: lessons learned. Semin Fetal Neonatal Med. 2018;23(4):278–284. doi: 10.1016/j.siny.2018.03.002.
    1. Jeong YH, Yun TJ, Song JM, Park JJ, Seo DM, Koh JK, et al. Left ventricular remodelling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure. Am Heart J. 2007;154:436–440. doi: 10.1016/j.ahj.2007.04.045.
    1. Weisz DE, More K, McNamara PJ, Shah PS. PDA ligation and health outcomes: a meta-analysis. Pediatrics. 2014;133:e1024. doi: 10.1542/peds.2013-3431.
    1. Ulrich TJ, Hansen TP, Reid KJ, Bingler MA, Olsen SL. Post-ligation cardiac syndrome is associated with increased morbidity in preterm infants. J Perinatol. 2018;38:537–542. doi: 10.1038/s41372-018-0056-4.
    1. El-Khuffash AF, Jain A, Weisz D, Mertens L, McNamara PJ. Assessment and treatment of post patent ductus arteriosus ligation syndrome. J Pediatr. 2014;165(1):46–52. doi: 10.1016/j.jpeds.2014.03.048.
    1. Tilahun B, Tefera E. Transient left ventricular systolic dysfunction following surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac Centre, Ethiopia. J Cardiothorac Surg. 2013;8:139. doi: 10.1186/1749-8090-8-139.
    1. Saida K, Nakamura T, Hiroma T, Takigiku K, Yasukochi S. Preoperative left ventricular internal dimension in end-diastole as earlier identification of early patent ductus arteriosus operation and postoperative intensive care in very low birth weight infants. Early Hum Dev. 2013;89(10):821–823. doi: 10.1016/j.earlhumdev.2013.07.011.
    1. Rubio M, Wiegman A, Naeff M. ICRF-187 (Cardioxane®) protection against doxorubicin induced cardiomyopathy in paediatric osteosarcoma patients. [abstract] Proc Am Soc Clin Oncol. 1995;14:A440.
    1. Gupta SK, Krishnamoorthy K, Tharakan JA, Sivasankaran S, Sanjay G, Bijulal S, et al. Percutaneous closure of patent ductus arteriosus in children: immediate and short-term changes in left ventricular systolic and diastolic function. Ann Pediatr Cardiol. 2011;4:139–144. doi: 10.4103/0974-2069.84652.
    1. Galal MO, Amin M, Hussein A, Kouatli A, Al-Ata J, Jamjoom A. Left ventricular dysfunction after closure of large patent ductus arteriosus. Asian Cardiovasc Thorac Ann. 2005;13:24–29. doi: 10.1177/021849230501300106.
    1. SA E-s, WS E-S. Could the size of ductus arteriosus be an independent predictor for the changes in left ventricular function post percutaneous closure! Evaluation by tissue Doppler and speckle-derived strain rate echocardiography. Int J Cardiovasc Res. 2017;6:5. doi: 10.4172/2324-8602.1000325.
    1. Kim YH, Choi HJ, Cho Y, Lee SB, Hyun MC. Transient left ventricular dysfunction after percutaneous patent ductus arteriosus closure in children. Korean Circ J. 2008;38(11):596–600. doi: 10.4070/kcj.2008.38.11.596.
    1. Elsheikh RG, Hegab MS, Salama MM, Elseteha M, Omar AI. Echocardiograpic evaluation of short-term outcome of patent ductus arteriosus closure using Amplatzer Occluder device. J Cardiovasc Dis Diagn. 2015;3:220. doi: 10.4172/2329-9517.1000220.
    1. Eerola A, Jokinen E, Boldt T, Pihkala J. The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function: a prospective study using two and three-dimensional echocardiography and measurements of serum natriuretic peptides. J Am Coll Cardiol. 2006;47:1060–1066. doi: 10.1016/j.jacc.2005.09.067.
    1. Hussain BK, Shaikh AS, Sohail A, Naresh KC, Veena K, Muhammad AK, et al. Predictors for left ventricular systolic dysfunction and its outcome after patent ductus arteriosus (Pda) closure by device. Int J Cardiovasc Res. 2018;7:1.
    1. Kiran VS, Tiwari A. Prediction of left ventricular dysfunction after device closure of patent ductus arteriosus: proposal for a new functional classification. EuroIntervention. 2018;13(18):e2124–e2129. doi: 10.4244/EIJ-D-17-00235.
    1. Agha HM, Hamza HS, Kotby A, Ganzoury MEL, Soliman N. Predictors of transient left ventricular dysfunction following transcatheter patent ductus arteriosus closure in pediatric age. J Saudi Heart Assoc. 2017;29:244–251. doi: 10.1016/j.jsha.2017.02.002.
    1. Patole SK, Muller R. Enteral feeding of preterm neonates: a survey of Australian neonatologists. J Matern Fetal Neonatal Med. 2004;16(5):309–314. doi: 10.1080/jmf.16.5.309.314.
    1. Amoogzar H, Shakiba AM, Derakhshan D, Ajami G, Cheriki S, Borzouee M, et al. Evaluation of left ventricular function by tissue Doppler and speckle-derived strain rate echocardiography after percutaneous ductus closure. Pediatr Cardiol. 2015;36:219–225. doi: 10.1007/s00246-014-0989-0.

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