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

Abstract

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.

Cocoon devices for transcatheter closure of atrial septal defect and patent ductus arteriosus in children

“…Comparing to the number of Amplatzer, Gore Occluder, or Occlutech device implantation, the number of Cocoon device implantation is smaller, and only a few reports are present in the literature, many of them have focused on case reports for difficult cases of ASD associated with coronary anomalies, off-label use of Cocoon duct occluder for ruptured sinus of Valsalva aneurysm, or use of 10/12 mm Cocoon ductal occluder for closure of an 8 mm PDA in a 1-year-old child weighing 3 kg. [ 8 , 12 , 13 ]…”

“…Food and Drug Administration originally limited Amplatzer Duct Occluder use in infants < 6 kg for the risk of iatrogenic obstruction of the descending aorta by the protrusion of the device, together with the risk for other vascular complications. [ 1 , 13 ]…”