Cardiovascular Journal of Africa: Vol 30 No 3 (May/June 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019 AFRICA 151
Effect of time delay of PDA closure on the aortic
stiffness index and its relationship with cardiac function
Saud M Elsaughier, Ramadan Ghaleb, Hossam Mansour
Abstract
Background: Patent ductus arteriosus (PDA) causes volume
overload of the left side of the heart. Stiffening in the larger
central arterial system, such as the aortic tree, significantly
contributes to cardiovascular diseases in older individuals
and is positively associated with systolic hypertension and
coronary artery disease. In this study, we evaluated the effect
of time delay of PDA closure on aortic stiffness and its rela-
tionship with cardiac function before and after transcatheter
closure of the PDA.
Methods: Our study population consisted of 60 children who
were scheduled for transcatheter closure of the PDA. They
were divided into two groups as follows: group A in whom
PDA closure was performed before the age of one year, and
group B in whom PDA closure was performed after the age
of one year.
Results: Before PDA closure, the aortic stiffness index (ASI)
was significantly higher in children in group B than in those
in group A ( p < 0.001), and was it significantly higher in both
groups than in the control group (p < 0.001).
Conclusion: Aortic stiffness was significantly elevated in
patients with PDA, even small-sized PDAs, and was associ-
ated with impairment in cardiac function, particularly if PDA
closure was delayed after the age of one year.
Keywords: PDA closure, aortic stiffness index, cardiac function
Submitted 3/4/18, accepted 15/1/19
Published online 24/5/19
Cardiovasc J Afr 2019; 30: 151–156
DOI: 10.5830/CVJA-2019-005
Patent ductus arteriosus (PDA) causes a volume overload of the
left half of the heart, which leads to pulmonary hypertension.
The planning of treatment for congenital heart imperfections
depends on the haemodynamic reflection of chamber
renovation.1 Accordingly, it is vital to have numerous techniques
accessible for development. Clinical examination, chest X-ray,
electrocardiogram (ECG), blood vessel saturation (upper and
lower limbs) and echocardiography are indisputable in evaluating
the operability in the majority of patients with PDA.
Notwithstanding, the choice to intercede is troublesome if the
outcomes are obscure. Hardening in the larger focal blood vessel
framework, for example the aortic tree, essentially adds to the
development of cardiovascular disorders in older individuals and
is emphatically connected with systolic hypertension, coronary
artery disease, stroke, heart failure and atrial fibrillation,
which are the most frequent causes of mortality in low-income
countries, as assessed by the World Health Organisation in 2010.
Consequently, not necessarily intrusive measures, but rather
more exact measures of aortic stiffness have been created, which
are valuable as diagnostic indices, pathophysiological markers
and predictive indicators of disease.2
In this study, we attempted to assess the impact of time
postponement of PDA closure on aortic stiffness and its
connection with cardiac function prior and subsequent to the
transcatheter closure of PDA, and to utilise the aortic stiffness
index (ASI) as a tool for assessing patients with PDA.
Methods
Our study population consisted of 60 children who were
scheduled for transcatheter closure of PDA. They were split
into two groups as follows: group A in whom PDA closure was
performed before the age of one year, and group B in whom PDA
closure was performed after one year of age. The control group
consisted of 60 healthy children. All patients had clinical and
echocardiographic proof of haemodynamically notable PDA.
Patients with silent PDA, PDA not practical for percutaneous
closure, irreversible pulmonary vascular disease [pulmonary
vascular resistance index (PVRI) > 7 WU/m2], and individuals
who had related haemodynamically notable congenital
cardiovascular disease or a significant remaining shunt were
excluded from the study.
Control subjects were observed once. They were asymptomatic
and demonstrated no abnormalities on clinical examination,
ECG or echocardiography.
Tissue Doppler imaging (TDI) and transthoracic
two-dimensional echocardiography were performed on an
out-patient basis with the patient in the supine position, utilising
Philips IE with S8-3- and X5-1-MHz transducers at baseline, one
day after the procedure and at follow up (no less than six months
after the procedure).
Left ventricular (LV) systolic malfunction was characterised
post-PDA closure as a LV ejection fraction (LVEF) of < 50% or
a potential decline in LVEF of 10% from baseline.
For non-invasive assessment of aortic stiffness, the transverse
relocation of the aorticwall wasmeasuredwith available hardware
(Philips IE 33 utilising S8-3- and X5-1-MHz transducers).
The ascending aorta was recorded in two-dimensional, guided
M-mode tracings. The aortic width was recorded using M-mode
echocardiogram at a level of 3 cm over the aortic valve. The
interior aortic widths were measured using calliper methods in
systole and diastole as the separation between the trailing edge
of the front aortic wall and the main edge of the back aortic wall.
The aortic systolic diameter (AoSD) was measured at the time
Cardiology Department, Aswan University, Egypt
Saud M Elsaughier, MD,
Ramadan Ghaleb, MD
Hossam Mansour, MD