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Transcatheter occlusion of the patent ductus arteriosus in premature infants weighing less than 1200 g
  1. Patrice Morville1,
  2. Stephanie Douchin2,
  3. Helene Bouvaist3,
  4. Claire Dauphin2
  1. 1Polyclinique les bleuets, Pediatric Cardiology, Groupe Courlancy, Reims, France
  2. 2Department of Pediatric Cardiology, CHU de Grenoble France, Grenoble, France
  3. 3Department of Cardiology, CHU de Grenoble France, Grenoble, France
  1. Correspondence to Professor Patrice Morville, pediatric cardiology, Groupe Courlancy, Polyclinique les bleuets, Reims, 51100, France; morvillep{at}aol.com

Abstract

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.

  • neonatology
  • cardiology
  • patent ductus arteriosus preterm infants
  • interventional catheterism
  • treatment of patent ductus arteriosus in preterm infants

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Footnotes

  • Contributors SD, HB and CD are paediatric cardiologists working in University Hospital Centres (Grenoble and Clermont Ferrand) who promotes PDA transcatheter occlusion and performed part of the study.

  • Funding None declared.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The description of our experience from September 2013 to June 2015 has been proposed to catheterisation and cardiovascular intervention. It is mainly read by paediatric cardologists or cardiologists. It seems important to inform the world of neonatology of this new approach.

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