Predictive Echocardiographic Parameters for Persistent Mitral Regurgitation Following Percutaneous Closure of Patent Ductus Arteriosus in Pediatric Population

Background Hemodynamically significant patent ductus arteriosus (hsPDA) leads to left‐sided chamber dilatation and mitral valve (MV) annular stretching, potentially resulting in mitral regurgitation (MR). While transcatheter PDA closure often improves MR, persistent MR may be associated with adverse outcomes. This study aimed to identify echocardiographic predictors of persistent MR following transcatheter PDA closure in pediatric patients. Methods We conducted a retrospective study of 183 pediatric patients (aged 1–18 years) who underwent transcatheter PDA closure at Seoul National University Hospital between 2004 and 2021. Echocardiographic parameters, including left ventricular internal diameter in diastole (LVIDd), MV annulus diameter, and MR severity were analyzed before and after the procedure. Cardiac catheterization data were also reviewed. Results The mean age at the time of the procedure was 1.92 years, and the average pulmonic end diameter of PDA was 2.91 mm. After transcatheter PDA closure, LVIDd (Z‐score), LVIDd/BSA, and MV annulus (Z‐score) significantly decreased. The prevalence of MR decreased from 22.4% (preclosure) to 8.2% (postclosure). Multivariate analysis identified preclosure LVIDd (Z‐score), postclosure MV annulus diameter (mm), MV annulus (Z‐score), and the presence of MV prolapse as independent predictors of persistent MR. ROC analysis demonstrated that a preclosure LVIDd (Z‐score) ≥ 2.95 predicted persistent MR with a sensitivity of 66.7% and a specificity of 83.9%. Conclusions Persistent MR after transcatheter PDA closure is predicted by preclosure LVIDd (Z‐score), postclosure MV annulus diameter, and the presence of MV prolapse. Recognizing these factors may help guide clinical management and improve outcomes for patients at the risk of persistent MR.