208 - Hemodynamic alterations recorded by electrical cardiometry during and after percutaneous closure of ductus arteriosus in preterm infants

Poster Number: 208
Publication Number: 208.220

Ottavio Vitelli, ASST Grande Ospedale Metropolitano Niguarda, Milan, Lombardia, Italy; Italo Gatelli, ASST Grande Ospedale Metropolitano Niguarda, Milan, Lombardia, Italy; Francesca De Rienzo, Grande Ospedale Metropolitano Niguarda, Milan, Lombardia, Italy; Marco Fossati, ASST - Grande Ospedale Metropolitano Niguarda, Milano, Lombardia, Italy; Giuseppe Annoni, Grande Ospedale Metropolitano Niguarda, Milan, Lombardia, Italy; Alice O. Proto, ASST Grande Ospedale Metropolitano Niguarda, Milano, Lombardia, Italy; Stefano Martinelli, ASST Grande Ospedale Metropolitano Niguarda, Milan, Lombardia, Italy

Background: Patent ductus arteriosus closure by catheter-based interventions has become the preferred therapeutic choice. However hemodynamic perturbances associated to this procedure have not yet been investigated.

Objective: This study sought to examine the on-site hemodynamic impact caused by the procedure in preterm neonates.

Design/Methods: This is a single-center, prospective, consecutive, case series study. Five patients who underwent patent ductus arteriosus closure between July 2020 and March 2021 were consecutively enrolled in the Neonatal Intensive Care Unit of the ASST Grande Ospedale Metropolitano Niguarda of Milan.
Hemodynamic parameters have been continuously detected in a non-invasive way using electrical cardiometry before, during and after percutaneous patent ductus arteriosus closing.

Results: The 5 infants with patent ductus arteriosus underwent successful transcatheter closures. All patients experienced immediate hemodynamic changes upon ductal closing. Significative modifications occurred mainly in heart contractility, cardiac output and stroke volume (figure 1). In three cases there was also a significative increase of systemic vascular resistance which persisted for four hours after patent ductus arteriosus closing. While in two case they spontaneously reduced with an amelioration of cardiac output and contractility, in the other case they were persistently high, associated with an hypertensive crisis and a progressive reduction of cardiac functions (Figure 2). For these reasons, milrinone was started and hemodynamic parameters returned normal in about 3 hours, so therapy was discontinued (figure 3).Conclusion(s): Our study demonstrated that abrupt diversion of a ductal shunting contributes to hemodynamic aberrations in infants undergoing patent ductus ateriosus percutaneous closure. Moreover, post procedural hemodynamic monitoring is important in order to precociously detect possible cardiac impairment and start an adequate therapy. Electrical cardiometry, compared to echocardiography has the advantage of being non-invasive, operator-independent and, above all, continuous.
Figure 1. Hemodynamic perturbations at patent ductus arteriosus closing.Graphical representation of cardiac output (CO) , contractility index (ICON) and systemic vascular resistance (SVR) trends values during patent ductus arteriosus closing procedures. The arrow marks the moment of closure
Figure 2. Hemodynamic perturbations during hypertensive crisisGraphical representation of cardiac output (indexed for body weight, CI), contractility index (ICON) and systemic vascular resistance (SVR) trends values at the end of closing procedures. The arrow marks the moment of hypertensive crisis.