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Original Research

Program: Section on Cardiology and Cardiac Surgery

O2049: Effect of Transcutaneous Device Closure of Patent Ductus Arteriosus in Premature Infants on Right Ventricular Function Using Speckle Tracking Echocardiography

Saturday, October 21, 2023
3:20 PM – 3:30 PM US EDT
Location: H2017: Section on Cardiology & Cardiac Surgery Program: Day 2
Oral Presentation
Background: In 2019, the Food and Drug Administration approved the Amplatzer Piccolo device for transcatheter closure of patent ductus arteriosus (PDA) in neonates weighing >700 grams. Two-dimensional speckle tracking echocardiography can measure parameters of deformation in different dimensions for a comprehensive assessment of ventricular systolic function. We aimed to assess the acute effect of device closure of PDA on right ventricle (RV) function in premature neonates, using speckle tracking echocardiography, which has been shown to be independent of preload and heart rate.

Methods: This was a single center retrospective study of preterm infants’ ≤ 2.5 kg, who underwent PDA device closure over the last 5 years. Patients (n=3) with post-device severe tricuspid regurgitation, coarctation aorta or congenital heart disease were excluded. Echocardiograms performed before and within 24 hours after device implantation were read by a single reader blinded to clinical data. From the apical four chamber view (with special focus on RV), global longitudinal strain (GLS) for endocardium as well as strain for various (n=6) segments for endocardium were calculated using vendor-independent software (TomTec Imaging). Paired t-test was used to compare parameters before and after device closure; p-value < 0.05 was taken as significant.

Results: Our study cohort (n=41), 22 (53.7%) of whom were males, had device closure of PDA at a mean (SD) age of 39.6 (9.1) days. After device closure of the PDA, mean (SD) heart rate declined and GLS for RV myocardium and endocardium as well as segmental strain for the free wall and septal mid and basal segments improved significantly from baseline. RV septal apical segment strain did not reach statistical significance.

Conclusion: In a cohort of preterm neonates with hemodynamically significant PDA, we found evidence of improved global and segmental RV function on speckle tracking echocardiography, within 24 hours of transcatheter closure. These novel data, using a sensitive new technique, provide novel insights into the effects of RV unloading in preterm infants following device closure of the PDA.