ABSTRACT
The hemodynamic effects of a patent ductus arteriosus (PDA) are well known including systemic hypoperfusion and volume overload on the left ventricle. This article aims to provide a review of the long-standing effect of a hemodynamically significant PDA on the pulmonary vasculature and the role of cardiac catheterization in preterm infants with a PDA and pulmonary hypertension.
Subject(s)
Ductus Arteriosus, Patent/physiopathology , Hypertension, Pulmonary/physiopathology , Infant, Premature , Pulmonary Artery/physiopathology , Pulmonary Circulation/physiology , Vascular Resistance/physiology , Cardiac Catheterization , Ductus Arteriosus, Patent/complications , Ductus Arteriosus, Patent/diagnosis , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Infant , Infant, NewbornABSTRACT
BACKGROUND: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. METHODS: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. RESULTS: Eighty ELBW infants (median procedure weight: 1060 [range 640-2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650-1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2-9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5-4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. CONCLUSIONS: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.
Subject(s)
Cardiac Catheterization , Cardiac Surgical Procedures , Ductus Arteriosus, Patent/therapy , Infant, Extremely Low Birth Weight , Birth Weight , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cardiac Surgical Procedures/adverse effects , Ductus Arteriosus, Patent/diagnostic imaging , Ductus Arteriosus, Patent/physiopathology , Female , Hemodynamics , Humans , Infant , Infant, Newborn , Ligation , Lung/physiopathology , Male , Respiration , Respiration, Artificial , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Ventilator WeaningABSTRACT
OBJECTIVES: The primary aim of this study was to compare thermodilution (TD) cardiac index (TDCi) measured by injecting cold saline (C-TDCi) to saline at room temperature (R-TDCi). The secondary aim was to assess the change in body temperature with cold saline injections in children. DESIGN: This is a prospective, case control study. SETTING: Cardiac catheterization lab at Le Bonheur Children's Hospital, Memphis, Tennessee. PATIENTS: Eighty-six children ≤18 years of age that underwent cardiac catheterization between April 2013 and April 2015, excluding patients with admixing lesions, on inotropic support and with ejection fraction < 30%. INTERVENTIONS: A TD catheter in the main pulmonary artery was used to measure cardiac output (CO). Each patient received manual injections of saline at room temperature followed by cold saline to calculate the CO. OUTCOME MEASURES: CO by C-TDCi, R-TDCi, and Fick-Ci were compared using four different statistical methods. RESULTS: R-TDCi and Fick-Ci had a strong linear correlation (rho = 0.91 and 0.77, respectively; P < 0.0001) to C-TDCi. R-TDCi and Fick-Ci also had high 1:1 intra-class correlation to C-TDCi (ICC-rho= 0.82 and 0.68, respectively; P < 0.01). 96% confidence limits by equivalence testing for R-TDCi and Fick-Ci were 0.98-1.02 and 0.96-1.05 respectively (P < 0.0001), when compared to C-TDCi. Mean difference (±SD) calculated by Bland-Altman analysis showed a higher score for R-TDCi (0.012 ± 0.32 L/min/m2 ) compared to Fick-Ci (0.2 ± 0.72 L/min/m2 ), but it was not statistically different (P = 0.25). In a subgroup analysis of children ≤2 years (n = 27), the results from all 3 techniques were equivalent. There was a 0.2 ± 0.16ºC drop in BT compared to a 0.08 ± 0.19ºC drop in those >2 years (P > 0.05). CONCLUSIONS: Cardiac indexes determined by Fick, C-TDCi, and R-TDCi were equivalent in children. Saline at room temperature can be used as an alternative to cold saline to avoid potential drop in body temperature of these patients.
