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Closing the patent duct: context and controversy
  1. Frances Bulock
  1. Correspondence to Dr Frances Bulock, Department of Congenital and Paediatric Cardiology, East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK; frances.bulock{at}uhl-tr.nhs.uk

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In preterm babies, there used to be just two options for actively closing a patent arterial duct: medication, meaning indometacin or ibuprofen, or ligation. A third is fast approaching: transcatheter occlusion. Dr Morville1 and her colleagues report percutaneous transcatheter duct closure in 18 babies, the smallest of which was just 680 g at the time of the procedure. They are to be congratulated on publishing these data. The ability to place these newer devices via ever smaller catheters and without the use of angiography has now brought this procedure within reach of interventional paediatric cardiologists everywhere. However, the question of whether ‘we should, just because we can?’ remains.

Three babies died, although only one death was directly related to procedural issues. There is a mortality associated with any form of treatment for a patent duct, so it will be important that the safety of this new modality is rigorously tested in randomised trials against standard open ligation, as has been done for most transcatheter cardiac procedures, such as valve replacement, in adults.

However, there are other aspects of this approach that also need …

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