Factors influencing diagnostic discrepancy between preoperative transthoracic echocardiography and cardiovascular angiography in patent ductus arteriosus intervention: a multicenter retrospective study

Introduction Discrepancies between transthoracic echocardiography (TTE) and angiocardiography in assessing patent ductus arteriosus (PDA) dimensions may impact transcatheter closure outcomes. Methods This multicenter retrospective study included 216 pediatric patients who underwent PDA closure, aiming to evaluate the prevalence and predictors of TTE-angiocardiography measurement discrepancy (defined as ≥0.5 mm difference). Results 45.4% of patients exhibited significant discrepancy. Multivariate analysis identified tubular PDA morphology (OR = 2.71, P = 0.004), small PDA size (<2.5 mm, OR = 3.42, p < 0.001), preterm birth (OR = 2.87, p = 0.003), growth retardation (OR = 2.19, p = 0.022), and abnormal ECG, chest x-ray, or cardiac enzymes (ORs: 1.96–2.05, all p < 0.05) as independent predictors. Measurement agreement was highest for funnel-type and larger PDAs. Dsicussion Nearly half of pediatric PDA cases show clinically relevant TTE-angiography discordance, particularly in patients with tubular morphology, small size, prematurity, or systemic abnormalities. These factors should prompt cautious interpretation of TTE and consideration of intraoperative angiographic confirmation to optimize device selection and procedural success.