A new perspective on aortic pressure for transcatheter closure of patent ductus arteriosus in the pediatric population.

Abstract

Background: Hemodynamic assessment is not routinely performed when closing a patent ductus arteriosus (PDA). Significant PDA flow causes a drop in the aortic pressure distal to the shunt. Closure of PDA should increase distal systemic blood flow and significantly elevate distal aortic pressure, changing the systolic pressure gradient (ΔP) between the proximal and distal aorta. However, this phenomenon has yet to be studied.

Aims: This study aimed to analyze the influence of PDA closure on the difference of the aortic pressures proximal versus distal to the shunt.

Methods: A registry included 50 consecutive children who had undergone PDA closure in the years 2022-2023. A simplified hemodynamic assessment was regularly performed by measuring blood pressure in the ascending and descending aorta, with a ΔP calculated before and after the procedure.

Results: Following PDA closure, ΔP between the ascending and descending aorta improved in 54% of patients, remained unchanged in 16%, and worsened in 30%. Abnormal mean (SD) ΔP was observed before the procedure (85.06 [10.22] mm Hg vs. 83.72 [10.47] mm Hg; P = 0.004) with a marked improvement after the intervention (80.64 [9.82] mm Hg vs. 79.72 [9.9] mm Hg; P = 0.24). A significant ΔP improvement was observed after PDA closure (P = 0.02).

Conclusions: Simple pressure measurements may help to understand the hemodynamic changes during PDA closure. Restoration of physiological pressure in the distal and proximal aorta was observed in most patients but not all. Further studies are needed to better understand the hemodynamics during PDA closure.