Transcatheter occlusion of the patent ductus arteriosus in premature infants weighing less than 1200 g.
OBJECTIVES
Over the last few decades different strategies have been proposed to treat persistent ductal patency in premature infants. The advent of the Amplatzer Duct Occluder II Additional Size (ADOIIAS) provided the potential to close the patent ductus arteriosus (PDA). Opinions differ on the significance and treatment of PDA in premature neonates. Because surgical ligation and medical therapy both have their drawbacks, interventional catheterisation can be considered as an alternative means of closing the ductus arteriosus. Our aim was to analyse the feasibility, safety and efficacy of this device in premature infants weighing <1200 g at procedure.


METHODS
Eighteen premature infants underwent transcatheter closure. The procedure was performed in the catheterisation laboratory by venous cannulation without angiography. The position of the occluder was directed by X-ray and ultrasound. We looked at procedural details, device size selection, complications and short-term and mid-term outcomes.


RESULTS
Eighteen infants born at gestational ages ranging between 23.6 and 29+6 weeks (mean±SD 25+6±3 weeks) underwent transcatheter PDA closure. Their mean age and weight at the time of the procedure was 20 days (range 8-44 days) and 980 g (range 680-1200 g), respectively. The mean PDA and device waist diameters were 3.2±0.6 mm (range 2.2-4 mm) and 4.5±0.6 mm, respectively, and the mean PDA and device lengths were 4.3±1.2 mm (range 2-10 mm) and 2.5±0.9 mm, respectively. Complete closure was achieved in all but one patient. There was no device migration. One patient developed a left pulmonary artery obstruction. Three infants died. Two deaths were related to complications of prematurity and one to the procedure.


CONCLUSIONS
Transcatheter closure of a PDA is feasible in very low weight infants with ADOIIAS and is an alternative to surgery. Success requires perfect selection and placement of the occluder.
['Morville|Patrice|P|', 'Douchin|Stephanie|S|', 'Bouvaist|Helene|H|', 'Dauphin|Claire|C|']
D006328:Cardiac Catheterization D004374:Ductus Arteriosus, Patent D006801:Humans D007223:Infant D007230:Infant, Low Birth Weight D007231:Infant, Newborn D007234:Infant, Premature D055989:Septal Occluder Device D016896:Treatment Outcome
cardiology interventional catheterism neonatology patent ductus arteriosus preterm infants treatment of patent ductus arteriosus in preterm infants