Device Closure of Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Abstract

The patent ductus arteriosus is a very common condition in preterm infants, and a hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. However, despite numerous randomized controlled trials, there is no consensus regarding management. Medical therapy is typically offered as first-line treatment, although it yields limited success and carries the potential for severe adverse events. In recent years, there has been rapid development in transcatheter patent ductus arteriosus closure primary with the use of the Amplatzer Piccolo Occluder, and this has gained widespread acceptance as a safe and effective alternative to surgical ligation in extremely low-birth-weight infants weighing over 700 g. This article aims to provide an appraisal of the patient selection process, a step-by-step procedural guide, and a comprehensive review of the outcomes associated with this approach. • Surgical ligation has traditionally been the standard of care for hemodynamically significant patent ductus arteriosus in extremely low-birth-weight premature infants. However, transcatheter closure is emerging as a safe and effective alternative in experienced centers. • Optimal patient selection and management requires multidisciplinary involvement. • The procedure relies on close collaboration between the interventionalist and the sonographer performing the transthoracic echocardiogram, as it is essential in confirming the indication for closure, choosing the right device and guiding appropriate device placement. • Modified techniques including bedside procedures and fluoroscopy-free approaches, combined with the increasing expertise of interventionalists and echocardiographers, will further enhance the safety and broaden the application of transcatheter patent ductus arteriosus closure in these extremely vulnerable patients.

Topics & Concepts