31. Left ventricular dysfunction after patent ductus arteriosus (PDA) closure

Abstract

Left ventricular (LV) dysfunction is a known complication after patent ductus arteriosus (PDA) occlusion. However, only limited studies with small number of patients and shorter duration of follow up were published. The study objective is to evaluate the effect of PDA occlusion on LV systolic function (LV-SFx). Methods: A retrospective study conducted from January 2003 till December 2013. Our cardiac database was used to identify all patients who underwent either surgical or catheter occlusion for PDA in this study period. Our echocardiography (echo) data base was used for echo review. From M-Mode recordings, LV dimensions were measured and Fractional Shortening (FS) derived before and after the intervention to assess LV-Sfx. The end-point of follow-up was either a normalization of LV-SFx defined by FS equal to/or more than 28% or reaching one year of follow-up after the intervention in patients with depressed LV-SFx. Patients with depressed LV-SFx prior to PDA occlusion, additional hemodynamically significant cardiac defects, multiple PDA interventions, incomplete follow-up or incomplete echo studies were excluded. Results: The total number of patients who underwent one intervention for PDA occlusion and had complete echo data were 188. 16/188 patients (8.5%) were born prematurely. 159 patients (85%) had normal LV-SFx while 29 patients (15%) had depressed LV-SFx after PDA occlusion. Of those with depressed function, 7 patients were after surgical PDA ligation while 22 patients had catheter PDA device occlusion. LV-SFx recovered within 4–6 weeks in 11 patients, within 3–6 months in 11 patients, and within 7–12 months in 7 patients. Within the first 6 month, complete recovery of LV-SFx was observed in 70% of these patients. None of the preterm babies in our study had depressed LV-SFx after PDA occlusion. Conclusions: Depressed LV-SFx may occur after PDA closure with higher incidence after catheter PDA device occlusion. All of preterm babies had surgical PDA occlusion and none of them presented with depressed LV-SFx in the post-operative follow-up. Further prospective studies are needed to investigate these observations.