Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants

Abstract

(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients' data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.

Keywords: arterial duct; closure; premature.

Figure 1

Study flow chart.

Figure 2

(A) PDA and aortic isthmus at the beginning of the procedure. Arrow is the F-type large PDA. (B) Protrusion of the device in the aorta occluding the isthmus. (C) Aortic isthmus and PDA spasm persisting after removal of the device. (D) Typical coarctation flow with diastolic run off on the isthmus after removal of the device.