Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. PDA-Stenting
2.3. Medical Variables
2.4. Statistics
3. Results
3.1. Patients and Cardiac Diagnoses
3.2. Management of Intravenous Prostaglandin E1
3.3. Short-Term Follow-Up
3.3.1. PDA-Stenting
3.3.2. Stent Complications
3.4. Mid-Term Follow-Up
3.4.1. Interstage Period
3.4.2. Catheter Re-Interventions
3.4.3. Somatic and Pulmonary Artery Growth
3.4.4. Subsequent Surgical Procedures
3.4.5. Neurodevelopmental Outcome and Head Circumference
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patients (n=, %) | 26 (100) |
---|---|
Age at PDA-stenting (days) | 7 (4–10) |
Male (n=) | 17 (65) |
Weight (kg) | 3.3 (2.9–3.6) |
Body surface area (m2) | 0.21 (0.20–0.23) |
Gestational age (weeks) | 38.3 (37.6–39.0) |
Pre-term (n=) | 4 (15) |
Cardiac diagnosis (n=, %) | |
Univentricular CHD | 10 (38) |
Pulmonary atresia with VSD (n=) | 2 (8) |
Pulmonary atresia with intact ventricular septum (n=) | 5 (19) |
Tricuspid atresia (n=) | 1 (4) |
Ebstein anomaly (n=) | 1 (4) |
Double outlet right ventricle (VSD type) (n=) | 1 (4) |
Biventricular CHD | 16 (62) |
Tetralogy of Fallot (n=) | 5 (19) |
Pulmonary atresia with VSD (n=) | 7 (27) |
Pulmonary atresia with VSD and aorto-pulmonary collaterals (n=) | 1 (4) |
Left pulmonary artery isolation (n=) | 2 (8) |
Double outlet right ventricle (Fallot type) (n=) | 1 (4) |
Pulmonary perfusion (n=, %) | |
Single supply | 19 (73) |
Double supply | 7 (27) |
Discharged (n = 14) | Non-Discharged (n = 9) | p | |
---|---|---|---|
Sex (male) | 12/14 (86) | 4/9 (45) | 0.04 |
Gestational age (w) | 38.5 (37.4–39.4) | 38.1 (37.6–38.6) | 0.62 |
Prematurity (<37 weeks) (n) | 3/14 (21) | 0/9 (0) | 0.15 |
Birth weight (kg) | 3.2 (2.9–3.4) | 3.1 (3.0–3.3) | 0.51 |
Body surface area | 0.21 (0.19–0.21) | 0.20 (0.19–0.21) | 0.99 |
Single pulmonary perfusion (n) | 9/14 (64) | 7/9 (78) | 0.52 |
Genetic syndrome (n) | 3/14 (21) | 3/9 (33) | 0.55 |
Age (d) at stent implantation | 7.5 (6–13) | 6 (4–10) | 0.39 |
Weight (kg) at stent implantation | 3.3 (3–3.7) | 3.3 (3–3.5) | 0.49 |
Length (cm) at stent implantation | 50 (48–52) | 49 (48–51) | 0.39 |
Procedural time (min) | 88 (56–99) | 73 (62–85) | 0.92 |
X-ray time (min) | 18.5 (11.3–26.1) | 22 (16–32) | 0.62 |
X-ray exposure (G/cm2) | 0.71 (0.43–1.28) | 0.7 (0.6–0.9) | 0.66 |
PGE1 before intervention (n) | 10/14 (71) | 9/9 (100) | 0.08 |
Oxygen saturation before intervention (%) | 87 (84–92) | 85 (83–88) | 0.46 |
Oxygen saturation after intervention (%) | 91 (87–94) | 90 (85–90) | 0.48 |
Stents used pro patients (n) | 2 (1–3) | 2 (1–2) | 0.32 |
Ductal tortuosity index: | |||
Tortuosity Index Typ I (n) | 4/14 (28) | 3/9 (33) | 0.82 |
Tortuosity Index Typ II (n) | 5/14 (36) | 2/9 (22) | 0.52 |
Tortuosity Index Typ III (n) | 5/14 (36) | 4/9 (44) | 0.69 |
Typical duct anatomy (n) | 10/14 (71) | 7/9 (78) | 0.75 |
Atypical duct anatomy (n) | 4/14 (29) | 2/9 (22) | 0.75 |
Thrombosis after intervention(n) | 2/14 (14) | 3/9 (33) | 0.30 |
Anticoagulation: | |||
Change to ASS possible (n) | 14/14 (100) | 7/9 (78) | 0.07 |
Change to ASS after n days (n) | 3.5 (1–6.25) | 1 (1–9.5) | 0.85 |
ICU time (d) | 1 (1–3) | 1 (1–2) | 0.89 |
NEC (y/n) | |||
Bell Stage II: | 1/14 (7) | 1/9 (11) | 0.75 |
Bell Stage III: | 0/14 (0) | 1/9 (11) | 0.22 |
Mortality (n) | 0/14 (0) | 2/9 (22) | 0.07 |
Total hospitalisation time (d) | 18.5 (16–34) | ||
Unplanned surgery (n) | 0/14 (0) | 1/9 (11) | 0.75 |
Interstage (n) | 8/14 (57) | ||
Interstage mortality (n) | 0/14 (0) | ||
Total interstage time (w) | 10 (3.3–14) | ||
Re-interventions (n) | 1/14 (7) | 4/9 (44) | 0.04 |
Time period until surgery (d) | 118 (89.5–132) | 45 (18.5–73) | 0.08 |
Univentricular palliation (n) | 6/14 (43) | 1/7 (7) | 0.29 |
1.5 chamber correction (n) | 2/14 (14) | 0/7 (0) | 0.30 |
Biventricular correction (n) | 6/14 (43) | 6/7 (86) | 0.09 |
Body weight growth (g/d) | 22.6 (20.7–27.2) | 24 (18–27.5) | 0.89 |
Age (Months) | Head Circumference (Percentile) | Neuromotor Findings | Cognitive Assessment Tool | Cognitive Development Quotient or BSID III CCS | Sum Score |
---|---|---|---|---|---|
Univentricular CHD after primary PDA-stenting | |||||
19 | >97 | No pathologies | BSID III | 85 | 0 |
46 | 50–75 | Mild hypotonia | SON 2–8 | 63 | 2 |
26 | 10–25 | No pathologies | Griffith | 85 | 0 |
22 | 10–25 | No pathologies | BSID III | 50 | 2 |
10 | 3–10 | Mild hypotonia | BSID III | 100 | 1 |
Biventricular CHD after primary PDA-stenting | |||||
14 | 50–75 | No pathologies | BSID III | 100 | 0 |
15 | <3 | No pathologies | BSID III | 55 | 2 |
13 | 10–25 | Mild hypotonia | BSID III | 60 | 2 |
15 | no data | CP | BSID III | 60 | 3 |
21 | 50–75 | No pathologies | BSID III | 100 | 0 |
11 | 3–10 | Motor delay (BSID III MCS: 79) | BSID III | 105 | 1 |
12 | 25–50 | No pathologies | BSID III | 115 | 0 |
11 | <3 | Motor delay (BSID III MCS: 61) | BSID III | 70 | 3 |
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Wespi, R.; Callegari, A.; Quandt, D.; Logoteta, J.; von Rhein, M.; Kretschmar, O.; Knirsch, W. Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation. Int. J. Environ. Res. Public Health 2022, 19, 12794. https://doi.org/10.3390/ijerph191912794
Wespi R, Callegari A, Quandt D, Logoteta J, von Rhein M, Kretschmar O, Knirsch W. Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation. International Journal of Environmental Research and Public Health. 2022; 19(19):12794. https://doi.org/10.3390/ijerph191912794
Chicago/Turabian StyleWespi, Regina, Alessia Callegari, Daniel Quandt, Jana Logoteta, Michael von Rhein, Oliver Kretschmar, and Walter Knirsch. 2022. "Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation" International Journal of Environmental Research and Public Health 19, no. 19: 12794. https://doi.org/10.3390/ijerph191912794