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Abstract 11587: Absent Ductus Arteriosus is Relatively Common in Neonates with Symptomatic Tetralogy of Fallot, and Rarely Associated with Critically Deficient Pulmonary Blood Flow at Birth

Authors :
Shiraz A Maskatia
Andrew C Glatz
Bryan H Goldstein
Athar M Qureshi
Jeffrey Zampi
Courtney McCracken
Michael Kelleman
George Nicholson
Jeffery J Meadows
Shabana Shahanavaz
Mark A Law
Sarosh P Batlivala
Joelle Pettus
Christopher Mascio
Paul Chai
Jennifer Romano
Ivor Asztalos
Amy Pajk
Asaad Beshish
Christopher J Petit
Source :
Circulation. 144
Publication Year :
2021
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2021.

Abstract

Introduction: Absent ductus arteriosus (ADA) is a poorly described feature associated with tetralogy of Fallot (TOF). We compare characteristics and outcomes of neonates with symptomatic TOF (sTOF) with ADA to those with a ductus arteriosus (DA). Hypothesis: We hypothesized: neonates with sTOF and ADA would have similar outcomes to those born with a DA, and a small portion of the ADA cohort would have critically-deficient pulmonary blood flow (CDPBF). Methods: Consecutive neonates with sTOF who underwent intervention during the neonatal period from 2005—2017 were identified from the Congenital Cardiac Research Collaborative. Those with DA on echocardiogram performed on the first day of life or on fetal echocardiogram were identified and compared to those with ADA. ADA neonates who required ECMO or intervention to augment PBF on the first day of life were defined as having CDPBF. Patient characteristics and outcomes were compared between DA and ADA groups. Results: Among 519 neonates, 460 (89%) had a DA and 59 (11%) had ADA. ADA neonates were more likely to carry a genetic or syndromic diagnosis, had smaller branch PA sizes, and were more likely to receive a transannular patch compared to those with a DA. Despite this, reintervention rates were similar (data not shown), and there was only a small difference in mortality that did not reach statistical significance. Of ADA neonates, 7/59 (12%) had CDPBF. Compared to ADA neonates without CDPBF, those with CDPBF had lower baseline oxygen saturation (58 vs 87%, p=0.031) and smaller pulmonary valve (PV) annular z-score (-2.9 vs -2.5, p=0.015) with similar reintervention rates and mortality. Conclusion: ADA is relatively common in sTOF. Despite higher rates of comorbidities, mid-term reintervention rates and mortality are similar to those with DA. CDPBF is a rare, high-risk feature of infants with sTOF and ADA. Smaller PV size may be a marker of CDPBF. Future work should focus on prenatal factors to identify fetuses with TOF, ADA and CDPBF.

Details

ISSN :
15244539 and 00097322
Volume :
144
Database :
OpenAIRE
Journal :
Circulation
Accession number :
edsair.doi...........6466ca55bbe290f810f1c976ebcb5750
Full Text :
https://doi.org/10.1161/circ.144.suppl_1.11587