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. 2022 Sep;119(3):460-467.
doi: 10.36660/abc.20210818.

Percutaneous Closure of Ductus Arteriosus in Preterm Babies: The Initial Brazilian Experience

[Article in English, Portuguese]
João Luiz Langer Manica  1 , Juliana Rodrigues Neves  2 , Raul Arrieta  3 , Pedro Abujamra  4   5 , Raul Ivo Rossi Filho  1 , Luiz Carlos Giuliano  6   7 , Germana Coimbra  3 , Pablo Tomé Teixeirense  8 , João Henrique Aramayo Rossi  1   9 , Rodrigo Nieckel da Costa  10   11 , Salvador André Bavaresco Cristóvão  11   12 , Carlos Pedra  10   13
Affiliations

Percutaneous Closure of Ductus Arteriosus in Preterm Babies: The Initial Brazilian Experience

[Article in English, Portuguese]
João Luiz Langer Manica et al. Arq Bras Cardiol. 2022 Sep.

Abstract
in English, Portuguese

Background: The presence of patent ductus arteriosus can be as high as 50% in preterm babies. Hemodynamically significant patent ductus arteriosus is a common cause of delayed weaning of respiratory support and an important risk factor of necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia in this population.

Objective: The aim of this study is to describe an initial experience of percutaneous closure of the ductus arteriosus in preterm infants weighing less than 2 kg.

Methods: This was a prospective study, comprised of 14 consecutive patients submitted to percutaneous closure of ductus arteriosus between March 2020 and February 2021 in 6 institutions in Brazil.

Results: Mean gestational age was 28.45±3.14 weeks, mean age at the procedure was 38.85±17.35 days and mean weight was 1.41 ±0.41 kg; 79% of the patients were under mechanical ventilation, and 79% had been submitted, on average, to a 1.5 cycle of non-steroidal anti-inflammatory drugs. Most patients were weaned off of mechanical ventilation in a mean of 12.6 ±7.24 days after the procedure. Success rate was 100%. No procedure-related mortality was observed.

Conclusion: This study concluded that percutaneous closure of ductus arteriosus in premature babies below 2 kg has satisfactory results and a low complication rate in this study sample.

Fundamento: A incidência de ductus arteriosus patente (PCA) pode chegar a 50% em pacientes prematuros. Quando hemodinamicamente significativo, pode ser responsável por tempo de ventilação mecânica prolongado, além de importante fator de risco para o aparecimento de enterocolite necrotizante, hemorragia intraventricular e displasia broncopulmonar nessa população.

Objetivo: O objetivo deste estudo é descrever a experiência inicial do fechamento percutâneo de canal arterial em prematuros pesando menos de 2 kg.

Métodos: Trata-se de estudo prospectivo que compreendeu 14 pacientes consecutivos submetidos a fechamento percutâneo de canal arterial de março de 2020 a fevereiro de 2021 em 6 instituições no Brasil.

Resultados: A idade gestacional média ao nascimento foi de 28,45 ±3,14 semanas, a idade média no momento do procedimento foi de 38,85 ±17,35 dias e o peso médio de 1,41±0,41 kg. Dentre os prematuros, 79% necessitavam de ventilação mecânica e 79% tinham feito uso de, em média, 1,5 ciclos de anti-inflamatórios não esteroides. A maioria dos pacientes teve melhora dos parâmetros ventilatórios e o tempo médio de extubação foi de 12,6 ±7,24 dias. A taxa de sucesso foi de 100%. Não houve mortalidade relacionada ao procedimento.

Conclusão: Este estudo concluiu que o fechamento percutâneo do canal arterial em prematuros é uma realidade no Brasil, com resultados satisfatórios e baixa taxa de complicações.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. A) Guia 0`014”cruzando canal arterial inserido através de cateter posicionado no ventrículo direito. B) Microcateter sobre guia 0`014”cruzando o canal arterial e servindo de suporte para subida de sistema de liberação do dispositivo.
Figura 2
Figura 2. Injeção de contraste em posição 90o através do sistema de liberação.
Figura 3
Figura 3. A) Ecocardiograma realizado durante o procedimento com medidas dos diâmetros nas extremidades aórtica e pulmonar e comprimento do canal. B) Ecocardiograma realizado imediatamente após a liberação do dispositivo para descartar lesões residuais como estenoses de artéria pulmonar esquerda ou aorta.
Figura 4
Figura 4. A) Sistema de liberação TorqueVue 4F e dispositivo. B) Dispositivo PiccoloTM de 4 mm de diâmetro nos diferentes comprimentos 2, 4 e 6 mm.
Figure 1
Figure 1. A) 0.014” guide crossing the ductus arteriosus inserted through a catheter placed in the right ventricle. B) Microcatheter on 0.014” guide crossing the ductus arteriosus and serving as support to access the delivery system of the device.
Figure 2
Figure 2. Injection of contrast in a 90° position through the release system.
Figure 3
Figure 3. A) Echocardiogram performed during the procedure, with measures of the diameters in the aortic and pulmonary ends and ductus length. B) Echocardiogram performed immediately after the release of the device so as to dismiss residual injury such as left pulmonary artery or aorta stenosis.
Figure 4
Figure 4. A) TorqueVue 4F delivery system and device. B) 4 mm diameter PiccoloTM device in different lengths 2, 4, and 6 mm.
See this image and copyright information in PMC

References

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