A small angle of shunting and detectable shunting inlet may predict successful exclusive transvenous closure of patent ductus arteriosus with a 3-year follow-up

Background The transvenous V-method simplifies transcatheter patent ductus arteriosus (PDA) closure compared with the arteriovenous (AV) method and retrograde transarterial coil occlusion, with fewer complications, but it carries variable failure rates. This study aimed to identify preoperative transthoracic echocardiography (TTE) predictors for V-method failure and establish a practical model to optimize procedural strategies. Methods A total of 403 consecutive patients undergoing transcatheter PDA closure in Fujian Medical University Union Hospital between October 2014 and July 2019 were retrospectively enrolled and randomly split to training ( n = 282) and internal validation ( n = 121) cohorts at a 7:3 ratio. LASSO regression was performed to screen independent predictors. Model performance was validated via ROC, calibration and decision curve analysis. All patients received standardized 3-year postoperative follow-up. Results Overall, 323 patients completed V-method closure, and 80 converted to the AV-method. The median age was 7 years (6 months-73 years) and an average PDA size of 4.43 mm (1.0mm–14.5 mm). Large shunt angle (defined as shunt beam–PDA inlet plane angle; A larger angle may indicate more perpendicular insertion to the pulmonary artery wall) and undetectable PDA shunting inlet on preoperative TTE were independent predictors of V-method failure. The dual-index model achieved excellent predictive performance with AUCs of 0.933 (training) and 0.910 (validation), along with favorable calibration and clinical net benefit. The optimal cut-off value for the model was defined as an undetectable PDA shunting inlet or a shunt angle > 81.61°, with a sensitivity of 89.5% and a specificity of 96.4%. At 3-year follow-up, no signal of excess harm was detected in either group. Conclusion A small angle of shunting and detectable shunting inlet by echocardiography may predict successful exclusive transvenous PDA closure. The 3-year follow-up suggested the safety and efficacy of the exclusive transvenous access.