Abstract 12270: The Evolution of Tricuspid Regurgitation After Percutaneous Patent Ductus Arteriosus Closure in Ex-Preterm Infants Under 2 Kilograms

Objective: To evaluate incidence and evolution of new tricuspid regurgitation (TR) after percutaneous patent ductus arteriosus (PDA) closure in preterm infants under 2 kg. Background: Multiple advances in techniques and technology in cardiac catheterization have facilitated percutaneous closure of neonatal PDAs. A higher rate of complications has been suspected in this setting, but robust scientific evidence concerning this association is not yet available. TR has been a recognized significant complication, gaining notoriety with the use of the Piccolo device over the last few years. Methods: We performed a single-center retrospective cohort study. We included 29 patients under 2 kg who underwent percutaneous PDA closure between January 2019 and December 2020. This cohort was then matched with a control group of sub 2 Kg patients who did not have percutaneous PDA closure at a ratio of 2:1 (n=58). Echocardiographic data points were collected prior to catheterization and at intervals up to 1-year post-procedure. To standardize the temporal change in TR, we measured the zone of convergence and normalized it with the body surface area related to time. Results: TR after percutaneous PDA closure was seen in 9 cases (31.1%), of which 8 cases were classified as mild-to-moderate (27.6%) and 1 case as severe (3.4%). At the end of follow-up, TR persisted in 5/9 cases (17.2%); however, no increases in TR, clinical complications, or need for reintervention were noted for these patients. In the control group of 58, we incidentally noted two patient with moderate to severe TR which diminished over time. Compared to the control group, our cohort did not present significant difference in terms of survival or weight gain characteristics. Conclusions: TR remains a worrying likely mechanical consequence of catheter and device manipulation in percutaneous preemie duct closure. We should strive to decrease such complications by technical and procedural improvement. Despite this, no patient in our cohort has required specific medical or surgical reintervention for TR, and the echocardiographic trend is tending towards a decreasing grade of TR over time.