Minimizing tricuspid valve damage during neonatal patent ductus arteriosus closure by implementing a change in procedural technique.

OBJECTIVE: This study aims to document the progression of tricuspid regurgitation (TR) following percutaneous patent ductus arteriosus (PDA) closure in preterm neonates weighing <2 kg following an institutional change in procedural technique. MATERIALS AND METHODS: Before June 1, 2021, the tricuspid valve was crossed with a glide catheter and glide wire. As of June 1, the tricuspid valve was crossed with a diagnostic catheter, microcatheter, and floppy 0.014" wire. This retrospective single-center chart review of the progression of TR in ex-preterm infants weighing <2 kg following percutaneous PDA closure included cases from January 2019 to December 2022. Echocardiograms completed prior to and following the procedure were graded, and a comparison was made between the progression of TR in the old technique group (control) and the new technique group (treatment). RESULTS: There were 58 patients who met the criteria during the study period. Median weight was 1.2 kg in the control group and 1.29 kg in the treatment group. The rate of TR progression was 32% (10/31) in the control group and 7% (2/27) in the treatment group. Both cases in the treatment group were progression from none/trivial to mild TR. Of the 10 cases that demonstrated progression in the control group, 4 progressed from none/trivial to mild and 6 progressed from none/trivial to moderate (P= 0.026). CONCLUSIONS: Despite the small sample size, this change in technique does demonstrate less progression in TR. Further studies are warranted to assess the longitudinal natural history of TR caused by trauma during neonatal duct closure.