Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience

Abstract

Objective Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. Design The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. Setting A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Patients To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure‐related complications. Interventions It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Outcome measures This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. Results There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure‐related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. Conclusions It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

“…The 3Fcatheter is positioned in the descending aorta. Sathanandam et al have reported a similar technique using a 4Fr angled glide catheter (Terumo, Japan) and a 0.035 Wholey wire (Medtronic, Minneapolis, MN, USA) to cross the PDA antegradely into the descending aorta (59). Other teams have used 4Fr Swan Ganz catheter instead of catheters described above (43).…”

PDA Closure in ELBW Infants: If, When, and How to Do It

“…Transcatheter therapy has evolved significantly in the last decade. Emerging technology has paved the way for the use of this therapy in smaller and smaller infants [34,35]. The Amplatzer Piccolo Occluder (Abbott Structural Heart, Plymouth, MN, USA) is a self-expandable, Nitinol mesh device with a central cylindrical waist and low-profile retention discs that are marginally larger than the waist, resulting in a nearly isodiametric device.…”

“…• Arterial access in these small patients is very likely to cause damage leading to limb ischemia and should be avoided [34,38]. Instead, antegrade access through the femoral vein is the method of choice.…”

“…• The central waist of the APO is designed to fill the ductal lumen, and the retention discs are designed to deploy in the pulmonary and the aortic ends of the PDA. However, when treating small infants, especially those ≤2 kg, implantation of both retention discs completely within the duct (intraductal placement) to avoid protrusion into the aorta or the LPA (Figure 4) is essential to avoid inadvertent stenosis of these vessels by the device discs [24,34,40].…”

“…• Minimization of contrast dosing, intracardiac catheter manipulation, and unnecessary hemodynamic measurements that prolong procedure time are recommended to achieve optimal outcomes [24,34,40].…”