Heart size, heart function, and plasma B-type natriuretic peptide levels after transcatheter closure of patent ductus arteriosus
Keywords:
heart failure score, heart size, heart function, B-type natriuretic peptide, patent ductus arteriosus, Amplatzer® duct occluder
Abstract
Background Patent ductus arteriosus (PDA) is a commoncongenital 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 Amplatzer® 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
observed afterwards.
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
the procedure.
References
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Frigiola A, et al. Transcatheter closure of persistent ductus
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Multicenter USA Amplatzer patent ductus arteriosus
occlusion device trial. Initial and one-year results. J Am Coll
Cardiol. 2004;44:513-9.
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Saunders; 2006. p. 201-10.
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of the pat ent ductus arteriosus in very low birthweight
neonates: echocardiograpic and clinical finding. Pediatr
Cardiol. 1994; 15 :219-24.
17. Su BH, Wat anabe T, Shimizu M, Yanagisawa M. Echocardiographic
assessment of patent ductus arteriosus
shunt flow pattern in premature infants. Atch Dis Child.
1997;77:F36-F40.
18. Eidem BW Echocardiographic quantitation of ventricular
function. In: Chang AC, Towbin JA, editors. Heart failure
in children and young adults from molecular mechanisms
to medical and surgical strategies. Philadelphia: Saunders;
2006. p. 140-54.
Orphan J Rare Dis. 2009;4:l 7.
2. Sastroasmoro S, Madiyono B. Epidemiologi dan etiologi
penyakit jantung bawaan. In: Sastroasmoro S, Ismael S,
editors. Dasar-dasar metodologi penelitian klinis. 2nd ed.
Jakarta: Sagung Seto; 2002. p. 165-72.
3. M. K. Park MK. Pediatric cardiology for practitioners. St
Louis: Mosby; 2002. p. 67-82.
4. 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;47:1060-6.
5. Nan L, Wang J. Brain natriuretic peptide and optimal
management of heart failure. J Zhejiang Univ Sci B.
2005;6:877 -84.
6. Cowie MR, Jourdain P, Maisel A, Dahlstrom U, Follath F,
Isnard R, et al. Clinical application of B-type natriuretic
peptide (BNP) testing. Eur Heart J. 2003 ;24: 1710-8.
7. Mueller C, Buser P. B- type natriuretic peptide (BNP) : can it
improve our management of patients with congestive heart
failure? Swiss Med Wkly. 2002;132:618-22.
8. Cardarelli R, Lumicao TG. B-type n atriuretic peptide:
a review of its diagnostic, prognostic, and therapeutic
monitoring value in heart failure for primary care physicians.
J Am Board Fam Pract. 2003; 16:327-33.
9. Dao Q, Krisnaswamy P, Kazanegra R, Harrison A, Amirnovin
R, Lenert L, et al. Utility ofB-type natriuretic peptide in the
diagnosis of congestive heart failure in an urgent-care setting.
186 • Paediatrlndones, Vol. 53, No. 3, May 2013
J Am Coll Cardiol. 2001;37:379-85.
10. Ghasemi A, Pandya S, Reddy SV, Turner DR, Wei D,
Navabi MA, et al. Trans-catheter closure of patent ductus
arteriosus~what is the best device? Cathet Cardiovasc
Intervent. 2010;76:687-95.
11. Giroud JM, Jacobs JP. Evolution of strategies for management
of the patent arterial duct. Cardiol Young. 2007;17:68-74.
12. G. Butera G, De Rosa G, Chessa M, Piazza L, Delogu A,
Frigiola A, et al. Transcatheter closure of persistent ductus
arteriosus with the Amplatzer duct occluder in very young
symptomatic children. Heart. 2004;90:1467-70
13. Pass RH, Hijazi ZM, Hsu DT, Lewis V, Hellenbrand WE.
Multicenter USA Amplatzer patent ductus arteriosus
occlusion device trial. Initial and one-year results. J Am Coll
Cardiol. 2004;44:513-9.
14. Ross RD, Bollinger RO, Pinsky WW. Grading severity
of congenital heart failure in infants. Pediatr Cardiol.
1992;13:72-5.
15. Altman CA, Kung G. Clinical recognition of congenital
heart disease in children. In: Chang AC, TowbinJA, editors.
Heart failure in children and young adults from molecular
mechanisms to medical and surgical strategies. Philadelphia:
Saunders; 2006. p. 201-10.
16. Robertson DA, Silverman NH. Color Doppler flow mapping
of the pat ent ductus arteriosus in very low birthweight
neonates: echocardiograpic and clinical finding. Pediatr
Cardiol. 1994; 15 :219-24.
17. Su BH, Wat anabe T, Shimizu M, Yanagisawa M. Echocardiographic
assessment of patent ductus arteriosus
shunt flow pattern in premature infants. Atch Dis Child.
1997;77:F36-F40.
18. Eidem BW Echocardiographic quantitation of ventricular
function. In: Chang AC, Towbin JA, editors. Heart failure
in children and young adults from molecular mechanisms
to medical and surgical strategies. Philadelphia: Saunders;
2006. p. 140-54.
Published
2013-06-30
How to Cite
1.
Djer M, Sastroasmoro S, Madiyono B. Heart size, heart function, and plasma B-type natriuretic peptide levels after transcatheter closure of patent ductus arteriosus. PI [Internet]. 30Jun.2013 [cited 29Apr.2024];53(3):181-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/278
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-06-30
Accepted 2016-08-21
Published 2013-06-30
