Heart size, heart function, and plasma B-type natriuretic peptide levels after transcatheter closure of patent ductus arteriosus
AbstractBackground Patent ductus arteriosus (PDA) is a common
congenital heart disease causing some blood in the aorta to flow
into the pulmonary artery (PA), resulting in dilatation of the left
atrium (IA) and left ventricle (LY), increased B-type natriuretic
peptide (BNP) level, and the development of h eart failure.
Objectives To evaluate the clinical course, changes in heart size
and function, and BNP level after transcatheter closure of PDA
using the AmplatzerÂ® duct occluder (ADO).
Methods This quasi-experimental study used a one-group, pretestposttest
design, and was done on PDA patients who underwent
transcatheter closure using ADO. The outcomes measurements
were performed four times, namely, before the procedure and
at one, three, and six months after the procedure. Results were
compared using a serial time analysis. Outcomes measured were
heart failure scores, chest x-ray (CXR) and echocardiography
findings, and plasma BNP level.
Results There were 23 PDA patients enrolled, of which 12 were
females. Subjects' median bodyweight was 11 (range 6.6 to 55) kg.
Prior to PDA closure, 12 subjects had mild heart fa ilure (class II)
and 7 had moderate heart failure (class III). On follow-up at one
month after the procedure, all subjects had improved heart failure
scores (P<0.0001), and no heart failure was found on further
follow up. Likewise, there was a decreased mean cardiothoracic
ratio (CTR) from 58 to 55% at 1-month (P = 0.001), and also
from 55 to 52% at3-month follow up (P<0.0001), but no further
decrease was found afterwards (P = 0.798). The left atrium/aorta
(LA/Ao) ratio measured by echocardiography also showed a
statistically significant decrease from 1.6 prior to the procedure
to 1.3 (P<0.0001) in the first month, but it remained stable
afterwards. Diastolic function, represented by peak E and A waves
also significantly decreased from 127 and 91 cm/sec, before the
procedure, to 90 and 68 cm/sec, respectively, at 1 month follow-up
(P <0.0001 and P < 0.0001, respectively) . However, there were no
statistically significant changes in E/ A ratio, ejection fract ion and
fractional shortening. Plasma BNP level significantly decreased
from 58 pg/mL before the procedure to 28 pg/mL at 1 month
follow-up (P= 0 .001), but no further significant decrease was
Conclusion After PDA closure with ADO, we observe significant
improvements in heart failure scores, heart size, diastolic function,
and BNP level of our subjects especially in the first month after
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