B-19 | Percutaneous Transcatheter Closure Of Patent Ductus Arteriosus In Premature Neonates – The Role Of Echocardiography To Predict Post Ligation Syndrome

Patent ductus arteriosus (PDA) is the most common cardiovascular abnormality in extremely premature neonates. PDA can be closed by medications, surgical ligation, or transcatheter device closure. Surgical ligation for PDA is associated with substantial complications. Recently, transcatheter PDA (cath) closure is increasingly used. Cath closure has been demonstrated to have less complications with shorter recovery time. Cardiorespiratory compromise in the first 24 hours after closure of PDA is known as post-ligation syndrome (PLS). It manifests as hypotension requiring inotropic support, and respiratory failure with escalation of ventilatory support and/or supplemental oxygen. PLS has immediate mortality risks. ∼ 45% of surgical ligation patients developed PLS. Prophylactic inotropes have been used to minimize PLS. Cath closure PLS incidence is not well described. We aim to identify incidence and predictive factors using echocardiographic data in premature neonates who had cath closure. This was a retrospective study of all preterm neonates with cath closure at our institution from August 2018 to December 2022. Demographic and echocardiographic data were obtained. Cardiac output was calculated from echo recordings. These parameters were reviewed to investigate the relationship between myocardial function and post-closure cardiorespiratory instability. We performed comparative evaluation between those with and without PLS. Of 59 cases, 3 (5%) had PLS. There was no significant difference in cardiac output before and after cath closure between the group of neonates with and without PLS. Cath closure has low incidence of PLS. Contrary to previous studies, cardiac output did not predict those who developed PLS. Our data does not support prophylactic inotropes in neonates who had low cardiac output by echo after cath closure. We hypothesize there are other factors that lead to development of PLS that may warrant further study to prevent PLS.