CLINICAL RESEARCH: CONGENITAL HEART DISEASE
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
Anneli Eerola, MD*,
Eero Jokinen, MD, PhD,
Talvikki Boldt, MD, PhD and
Jaana Pihkala, MD, PhD
Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
Manuscript received July 28, 2005;
revised manuscript received August 23, 2005,
accepted October 3, 2005.
* Reprint requests and correspondence: Dr. Anneli Eerola, Hospital for Children and Adolescents, PL 281, 00029 Helsinki, Finland (Email: anneli.eerola{at}fimnet.fi).
OBJECTIVES: We aimed to evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) hemodynamics.
BACKGROUND: Today, most PDAs are closed percutaneously. Little is known, however, about hemodynamic changes after the procedure.
METHODS: Of 37 children (ages 0.6 to 10.6 years) taken to the catheterization laboratory for percutaneous PDA closure, the PDA was closed in 33. Left ventricular diastolic and systolic dimensions, volumes, and function were examined by two-dimensional (2D) and three-dimensional (3D) echocardiography and serum concentrations of natriuretic peptides measured before PDA closure, on the following day, and 6 months thereafter. Control subjects comprised 36 healthy children of comparable ages.
RESULTS: At baseline, LV diastolic diameter measured >+2 SD in 5 of 33 patients. In 3D echocardiography, a median LV diastolic volume measured 54.0 ml/m2 in the control subjects and 58.4 ml/m2 (p < 0.05) in the PDA group before closure and 57.2 ml/m2 (p = NS) 6 months after closure. A median N-terminal brain natriuretic peptide (pro-BNP) concentration measured 72 ng/l in the control group and 141 ng/l in the PDA group before closure (p = 0.001) and 78.5 ng/l (p = NS) 6 months after closure. Patients differed from control subjects in indices of LV systolic and diastolic function at baseline. By the end of follow-up, all these differences had disappeared. Even in the subgroup of patients with normal-sized LV at baseline, the LV diastolic volume decreased significantly during follow-up.
CONCLUSIONS: Changes in LV volume and function caused by PDA disappear by 6 months after percutaneous closure. Even the children with normal-sized LV benefit from the procedure.
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Abbreviations and Acronyms
| | 2D = two-dimensional | | 3D = three-dimensional | | A = atrial peak flow velocity | | ANPN = N-terminal proatriopeptide | | BSA = body surface area | | E = early mitral peak flow velocity | | EF = ejection fraction | | LV = left ventricle/ventricular | | PDA = patent ductus arteriosus | | pro-BNP = N-terminal brain natriuretic peptide |
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