Characteristics of Patent Ductus Arteriosus in Congenital Rubella Syndrome

Abstract

This study investigated the characteristics of congenital rubella syndrome (CRS)-associated cardiac complications, particularly patent ductus arteriosus (PDA). We reviewed the medical records of patients with CRS who were admitted to the Children's Hospital 1 in Vietnam between December 2010 and December 2012, and patients with CRS who underwent PDA transcatheter occlusion therapy at the cardiology department between December 2009 and December 2015. We compared the characteristics of PDA treated with transcatheter closure between children with CRS (CRS-PDA) and those without CRS (non-CRS-PDA) who underwent PDA transcatheter closure between July 2014 and December 2015. One-hundred-and-eight children with CRS were enrolled. Cardiac defects (99%), cataracts (72%), and hearing impairment (7%) were detected. Fifty CRS-PDA and 290 non-CRS-PDA patients were examined. CRS-PDA patients had smaller median birthweight (p < 0.001), more frequent pulmonary (p < 0.001) and aortic stenosis (p < 0.001), higher main pulmonary artery pressure, and higher aortic pressure in systole/diastole (p < 0.001 for each) than did non-CRS-PDA patients. The proportion of tubular-type PDA was higher in CRS-PDA patients (16%) than in non-CRS-PDA patients (3%) (p = 0.020). Tubular-type PDA was frequently seen in patients with CRS and accompanied by pulmonary/systemic hypertension and pulmonary/aortic stenosis; in these patients, more cautious device selection is needed for transcatheter PDA closure.

Figure 1

Enrollment flow chart for the study populations. Part 1; a study for characteristics of cases of congenital rubella syndrome, Part 2; a study for patent ductus arteriosus with or without congenital rubella syndrome. Symptoms in Group A; congenital heart disease, cataract(s), glaucoma, and suspected hearing impairment Symptoms in Group B; purpura, jaundice within 24 hours after birth, hepatosplenomegaly, meningoencephalitis, developmental delay, and microcephaly.

Figure 2

Birth months of the children enrolled in this study who received the transcatheter patent ductus arteriosus occlusion therapy with or without congenital rubella syndrome. CRS-PDA; children with congenital rubella syndrome and patent ductus arteriosus treated by transcatheter closure, non-CRS-PDA; children without congenital rubella syndrome and with patent ductus arteriosus treated by transcatheter closure.

Figure 3

Proportion of frequency of each device use for patent ductus arteriosus occlusion in CRS-PDA and non-CRS-PDA. (a) Fischer’s exact test CRS-PDA; children with congenital rubella syndrome and patent ductus arteriosus treated by transcatheter closure, non-CRS-PDA; children without congenital rubella syndrome and with patent ductus arteriosus treated by transcatheter closure, ADO-I type; PDA occluders with retention skirt, ADO-II; Amplatzer™ Duct Occluder II, Others; other occluders including muscular ventricular septal defect occluder, atrial septal defect occluder, coil for ventricular septal defect, and use ADO-II and coil in combination.

Figure 4

Type C PDA with CRS and type A PDA without CRS. (a) Type C PDA of a 24-month-old girl with CRS (a-1) and the closure with a muscular VSD occluder (a-2). (a) Type A PDA of 29-month-old girl (b-1) and the closure with Amplatzer™ Duct Occluder (b-1). PDA; patent ductus arteriosus, CRS; congenital rubella syndrome, VSD; ventricular septal defect.