Outcomes of Transcatheter Occlusion of Patent Ductus Arteriosus in Infants Weighing ≤6 kg

Dimas, Vasiliki V; Takao, Cheryl; Ing, Frank F.; Mattamal, Raphael; Nugent, Alan; Grifka, Ronald G.; Mullins, Charles E.; Justino, Henri

doi:10.1016/j.jcin.2010.08.022

Cited by 77 publications

(80 citation statements)

References 12 publications

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“…Evidence on the risks of drug therapy or surgical PDA ligation26, 27 has led to growing interest in the use of percutaneous closure in premature infants 10, 15, 16, 28, 29, 30. The main finding of our 10‐year study is that, among a large cohort of infants born very premature and referred for percutaneous closure at weights <4 kg, the majority are successfully closed in the catheterization suite with evidence of improved pulmonary status following closure, but risk of arterial injury in these infants is noteworthy.…”

Section: Discussionmentioning

confidence: 99%

“…Although investigators have reported that percutaneous closure of the PDA is the procedure of choice among infants ≥4 kg,10 the lower limit for safe closure remains unknown. While 4 kg as a weight‐cutoff is not evidence based, previous studies have excluded preterm infants <4 kg or reported no cases of percutaneous PDA closure below this weight threshold 11, 12, 13, 14.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Backes

Cheatham

Deyo

et al. 2016

JAHA

109

111

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BackgroundPercutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg.Methods and ResultsRetrospective analysis (January 2005–January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2–3.9 kg) underwent attempted PDA closure. Twenty‐five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01).ConclusionsAmong infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Backes

Cheatham

Deyo

et al. 2016

JAHA

109

111

View full text Add to dashboard Cite

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“…Food And Drug Administration of USA has approved Amplatzer duct occluder (ADO) for pediatric patients with weight !6 kg. 5 The most important factors determining the success of PDA device closure are the weight of the baby, ductal size and anatomy, and the availability of suitable hardware. 6 Because of less complications, comparable success rates, less invasiveness, availability of suitable devices as compared to surgical ligation, PDA device closure is rapidly becoming a popular method in low weight for age pediatric patients with PDA which has favorable anatomy for device closure as in our case.…”

Section: Discussionmentioning

confidence: 99%

Transcathater percutaneous device closure of a large PDA closed in a 3 kg infant

Bansal

Prabhu

Ware

et al. 2014

Indian Heart Journal

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Patent ductus arteriosus (PDA) is common congenital heart disease which may require treatment as transcatheter percutaneous device closure (PDA device closure) or surgical ligation in symptomatic full-term patients. Surgical ligation is an invasive procedure and has more complications especially in the neonates. Problems in PDA device closure are difficult vascular access, manipulation of catheters and sheath, residual shunts, residual obstruction of major arteries etc and these complications increase in low birth weight babies, but it is a less invasive procedure and has fewer complications than surgery, so should be tried in low birth weight patients also. We are presenting a case of 3 kg infant with large PDA (8 mm) presented with failure to thrive, lower respiratory tract infection and heart failure. He successfully underwent PDA device closure with 10 × 12 mm Cocoon PDA device. To the best of our knowledge, this is the first case of the use of such a large device in a 3 kg child with good results.

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“…The Nitocclud coil was originally designed for closure of the PDA and normally results in closure rates of 94% in neonatal PDAs [4]. Its attractive diabolo-like shape and its soft recoil of the nitinol wire, which causes only minimal pressure on the surrounding tissue, were the reasons why it was chosen for the reported patient.…”

Section: Discussionmentioning

confidence: 99%

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

Burkamp

Ghisla²,

Knirsch

et al. 2012

Pediatr Cardiol

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Right pulmonary artery-to-left atrial communication is a rare congenital vascular malformation that results in a right-to-left shunting. This report describes the case history of a neonate with a large right pulmonary artery-to-left atrial connection resulting in cyanosis and severe heart failure who underwent successful early catheter interventional therapy. In the neonate, this lesion can be diagnosed accurately using transthoracic echocardiography. Closure of the communication can be achieved even in infants via percutaneous interventional catheterization with a low procedure-related risk and a good midterm follow-up result.Keywords Catheter interventional therapy Á Congenital heart defect Á Pulmonary artery-to-left atrium communication Á Neonate One-third of neonatal cyanosis cases are caused by congenital heart defects and it is important to differentiate them from pulmonary disease or persistent fetal circulation [5]. Right pulmonary artery (RPA)-to-left atrium (LA) communication involves a direct connection between the pulmonary artery and the pulmonary vein or LA [11] and is a very uncommon cause of right-to-left shunting. This pathologic vascular communication results in a large shunting of venous blood to the arterial side, leading to both cyanosis and volume overload. Case ReportA female term neonate with a birth weight of 3 kg and 620 g presented 14 h postnatally with central cyanosis and clinical signs of respiratory distress. An echocardiogram showed a large RPA-LA communication from the proximal RPA to the roof of the LA (Fig. 1). The LA and the left ventricle were dilated, and left ventricular function was impaired (ejection fraction, 33%).The patient's condition improved and stabilized after initiation of continuous epinephrine and milrinone administered intravenously. After 6 days, cardiac catheterization was performed with the patient under general anesthesia via a transfemoral venous approach using a 5-Fr introducer sheath. The size and anatomy of the fistula were identified and measured by a selective pulmonary angiogram (Fig. 2).Due to the shunt volume, the diameter of the proximal RPA was double that of the left pulmonary artery. The fistula itself measured 9-mm at the pulmonary end, narrowed to 2.2-mm, and widened again to 9-mm at the atrial end at the roof of the LA.The communication was entered from the pulmonary arterial side with an 0.018 in. wire. Through the 5-Fr sheath and across the wire, a flexible introducer catheter was advanced into the fistula. Successful closure then was performed with a detachable patent arterial duct (PDA) coil (7 9 6-mm, Nit-Occlud; pfm, Cologne, Germany) from the pulmonary arterial side. Three loops of the coil were placed into the LA, and the remaining loops were placed into the fistula and the RPA.After confirmation that the positioning of the device was stable and the flow of the RPA and LA was unimpaired (via a contrast injection through the introducer catheter and a transthoracic echocardiography), the coil was released. A final angiogram s...

show abstract

Outcomes of Transcatheter Occlusion of Patent Ductus Arteriosus in Infants Weighing ≤6 kg

Abstract: Percutaneous closure of PDA should be considered even in infants ≤6 kg.

Cited by 77 publications

References 12 publications

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Transcathater percutaneous device closure of a large PDA closed in a 3 kg infant

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

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