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Review
. 2024 Aug 24;3(10):101211.
doi: 10.1016/j.jacadv.2024.101211. eCollection 2024 Oct.

Device Closure of Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Alban-Elouen Baruteau  1   2   3   4 , Mathilde Méot  5 , Nadir Benbrik  1 , Céline Grunenwald  1 , Naychi Lwin  1   2 , Juliana Patkai  6 , Jean-Christophe Rozé  2 , Damien Bonnet  5   7 , Sophie Malekzadeh-Milani  5
Affiliations
Review

Device Closure of Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Alban-Elouen Baruteau et al. JACC Adv. .

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.

Keywords: echocardiography; extremely low birth weight infants; outcomes; patent ductus arteriosus; premature infant.

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Conflict of interest statement

Dr Alban-Elouen Baruteau is supported by the French Government as part of the “Investments of the Future” program managed by the National Research Agency (grant reference ANR-16-IDEX-0007); and is a consultant and proctor for Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Transcatheter Closure of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants ELBW = extremely low-birth-weight; IVC = inferior vena cava; PA = pulmonary artery; PDA = patent ductus arteriosus; RA = right atrium.
Figure 1
Figure 1
Pathophysiology and Clinical Consequences of a Hemodynamically Significant Patent DuctusArteriosus in an Extremely Low-Birth-Weight Infant
Figure 2
Figure 2
Patient Clinical Pathway for Case Planning 1Multidisciplinary: pediatric cardiology, neonatal intensive care, anesthesia; 2refer to appropriate PDA staging system; 3refer to the manufacturer’s instructions for use; 4as soon as possible based on clinical status, usually at postoperative day 1. LPA = left pulmonary artery; PDA = patent ductus arteriosus; TR = tricuspid regurgitation; TCPC = transcatheter PDA closure.
Figure 3
Figure 3
Ultrasound Guidance of Transcatheter PDA Closure in ELBW Infants (A to C) Last-Minute pre-procedural echocardiography. In the catheterization laboratory, before starting the case, a last-Minute echocardiography defines the best ultrasound window and carefully measures the ductal length and the minimal ductal diameter. Here is a large, left-to-right shunting, patent ductus arteriosus in an ex-24 weeker premature infant, with a procedural weight of 740 g (A). The minimal ductal diameter is measured at 2.6 mm (B), with a ductal length of 8.7 mm (C). (D to G) Real-time echocardiographic guidance. Ultrasound check of a well-positioned 4/2 Amplatzer Piccolo Occluder device, with no residual shunt (D and F) and no device-induced left pulmonary artery obstruction (D and E) (Vmax 1.9 m/s) or descending aorta obstruction (F and G) (Vmax 0.8 m/s). Note that the procedure is performed in an infant on high-frequency jet ventilation.
Figure 4
Figure 4
Prevention of Hypothermia (A) During infant’s transport from NICU to the catheterization laboratory and round trip; (B) on table, during the procedure.
Figure 5
Figure 5
Management Algorithm for Device-Induced Left Pulmonary Artery or Aortic Obstruction Adapted from Consensus guidelines, Sathanandam et al. LPA = left pulmonary artery; PDA = patent ductus arteriosus.
See this image and copyright information in PMC

References

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