The Incidence, Severity and Clinical Consequence of Left Pulmonary Artery Stenosis After PDA Device Closure in Premature Infants Less Than 2 Kilograms

BACKGROUND: Transcatheter patent ductus arteriosus (PDA) device closure is an effective treatment option for premature infants with hemodynamically significant PDA. Left pulmonary artery (LPA) stenosis has been reported as a complication, however there is limited data on risk factors, clinical significance, and long-term outcomes. We aim to determine the incidence of LPA stenosis after transcatheter PDA closure in premature infants, describe anatomic factors associated with LPA stenosis, and evaluate the impact of LPA stenosis on pulmonary artery growth and re-interventions over time. METHODS: Single center retrospective cohort study of 116 premature infants who underwent transcatheter PDA closure while less than 2 kg. Clinical, angiographic and serial echocardiographic data were collected to determine the presence, severity, and clinical impact of LPA stenosis. Patient factors associated with the occurrence of LPA stenosis were evaluated using standard descriptive statistics. RESULTS: LPA stenosis occurred in 43 of 116 patients (37%) within 1 day post-procedure, though none had severe stenosis precluding device placement. At the most recent follow-up (median 7.9 months), the degree of LPA stenosis improved in nearly all patients. Only one patient developed late, severe LPA stenosis related to device embolization post-procedure. LPA stenosis was not associated with patient or procedural factors, and the presence of LPA stenosis was not associated with worse LPA growth. CONCLUSION: LPA stenosis is common after PDA device closure in premature infants but was infrequently associated with persistent obstruction or the need for intervention during the available follow-up period. Most cases resolved over time without adverse impact, suggesting that its presence should not preclude device closure in this high-risk group.