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Review
. 2021 Aug;42(6):1258-1274.
doi: 10.1007/s00246-021-02665-3. Epub 2021 Jun 30.

Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants

Shyam Sathanandam  1 , Dan Gutfinger  2 , Brian Morray  3 , Darren Berman  4 , Matthew Gillespie  5 , Thomas Forbes  6 , Jason N Johnson  7 , Ruchira Garg  8 , Sophie Malekzadeh-Milani  9 , Alain Fraisse  10 , Osman Baspinar  11 , Evan M Zahn  8
Affiliations
Review

Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants

Shyam Sathanandam et al. Pediatr Cardiol. 2021 Aug.

Abstract

Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.

Keywords: Amplatzer Piccolo Occluder; Aortic obstruction; Cardiovascular injury; Device embolization; Device migration; Device protrusion; Pulmonary artery obstruction; Transcatheter PDA closure; Tricuspid regurgitation.

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Conflict of interest statement

Shyam Sathanandam is a proctor/consultant for Abbott. Dan Gutfinger is a full-time employee of Abbott. Brian Morray is a consultant for Medtronic and proctor for Abbott. Darren Berman is a proctor/consultant for Abbott, Edwards, Medtronic. Matthew Gillespie is a proctor/consultant for Abbott, Medtronic. T. Forbes is a proctor/consultant for Abbott, Edwards, AcuNav/Biosence Webster, B. Braun Medical, Siemens, Medtronic. Jason Johnson is a consultant for Abbott. Ruchira Garg is a consultant for Abbott. Sophie Malekzadeh-Milani is a consultant for Abbott. Alain Fraisse is a consultant for Abbott. Osman Baspinar is a consultant for Abbott. Evan Zahn is a consultant/proctor for Abbott, Edwards, Medtronic, National PI ADO II AS IDE Trial and Alterra/S3.

Figures

Fig. 1
Fig. 1
Algorithm to manage device embolization. MPA, main pulmonary artery; LPA, left pulmonary artery; RPA, right pulmonary artery. RV, right ventricle; RA, right atrium
Fig. 2
Fig. 2
Retrieval of device embolization into the main pulmonary artery (A) and right pulmonary artery (B)
Fig. 3
Fig. 3
F-type PDA angiogram in 720-g infant (A) followed by closure using the Amplatzer Piccolo occluder device position relative to temperature probe (B) followed by aortic coarctation seen six hours post implant on echocardiogram (C). Asterisk (*) marks superior edge of aortic disc protruding into aorta
Fig. 4
Fig. 4
Algorithm to manage aortic obstruction (A) and LPA obstruction (B)
Fig. 5
Fig. 5
Device Protrusion Causing Aortic or Left Pulmonary Artery Obstruction. A Extraductal implantation with distal disc projecting into the aorta leading to aortic arch obstruction (ARROW) in a 540-g infant. B Aortic arch obstruction in the infant (A) treated with stent implantation from a carotid approach with no residual stenosis (ARROW). C Extraductal implantation with proximal disc projecting into the LPA (ARROW) leading to LPA stenosis in an 800-g infant (echocardiographic parasternal ductal view). D Intraductal repositioning of the device (ARROW) in the infant (C) with disc no longer causing LPA stenosis
See this image and copyright information in PMC

References

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    1. Sathanandam S, Balduf K, Chilakala S, et al. Role of transcatheter patent ductus arteriosus closure in extremely low birth weight infants. Catheter Cardiovasc Interv. 2019;93(1):89–96. doi: 10.1002/ccd.27808. - DOI - PubMed
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