(Screen 2 - 6:00 PM Friday) Salvage transcatheter ductus arteriosus stenting for acute pediatric pulmonary arterial hypertension is associated with improvement in right ventricular function assessed by echocardiography strain

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Abstract:

Introduction: Interventional therapies for severe, refractory pulmonary arterial hypertension (PAH) can provide right ventricular (RV) decompression and preserve cardiac output. Transcatheter stent placement in a residual ductus arteriosus (PDA) may be a rapid and effective option in critically ill infants and young children with acute PAH. We sought to review our experience with PDA stenting for PAH and recovery of RV function assessed by echocardiographic strain.

Methods: We performed a retrospective chart review of all patients < 2 years-old who underwent ductal stenting for PAH at Boston Children’s Hospital from 2013-2021. Clinical and hemodynamic data were abstracted from the electronic medical record. Total and free wall RV strain was measured on selected images at baseline, 3 months, 6 months and 1-year post-intervention, and at most recent follow-up.

Results: Nine patients underwent attempted transcatheter ductal stenting for PAH at a median age of 38 (14, 571) days and median weight of 3.7 (3.0, 9.5) kg. Prior to the procedure, seven (78%) were intubated, treated with inhaled nitric oxide, and supported with veno-arterial extracorporeal membrane oxygenation (VA ECMO). Four (44%) underwent catheterization with a primary indication for ductal stenting, and 5 (56%) underwent secondary ductal stenting after hemodynamic and angiography assessment. Median PDA length was 10.2 (6.7, 13.6) mm and minimum diameter was 0.72 (0.44, 1.64) mm. One atretic ductus was recannalized. PDA stents were successfully deployed in 8 patients. Of these, 5 (63%) survived to discharge, 1 remains hospitalized and 2 died. Two patients required future redilation of PDA stents and two underwent ductal closure at later interventions. Of the 8 patients, 6 had adequate images to perform both total and free wall RV strain. Median baseline total RV strain was -14.3% and free wall -19.4%. Over time, there was a significant improvement in both total and free wall RV strain after ductal stenting (p < 0.001). (Figure 1 a and b).

Conclusions: In this small cohort, ductal stenting for PAH in critically ill children was associated with significant, sustained improvement in RV function as assessed by strain echocardiography. Ductal stenting may be a successful salvage therapy for the acute treatment of severe, medically-refractory PAH in patients whom have otherwise limited options with potential for RV recovery. Future multicenter studies should address patient selection, short and long term outcomes in larger cohorts.