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Leahy BF, Edwards EM, Ehret DEY, Soll RF, Yeager SB, Flyer JN. Transcatheter and Surgical Ductus Arteriosus Closure in Very Low Birth Weight Infants: 2018-2022. Pediatrics 2024; 154:e2024065905. [PMID: 39005106 DOI: 10.1542/peds.2024-065905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The optimal patent ductus arteriosus (PDA) closure method in very low birth weight (VLBW) infants is uncertain. In 2019, the first transcatheter occlusion device was approved in the United States for infants ≥700 g. We described survival and short-term outcomes among VLBW infants who underwent transcatheter or surgical PDA closure (2018-2022). METHODS Vermont Oxford Network members submitted data on infants born from 401 to 1500 g or 22 to 29 weeks' gestational age. Adjusted risk ratios (aRR) for survival, length of stay (LOS), prematurity complications, and discharge support were used to compare transcatheter versus surgical closure. Subgroup analyses were conducted for infants with birth weight ≥700 g and born in 2020-2022. RESULTS Overall, 6410 of 216 267 infants at 726 hospitals received invasive PDA treatment. Transcatheter closure increased from 29.8% in 2018 to 71.7% in 2022. VLBW infants undergoing transcatheter closure had higher survival (adjusted rate ratio [aRR] 1.03; 1.02-1.04) with similar LOS (aRR 1.00; 0.97-1.03), neonatal complications (aRR 1.00; 0.98-1.01), and receipt of discharge support (aRR 0.94; 0.89-1.01). In subgroup analyses, survival (aRR 1.02; 1.00-1.04) and discharge support (aRR 0.90; 0.81-1.01) were similar between groups, whereas selected neonatal complications (aRR 0.95; 0.93-0.98) and LOS (aRR 0.95; 0.90-0.99) were lower after transcatheter closure. CONCLUSIONS Transcatheter PDA closure in VLBW infants was increasingly used after 2018. Selected short-term outcomes for infants receiving transcatheter closure may be more favorable, compared with surgical, and warrants further clinical investigation.
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Affiliation(s)
- Brianna F Leahy
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
| | - Erika M Edwards
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, Burlington, Vermont
| | - Danielle E Y Ehret
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
- Vermont Oxford Network, Burlington, Vermont
- Divisions of Neonatology
| | - Roger F Soll
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
- Vermont Oxford Network, Burlington, Vermont
- Divisions of Neonatology
| | - Scott B Yeager
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
- Pediatric Cardiology, The University of Vermont Children's Hospital, Burlington, Vermont
| | - Jonathan N Flyer
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
- Pediatric Cardiology, The University of Vermont Children's Hospital, Burlington, Vermont
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2
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Duboue PM, Padovani P, Bouteiller XP, Martin-Kabore F, Benbrik N, Gronier CG, Bouissou A, Garnier E, Mitanchez D, Flamant C, Rozé JC, Baruteau AE, Lefort B. Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study. Eur J Pediatr 2024; 183:2193-2201. [PMID: 38381375 DOI: 10.1007/s00431-024-05481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24 h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000 g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2 weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.
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MESH Headings
- Humans
- Ductus Arteriosus, Patent/surgery
- Retrospective Studies
- Infant, Newborn
- Female
- Ligation/methods
- Ligation/adverse effects
- Male
- Cardiac Catheterization/methods
- Cardiac Catheterization/adverse effects
- Infant, Premature
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Infant, Low Birth Weight
- Incidence
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/methods
- Syndrome
- Propensity Score
- Septal Occluder Device
- Risk Factors
- Infant, Premature, Diseases/surgery
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/therapy
- Infant, Premature, Diseases/epidemiology
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Affiliation(s)
| | - Paul Padovani
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Xavier Paul Bouteiller
- Department of Cardiology, Electrophysiology and Heart Modelling Institute, CHU Bordeaux, IHU Liryc, Bordeaux University Foundation, Pessac, France
| | | | - Nadir Benbrik
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Céline Grunenwald Gronier
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Antoine Bouissou
- Department of Neonatology, CHU Tours, Tours University, Tours, France
| | - Elodie Garnier
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France
| | - Delphine Mitanchez
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- INSERM UMR_S 938 Centre de Recherche Saint Antoine, Paris, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes University, Nantes, France
| | | | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
- CNRS, INSERM, L'institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Bruno Lefort
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France.
- UMR 1069, INSERM, Tours University, Tours, France.
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Clocheville Hospital, CHRU Tours, 49, Boulevard Béranger, 37000, Tours, France.
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3
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Ramakrishnan K, Siddiq B, Fountain B, Sathanandam S, Kiene A, Boston US. Rescue Sternotomy in a 540 g Neonate for Right Atrial Perforation During Percutaneous Ductal Device Occlusion. World J Pediatr Congenit Heart Surg 2024; 15:120-122. [PMID: 37722806 DOI: 10.1177/21501351231189274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Percutaneous ductal device closure in neonates is gaining popularity. Cardiac perforation is a rare but catastrophic complication that can occur during this procedure. Surgical options to salvage this situation are limited in extremely low-weight babies. In this report, we describe one such case managed successfully and offer some suggestions to achieve a successful outcome.
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Affiliation(s)
- Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Bilal Siddiq
- College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Bailey Fountain
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, TN, USA
| | - Shyam Sathanandam
- Division of Pediatric Cardiology, LeBonheur Children's Hospital, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Ashley Kiene
- Division of Pediatric Cardiology, LeBonheur Children's Hospital, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Umar S Boston
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
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Baspinar O, Narin N, Baykan A, Yildiz K, Pamukcu O, Ozyurt A, Kervancioglu M, Kum YE, Temel MT, Dogan A, Bagli S, Demircan T, Aydin Sahin D, Elmali F, Karadeniz C. Piccolo in transcatheter PDA closure multi-centre study from premature to adolescent children. Cardiol Young 2024; 34:157-162. [PMID: 37283091 DOI: 10.1017/s1047951123001385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this multi-centre study, the mid- to long-term efficacy and safety of the Amplatzer Piccolo Occluder in patent ductus arteriosus closure in premature and term infants as well as children were discussed. Methods. Between 2016 and 2021, 645 patients, 152 of whom were less than 1 month old, underwent ductus closure with the Piccolo device from five different centres in Turkey. The median age of the patients was 2.2 years, and the mean narrowest point of duct diameter was 1.8 mm. Sixty-two patients weighed ≤ 1.5 kg, 90 patients 1.5-3 kg, and the mean follow-up was 20.4 months. In 396, the duct was closed by the retrograde route. Ductal anatomy was Type A in 285, C in 72, E in 171, and F in 64 patients. Fluoroscopy duration was 6.2 min. The procedure success rate was 99.1%. Device embolisation occurred in 13 patients (2%), and 11 were retrieved with a snare. Cardiac perforation and death developed in one premature baby. The left pulmonary artery and the descending aorta stenosis were observed in 3 (0.4%) and in 5 patients (0.5%). Results. Piccolo device is safe and effective in closing ductus in all age groups. It has low profile for use in premature and newborn babies, a small embolisation risk, and a low residual shunt rate after closure. Conclusion. The Piccolo device can be considered as close an ideal occluder. The lower profile, smaller delivery catheter size, and symmetry of this device allow for a venous or arterial approach.
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Affiliation(s)
- Osman Baspinar
- Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Nazmi Narin
- Pediatric Cardiology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Ali Baykan
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Kaan Yildiz
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
| | - Ozge Pamukcu
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Abdullah Ozyurt
- Pediatric Cardiology, Mersin Women's and Children's Hospital, Mersin, Turkey
| | - Mehmet Kervancioglu
- Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Yunus Emre Kum
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | | | - Alper Dogan
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Sedat Bagli
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
| | - Tulay Demircan
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
| | - Derya Aydin Sahin
- Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Ferhan Elmali
- Biostatistics Department. Izmir Katip Celebi University, Izmir, Turkey
| | - Cem Karadeniz
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
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5
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Honnorat M, Perouse-De-Montclos T, Bakloul M, Walton C, Butin M, Vo Van P. Transcatheter closure of patent ductus arteriosus in preterm infants: results from a single-center cohort. Front Pediatr 2023; 11:1292623. [PMID: 38178913 PMCID: PMC10765538 DOI: 10.3389/fped.2023.1292623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To assess the success rate of patent ductus arteriosus (PDA) transcatheter closure in preterm infants and to describe the nature of procedural adverse events and short-term clinical status. Study design All the preterm infants with PDA transcatheter closure were evaluated retrospectively between July 2019 and March 2023 in a single level III neonatal intensive care unit in France. The procedure was performed in the catheterization laboratory using venous canulation. We retrospectively collected data about the patients' characteristics, procedural outcomes and complications. Results Twenty-five infants born between 23.4 and 32.0 weeks of gestational age (mean ± SD 26.3 ± 1.9 weeks) underwent transcatheter PDA closure. Their mean age and weight at the time of the procedure were 52 days (range 22-146 days) and 1,620 g (range 890-3,700 g), respectively. Successful closure was achieved in all but one patient. Procedure related complications were reported in 10 infants (40%), including 6 left pulmonary artery stenosis one of which required a balloon dilatation, two cardiac tamponades and two inferior vena cava thrombosis. Only two post-ligature syndromes occurred after the procedure. Two infants died one of which was related to the procedure. Conclusion Transcatheter closure of a PDA is a valid alternative to surgical ligation due to its high success rate and low incidence of post-ligature syndrome. Nevertheless, we also report rare, although serious complications.
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Affiliation(s)
- Marion Honnorat
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
| | | | - Mohamed Bakloul
- Service de Cardiologie Pédiatrique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Camille Walton
- Cardiologie pédiatrique, Hôpital Privé Natécia, Lyon, France
| | - Marine Butin
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
- INSERM U1111, CNRS UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Equipe “Pathogénie des Infections à Staphylocoques”, Lyon, France
| | - Philippe Vo Van
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
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6
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Baruteau AE, Fraisse A, Butera G, Bautista-Rodriguez C. The Transcatheter Closure of Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants: Technique and Results. J Cardiovasc Dev Dis 2023; 10:476. [PMID: 38132644 PMCID: PMC10744056 DOI: 10.3390/jcdd10120476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered as first-line therapy, although it carries a limited success rate and potential severe adverse events. In recent years, transcatheter patent ductus arteriosus closure has fast developed and become widely accepted as a safe and efficient alternative to surgical ductal ligation in extremely low birth weight infants >700 g, using most often the dedicated Amplatzer Piccolo Occluder device. This article aims to provide an appraisal of the patients' selection process, and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, CHU Nantes, Nantes Université, FHU PRECICARE, F-44000 Nantes, France
- CIC FEA 1413, INSERM, CHU Nantes, Nantes Université, F-44000 Nantes, France
- L’institut du thorax, INSERM, CNRS, CHU Nantes, Nantes Université, F-44000 Nantes, France
- UMR 1280, PhAN, INRAE, Nantes Université, F-44000 Nantes, France
| | - Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
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7
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Mini N, Schneider MBE, Schneider K. Transcatheter closure of tubular PDA with amplatzer plug 4 in preterm infants weighing between 900 and 3,400 g: the pros and cons. Front Cardiovasc Med 2023; 10:1283992. [PMID: 37900563 PMCID: PMC10611490 DOI: 10.3389/fcvm.2023.1283992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To our knowledge, no prior study has focused on the outcome of PDA occlusion using an Amplatzer™ Vascular Plug 4 (AP4) in ill preterm infants. This study aims to highlight the pros and cons of AP4 in this cohort. Methods Between 2020 and 2022, 26 ill preterm infants underwent PDA closure in our centre. The median age, weight, and gestational age were 60 days (11-180 days), 1,900g (900-3,400 g), and 25 weeks (22-33 weeks), respectively. The indication of the intervention was hemodynamically significant PDA. A medical trial with non-steroid medication failed to close the ducts in all patients. Follow-up using echocardiography was done 24, 48, and 72 h after the intervention. Results Of 26 ducts, 21 were successfully closed with AP4. Five ducts shorter than 7 mm were unsuitable for AP4 and were closed with the Amplatzer Piccolo device. The median radiation time was 4 min (3-9 min). No early plug-related complications or deaths were documented. Plug-related jailing of the left pulmonary artery as a late complication was 9.5%, and LPA reintervention was required. All ducts were closed after 48 h. Conclusion Implantation of the AP4 using a 4 F 0.38 guide wire-compatible catheter without inserting a long sheath makes the closure of tubular ducts with this device feasible and uncomplicated with a short intervention time. However, the limited sizes with fixed lengths of the AP4 make it unsuitable for ducts wider than 4.5 mm and shorter than the chosen device length, which can increase the risk of significant left pulmonary stenosis. A wide range of plug diameters and lengths is required to accommodate the large and short ducts.
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Affiliation(s)
- Nathalie Mini
- Department of Cardiology, German Paediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
| | - Martin B. E. Schneider
- Department of Cardiology, German Paediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
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8
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Morray BH, Sathanandam SK, Forbes T, Gillespie M, Berman D, Armstrong AK, Shahanavaz S, Jones T, Rockefeller T, Justino H, Nykanen D, Weiler C, Gutfinger D, Zahn EM. 3-year follow-up of a prospective, multicenter study of the Amplatzer Piccolo™ Occluder for transcatheter patent ductus arteriosus closure in children ≥ 700 grams. J Perinatol 2023; 43:1238-1244. [PMID: 37587183 PMCID: PMC10541325 DOI: 10.1038/s41372-023-01741-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study describes 3-year follow-up of 200 infants weighing ≥ 700 grams who underwent transcatheter patent ductus arteriosus (PDA) closure with the Amplatzer Piccolo™ Occluder. STUDY DESIGN Between June 2017 and February 2019, 200 children were enrolled in this U.S. study (NCT03055858). PDA closure, survival, and device- or procedure-related events were evaluated. A total of 156 of the available 182 patients (86%) completed the study. RESULTS The implant success rate was 95.5% (191/200). At 3 years, PDA closure was observed in 100% (33/33) of patients. Survival was >95% with 9 reported deaths. No deaths were adjudicated as device- or procedure-related. Notable events included aortic obstruction (2) requiring stent placement and tricuspid regurgitation (5), for which no interventions were required. CONCLUSIONS This follow-up study demonstrates high rates of PDA closure, low serious complication rates, and survival > 95% at 3 years. The Amplatzer Piccolo™ Occluder is a safe and effective therapy for PDA treatment in premature infants. CLINICALTRIALS gov identifier: NCT0305585.
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Affiliation(s)
- Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.
| | | | - Thomas Forbes
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Darren Berman
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | | | - Thomas Jones
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | | | | | | | | | | | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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9
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Van Pelt E, Reo R, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed During Infancy. Cardiol Ther 2022; 11:523-530. [PMID: 36074260 PMCID: PMC9652175 DOI: 10.1007/s40119-022-00278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure during infancy. METHODS Chart review was performed on patients who had a PDA closure at not more than 1 year of age between January 1, 2002 and June 1, 2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE at least 3 months after procedure, or had a velocity greater than 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE at least 3 months after device placement. Time points included the first TTE after the procedure, first TTE at least 3 months after procedure, and the most recent TTE. RESULTS Total of 147 infants met the inclusion criteria. Age and weight at initial procedure were 141 ± 217 days and 4.2 ± 2.8 kg. There was no significant difference in DAo velocity between initial and most recent TTE. LPA velocity and left ventricular diastolic Z score significantly decreased between initial and most recent TTE. Seventy-eight patients had repeat echocardiograms more than 1 year after PDA procedure with no change in clinical management. No patient underwent an intervention on the LPA or DAo for stenosis. CONCLUSION In patients who underwent an uncomplicated PDA closure during infancy, TTE parameters either stayed stable or improved over time. These findings need to be corroborated in larger studies with longer follow-up. If verified, the long-term TTE guidelines may need to be simplified for this patient population.
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Affiliation(s)
- Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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10
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Reo R, Van Pelt E, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy. Cardiol Ther 2022; 11:445-452. [PMID: 35780440 PMCID: PMC9381662 DOI: 10.1007/s40119-022-00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure after infancy. Methods Chart review was performed on patients who had a PDA closure ≥ 1 year of age between 1/1/2002 and 6/1/2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE ≥ 6 months after procedure, had a residual PDA or velocity > 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE ≥ 6 months after device placement. Time points included the initial TTE after the procedure, first TTE ≥ 6 months after procedure, and the most recent TTE. Results A total of 189 patients met the study criteria. The median age and weight at initial procedure were 2.7 (1.0–64.7) years and 12.5 (3.4–69.2) kg. Most recent TTE was performed 2.0 (0.4–17.0) years after PDA closure. There were no significant differences in fractional shortening (36.4 ± 5.0% vs. 36.9 ± 5.6%) or LPA velocity (1.1 ± 0.4 m/s vs. 1.1 ± 0.4 m/s) from initial to most recent TTE, respectively. Left ventricular internal diastolic diameter Z-score significantly decreased (1.4 ± 1.8 vs. − 0.01 ± 1.2, p < 0.01) and DAo peak velocity significantly increased (1.2 ± 0.3 m/s vs. 1.3 ± 0.3 m/s, p = 0.02) from initial to most recent TTE, respectively. No patient died or underwent an intervention on the LPA or DAo for stenosis. Seventy-five patients had a total of 208 repeat TTE > 1 year after PDA procedure with no change in clinical management. Conclusions In patients who underwent an uncomplicated PDA closure after infancy, TTE parameters improved or stayed within normal limits on the most recent TTE. Repeat lifetime TTEs after 1-year post-device placement in this population may not necessarily be needed if there are no clinical concerns.
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Affiliation(s)
- Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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11
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Shibbani K, Mohammad Nijres B, McLennan D, Bischoff AR, Giesinger R, McNamara PJ, Klein J, Windsor J, Aldoss O. Feasibility, Safety, and Short‐Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High‐Frequency Jet Ventilation. J Am Heart Assoc 2022; 11:e025343. [PMID: 35574958 PMCID: PMC9238575 DOI: 10.1161/jaha.122.025343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure. Methods and Results This is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes. Conclusions Transcatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.
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Affiliation(s)
- Kamel Shibbani
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Bassel Mohammad Nijres
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Daniel McLennan
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | | | - Regan Giesinger
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Patrick J. McNamara
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Jonathan Klein
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Jimmy Windsor
- Division of Pediatric Anesthesia University of Iowa Carver College of Medicine Iowa City IA
| | - Osamah Aldoss
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
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12
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Pandey R, Youmans L, Aneji C, Bell C, Breinholt J, Khan A. Extremely premature infants with patent ductus arteriosus closure: Comparative analysis of surgical ligation versus cardiac catheterization-based closure. Medicine (Baltimore) 2022; 101:e29103. [PMID: 35357352 DOI: 10.1097/md.0000000000029103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/26/2022] [Indexed: 11/25/2022] Open
Abstract
Our objective was to compare postprocedure hemodynamic decompensation in extremely premature infants who had their patent ductus arteriosus (PDA) closed with surgical ligation (SL) versus cardiac catheter-based closure (CCC).This is a single-center retrospective review of extremely premature ( < 28 weeks) infants who had their PDA closed by SL or CCC.Of the total of 69 infants, 53 underwent SL, and 16 had CCC. Infants in 2 groups were comparable at birth. However, at the time of the procedure, infants in the SL group were smaller, less mature, and had higher respiratory support. Vasopressor use, both pre- and postprocedure, was more common in the SL group. Nineteen percent of the infants in the SL group, compared to 6% in the CCC group (P = .34), required dose escalation or use of vasopressors after the PDA closure.There was no significant difference between the 2 groups in postoperative hemodynamic decompensation. Large, multicenter, prospective study or randomized control trial will help to confirm our findings.
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Affiliation(s)
- Rajesh Pandey
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX
| | - Lydia Youmans
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX
| | - Chiamaka Aneji
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX
| | - Cynthia Bell
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX
| | | | - Amir Khan
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX
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13
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Barcroft M, McKee C, Berman DP, Taylor RA, Rivera BK, Slaughter JL, El-Khuffash A, Backes CH, Backes CH. Percutaneous Closure of Patent Ductus Arteriosus. Clin Perinatol 2022; 49:149-166. [PMID: 35209997 PMCID: PMC8887783 DOI: 10.1016/j.clp.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneous-based patent ductus arteriosus closure is technically feasible among infants less than 1.5 kg. However, marked heterogeneity in the type and nature of adverse events obscures current safety profile assessments. Although data on the risks of postdevice closure syndrome remain promising, a lack of comparative trials of surgical ductal ligation and inconsistent surveillance across published studies obscure confidence in present estimates of safety and efficacy. To minimize risk and yield the greatest benefits, clinical studies of patent ductus arteriosus treatment should consider incorporating more robust assessments to ensure that infants at greatest risk for adverse ductal consequences are included.
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Affiliation(s)
- Megan Barcroft
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christopher McKee
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Anesthesiology, Nationwide Children’s Hospital, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Darren P. Berman
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Rachel A. Taylor
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Brian K. Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Jonathan L. Slaughter
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital; Dublin, Ireland,Department of Paediatrics; The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carl H. Backes
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
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14
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Guyon P, Duster N, Katheria A, Heyden C, Griffin D, Steinbergs R, Moreno Rojas A, Ratnayaka K, El-Said HG. Institutional Trend in Device Selection for Transcatheter PDA Closure in Premature Infants. Pediatr Cardiol 2022; 43:1716-1722. [PMID: 35430709 PMCID: PMC9587941 DOI: 10.1007/s00246-022-02903-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the Microvascular Plug, "MVP" (Medtronic, Minneapolis, MN); Micro Plug Set, "Micro Plug" (KA Medical, Minneapolis, MN); and Amplatzer Piccolo Occluder, "Piccolo" (Abbot, Santa Clara, CA). We also report trends in device selection over time. Studies examining outcomes according to device selection for PDA closure in premature infants are lacking. We performed a retrospective review of all percutaneous PDA closures in premature infants at a single center (June 2018-May 2021). Patients were grouped by initial device selected for PDA closure (intention to treat). Institutional Review Board approval was obtained. 58 premature infants [MVP (n = 25), Micro Plug (n = 25), and Piccolo (n = 8)] underwent successful transcatheter PDA closure (mean gestational age 27 weeks 2 days; mean weight at procedure 1.4 kg; mean age at procedure 28 days). Pre-procedural demographics, procedural data, and follow-up data were similar between groups. There were no significant procedural adverse events. Three devices (2 MVP, 0 Micro Plug, 1 Piccolo p = 0.27) embolized after the procedure. One other device was removed for concern for aortic obstruction. Device selection evolved with a clear trend toward the Micro Plug device over time. Demographic, procedural, and follow-up data were similar between the MVP, Micro Plug, and Piccolo groups. The Micro Plug did not require exchange for suboptimal fitting or embolize and became our preferred device in most cases.
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Affiliation(s)
- Peter Guyon
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA.
| | - Nicole Duster
- Department of Pediatrics, Rady Children's Hospital | UC San Diego School of Medicine, San Diego, CA, USA
| | - Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Caitlyn Heyden
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Danica Griffin
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Ronald Steinbergs
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Andres Moreno Rojas
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Howaida G El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
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15
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Abstract
Patent ductus arteriosus (PDA) may be found in 0.1-0.2% of term infants, but the average incidence is at least five-fold higher in premature infants, correlating inversely with birth weight and gestational age. While not all patients with a PDA require treatment, the deleterious effects of persistent left-to-right shunting across the ductus can have important short- and long-term consequences. Medical and interventional approaches to PDA closure have evolved greatly in the past decade and add to the decision-making pathways. This article summarizes the pathophysiology of PDA and characterizes the medical, surgical and endovascular treatment approaches.
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16
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Bedside Transcatheter Patent Ductus Arteriosus Device Occlusion in an Extremely Low Birth Weight Neonate: A Novel Approach in a High-Risk Population. Case Rep Anesthesiol 2021; 2021:4716997. [PMID: 34745665 PMCID: PMC8566062 DOI: 10.1155/2021/4716997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Extremely low birth weight (ELBW) infants weighing less than 1 kilogram are at a high-risk for delayed patent ductus arteriosus (PDA) closure. Percutaneous PDA closure offers a less invasive approach when compared with surgical PDA closure, which may provide faster recovery times and less transfusion requirements. However, this procedure involves transporting tenuous, unstable patients from the neonatal intensive care unit (NICU) to the catheterization laboratory which introduces many potential risks for the neonate. Performing percutaneous PDA closure at the bedside offers a successful alternative to performing the procedure in the catheterization laboratory and avoiding risk associated with transporting ELBW neonates.
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17
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Scerbo D, Cua CL, Rivera BK, Marzec LC, Smith CV, Slaughter JL, Berman DP, Backes CH. Percutaneous Closure of the Patent Ductus Arteriosus in Very-Low-Weight Infants. Neoreviews 2021; 21:e469-e478. [PMID: 32611564 DOI: 10.1542/neo.21-7-e469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In view of the known complications of drug therapy and open surgical ligation, and the potential for prolonged patent ductus arteriosus (PDA) exposure to be harmful, health care practitioners have sought new approaches to achieve definitive ductal closure. Interest in percutaneous (catheter-based) PDA closure has emerged within the neonatal community as a viable treatment option, because it has been fueled by recent procedural and device modifications, as well as mounting feasibility and safety data. Herein, we provide a contemporary review of percutaneous PDA closure among infants at the crux of the medical debate-very-low-weight infants (≤1,500 g), including: 1) characterization of traditional PDA treatments (drug therapy, open surgical ligation) and conservative (nonintervention) management options; 2) a general overview of the major procedural steps of percutaneous ductal closure, including efforts to reduce thrombotic complications and the emergence of a novel US Food and Drug Administration-approved device; 3) a systematic review and meta-analysis to better understand risk profiles of percutaneous PDA closure in this population; and 4) discussion of current gaps in our understanding of optimal PDA care, including the critical need for well-designed, randomized, controlled clinical trials.
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Affiliation(s)
- Danielle Scerbo
- The Ohio University Heritage College of Osteopathic Medicine, Athens, OH.,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Clifford L Cua
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Brian K Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Laura C Marzec
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, WA
| | - Jonathan L Slaughter
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH
| | - Darren P Berman
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Carl H Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH
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18
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Meot M, Gaudin R, Szezepanski I, Bajolle F, Bonnet D, Malekzadeh-Milani S. Transcatheter patent arterial duct closure in premature infants: A new technique to ease access to the patent arterial duct, with particular benefit for the tricuspid valve. Arch Cardiovasc Dis 2021; 114:482-489. [PMID: 34312100 DOI: 10.1016/j.acvd.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 06/01/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature infants at Hôpital Necker Enfants Malades, we have changed our technique several times to advance the guidewire through the right heart to avoid tricuspid valve damage. AIM To describe the technique we have been using since May 2019, to report our results with a particular focus on tricuspid leaks and to analyse the potential mechanisms of tricuspid lesion development with previous methods. METHODS All premature infants weighing<2kg who underwent transcatheter PAD closure with this new technique were included. Demographic data, procedural data, outcome and procedural complications were reviewed, with particular attention to the occurrence of tricuspid regurgitation. RESULTS Between May 2019 and May 2020, 33 patients were included. Median gestational age was 25 weeks. Median birth weight and procedural weight were 690g (range 490-1065g; interquartile range [IQR] 620-785g) and 1160g (range 900-1900g; IQR 1030-1300g), respectively. Median age at procedure was 35 (IQR 30-46) days. PAD anatomy was evaluated on transthoracic echocardiography only. The median duct diameter was 3 (IQR 2.5-3.2) mm at the pulmonary end. Success rate was 100% (defined as successful closure without residual shunt). One patient had a renal vein thrombosis, which fully resolved with low-molecular-weight heparin anticoagulation. No tricuspid regurgitation or stenosis of the left pulmonary artery or the aorta was seen. One patient died of a superior caval vein obstruction with bilateral chylothorax related to a central catheter thrombosis 56 days after the procedure, unrelated to the catheter procedure. CONCLUSION In this prospective study, we describe a new technique to avoid tricuspid valve damage and facilitate delivery of the PAD device.
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Affiliation(s)
- Mathilde Meot
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France.
| | - Régis Gaudin
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Isabelle Szezepanski
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Fanny Bajolle
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker Enfants Malades, 75015 Paris, France
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19
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Kim H, Song J, Choi GJ, Huh J, Kang IS. How can stretched ductus diameter be predicted from angiographic diameter? Minerva Pediatr (Torino) 2021; 74:176-180. [PMID: 34128600 DOI: 10.23736/s2724-5276.21.06021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An appropriate size of device for patent ductus arteriosus (PDA) could be chosen by a stretched PDA size. We propose prediction of stretched size from intact PDA size. METHODS A total of 361 patients was enrolled. Intact size was measured on angiography before closure, and stretched size was the narrowest diameter immediately after device implantation. RESULTS The median patient age was 2.8 years. Intact diameter and stretched diameter were 3.6 ± 1.4 mm and 5.1 ± 1.3 mm. The difference and difference ratio were 1.5 ± 0.8 mm and 51.3 ± 38.1% and had negative linear correlations with age (P<0.001). Patients were divided into four groups; < 2 years old (159), 2-15 years old (68), 15 - 40 years old (72), and ≥ 40 years old (62). Among groups, difference and difference ratio were significantly different. Stretched diameter was inferred by the following formulas: stretched diameter = 0.660ⅹintact diameter + 2.791 (<2 years old); = 0.971ⅹintact diameter +0.058ⅹage +1.131 (2-15 years old); = 0.790ⅹintact diameter +2.263 (15 - 40 years old); and = 0.837ⅹintact diameter +1.353ⅹBSA -0.096 (≥40 years old). CONCLUSIONS Stretched PDA diameter can be predicted from intact diameter and might be helpful for safe PDA closure especially in small infants.
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Affiliation(s)
- Hanna Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea -
| | - Gwang-Jun Choi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
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20
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Transcatheter patent ductus arteriosus closure in extremely premature infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Respiratory Trajectory after Invasive Interventions for Patent Ductus Arteriosus of Preterm Infants. CHILDREN-BASEL 2021; 8:children8050398. [PMID: 34063345 PMCID: PMC8156843 DOI: 10.3390/children8050398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, neonatal morbidities, periprocedural vital signs, and respiratory support trajectories were compared between the transcatheter-treated and surgically ligated group. A total of 31 eligible VLBW infants received invasive intervention: 14 were treated with transcatheter occlusion (Group A), and 17 infants were treated with surgical ligation (Group B). Respiratory outcomes were not statistically significant between the two groups, despite Group A showing a trend toward early improvement in post-intervention respiratory trajectory. In this small case study, a different trend in post-intervention respiratory trajectories was observed. Future research with larger case numbers should be conducted to address our preliminary observations in more detail.
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22
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Amelia P, Adriansyah R, Lubis B, Akil M. The Outcomes of Transcatheter Closure in Patients with Patent Ductus Arteriosus at Haji Adam Malik General Hospital, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Patent ductus arteriosus (PDA) is one of the most common acyanotic congenital heart diseases. The incidence of PDA is approximately 1 in 500 full-term neonates. The current management of PDA includes pharmacological and surgical treatments. Transcatheter closure is a preferable PDA treatment than pharmacological intervention, for medications have a higher failure rate in premature infants. Several studies have reported the efficacy and safety of transcatheter closure in smaller and lower-weight infants.
AIM: This study aims to describe the outcomes of transcatheter closure of PDA, which are complete closure, migrating device, and residuals, while also investigating factors that might affect these outcomes.
METHODS: A descriptive cross-sectional study was conducted from January to March 2018 in the pediatric cardiology outpatient clinic of Haji Adam Malik Hospital, Medan, Indonesia. All PDA patients who underwent transcatheter closure were included in this study. We collected patients’ demographic data (age and sex), PDA size (categorize into large, moderate, and small), and PDA closure outcomes from medical records. The collected data were then analyzed with SPSS.
RESULTS: One hundred and two children were included in this study, comprised 34 (33.3%) males and 68 (66.7%) females, with a mean age of 4.3 (±4.02) years old and the mean size of the defects 4.4 (±2.25) mm. Transcatheter closure with Lifetech® PDA Occluder was performed in 95 (93.1%) and MFO® in 7 (6.9%) patients. Small residuals were found in three patients, device migration was found in one patient. No relationship was found between the size of PDA and the outcomes measured.
CONCLUSION: We concluded that transcatheter closure remains an effective treatment for PDA, with a considerable success rate.
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Percutaneous Closure of Patent Ductus Arteriosus in Infants 1.5 kg or Less: A Meta-Analysis. J Pediatr 2021; 230:84-92.e14. [PMID: 33098843 DOI: 10.1016/j.jpeds.2020.10.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. STUDY DESIGN A systematic review and meta-analysis was performed. Data sources included Scopus, Web of Science, Embase, CINAHL, Cochrane, and PubMed from inception to April 2020. Publications were included if they had a clear definition of the intervention as percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. Data extraction was independently performed by multiple observers. Primary outcome was technical success and secondary outcomes were adverse events (AEs). Subgroup analysis was performed in infants ≤6.0 kg. Data were pooled by using a random-effects model. RESULTS We included 28 studies, including 373 infants ≤1.5 kg and 69 studies enrolling 1794 infants ≤6.0 kg. In patients ≤1.5 kg, technical success was 96% (95% CI, 93%-98%; P = .16; I2 = 23%). The overall incidence of AE was 27% (95% CI, 17%-38%; P < .001; I2 = 70%) and major AEs was 8% (95% CI, 5%-10%; P = .63; I2 = 0%). There were 5 deaths related to the procedure (2%; 95% CI, 1%-4%; P = .99; I2 = 0%); 4 of these deaths occurred in infants <0.8 kg. The probability of technical failure was inversely related to age at the time of the procedure (OR, 0.9; 95% CI, 0.830-0.974; P = .009). Weight at intervention has decreased over time and procedural success has increased. CONCLUSIONS Percutaneous patent ductus arteriosus closure is feasible in infants ≤1.5 kg with few major AEs. The procedural success rate is high, despite performing the intervention in smaller patients. PROSPERO REGISTRATION CRD42020145230.
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Markush D, Tsing JC, Gupta S, Berndsen NC, Radville G, Garg R, Zahn EM, Almeida-Jones M. Fate of the Left Pulmonary Artery and Thoracic Aorta After Transcatheter Patent Ductus Arteriosus Closure in Low Birth Weight Premature Infants. Pediatr Cardiol 2021; 42:628-636. [PMID: 33394112 PMCID: PMC7990822 DOI: 10.1007/s00246-020-02523-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/04/2020] [Indexed: 01/07/2023]
Abstract
Transcatheter patent ductus arteriosus closure (TCPC) is an emerging treatment for low birth weight extremely premature neonates (EPNs). Left pulmonary artery (LPA) and descending aorta (DAO) obstruction are described device-related complications, however, data on mid- and long-term vascular outcomes are lacking. A retrospective analysis of EPNs who underwent successful TCPC at our institution from 03/2013 to 12/2018 was performed. Two-dimensional echocardiography and spectral Doppler velocities from various time points before and after TCPC were used to identify LPA and DAO flow disturbances. A total of 44 EPNs underwent successful TCPC at a median (range) procedural weight of 1150 g (755-2500 g). Thirty-two (73%) patients were closed with the AVP II and 12 (27%) with the Amplatzer Piccolo device. LPA and DAO velocities on average remained within normal limits and improved spontaneously in long-term follow up (26.1 months, range 1-75 months). One patient, who had concerning LPA flow characteristics immediately after device implant (peak velocity 2.6 m/s) developed progressive LPA stenosis requiring stent placement 3 months post-procedure. In the remaining infants, including 7 (16%) who developed LPA and 3 (7%) who developed DAO flow disturbances (range 2-2.4 m/s), all had progressive normalization of flow velocities over time. TCPC can be performed safely in EPNs with a low incidence of LPA and DAO obstruction. In the absence of significant progressive vascular obstruction in the early post-procedure period, mild increases in LPA and DAO flow velocities tend to improve spontaneously and normalize in long-term follow-up.
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Affiliation(s)
- Dor Markush
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Guerin Family Congenital Heart Program, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA.
| | - Jennifer C Tsing
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Surbhi Gupta
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Nicole C Berndsen
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ruchira Garg
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evan M Zahn
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Myriam Almeida-Jones
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Sathanandam S, Gutfinger D, Morray B, Berman D, Gillespie M, Forbes T, Johnson JN, Garg R, Malekzadeh-Milani S, Fraisse A, Baspinar O, Zahn EM. Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants. Pediatr Cardiol 2021; 42:1258-1274. [PMID: 34195869 PMCID: PMC8292293 DOI: 10.1007/s00246-021-02665-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022]
Abstract
Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.
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Affiliation(s)
- Shyam Sathanandam
- LeBonheur Children's Hospital, University of Tennessee, 848 Adams Avenue, Memphis, TN, 38103, USA.
| | | | | | | | | | | | - Jason N. Johnson
- LeBonheur Children’s Hospital, University of Tennessee, 848 Adams Avenue, Memphis, TN 38103 USA
| | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, CA USA
| | | | | | - Osman Baspinar
- Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Evan M. Zahn
- Cedars-Sinai Medical Center, Los Angeles, CA USA
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Thrombocytopenia associated with transcatheter closure of giant patent ductus arteriosus. Cardiol Young 2020; 30:1896-1901. [PMID: 33046148 DOI: 10.1017/s1047951120003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Thrombocytopenia occasionally occurs following the closure of some giant patent ductus arteriosus cases. Unfortunately, there is no associated research describing the associated risk factors for thrombocytopenia post-procedure. METHODS We reviewed all patients who received occluders with sizes ≥10/12 mm between January 2013 and June 2019. All the data and information on the characteristics of the patients and their follow-up were recorded. Univariate analysis, receiver operating characteristic curves, and linear regression were used to analyse the risk factors for thrombocytopenia and the predictors of hospitalisation stay. RESULTS Finally, 32 patients (17.5%) suffered from thrombocytopenia. Univariate analysis revealed the ratio between occluder disc size (mm) and body weight (kg) (1.71 ± 0.51 versus 1.35 ± 0.53) as an independent predictive factor for thrombocytopenia, and the area under the curve of the ratio of occluder size and body weight for predicting thrombocytopenia post-closure was 0.691 (95% confidence interval: 0.589-0.792, p = 0.001). The best cut-off value for the ratio of occluder size and weight was 1.5895, with a sensitivity and specificity of 68.8 and 66.9%, respectively. Each unit of the ratio of occluder size and body weight predicted an average hospitalisation stay of 2.856 days (95% confidence interval: 1.380-4.332). Treatment with medication did not reduce the hospitalisation stay or benefit platelet restoration. CONCLUSION Once the ratio of occluder size and body weight is greater than 1.6, thrombocytopenia always exists. Every unit of the ratio of occluder size and body weight represents an additional 3 days of hospitalisation. Treatment does not reduce the duration of hospitalisation.
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Heyden CM, El-Said HG, Moore JW, Guyon PW, Katheria AC, Ratnayaka K. Early experience with the Micro Plug Set for preterm patent ductus arteriosus closure. Catheter Cardiovasc Interv 2020; 96:1439-1444. [PMID: 32979038 DOI: 10.1002/ccd.29298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We intend to describe early experience using a new, commercially available Micro Plug Set for preterm neonate and infant transcatheter patent ductus arteriosus (PDA) occlusion. BACKGROUND Transcatheter PDA occlusion in premature neonates and small infants is safe and effective. The procedure is early in its evolution. METHODS Procedural and short-term outcomes of preterm neonates and infants undergoing transcatheter PDA occlusion with a new, commercially available device were reviewed. RESULTS Eight preterm neonates and infants born at median 27 weeks gestation (23-36 weeks) underwent transcatheter PDA device closure with the Micro Plug Set. The device is short (2.5 mm) with a range of diameters (3, 4, 5, 6 mm) and delivered through a microcatheter. Procedures were performed at median 41 days of age (12-88 days) and at 1690 g (760-3,310 g). Transvenous PDA device occlusion was performed with fluoroscopic and echocardiography guidance. All procedures were successful with complete PDA occlusion. There were no procedural or short-term adverse events. CONCLUSIONS Preterm neonate and infant transcatheter PDA device closure with a new, commercially available short and microcatheter delivered device (Micro Plug Set) was safe and effective in a small, early series of patients.
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Affiliation(s)
- Caitlin M Heyden
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Howaida G El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - John W Moore
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Peter W Guyon
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Anup C Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
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Piccolo devices in premie ductus arteriosi. Int J Cardiol 2020; 311:37-38. [DOI: 10.1016/j.ijcard.2020.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
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Taylor R, Forbes MJ, Kobayashi D. Transcatheter closure of patent ductus arteriosus in a tiniest baby – 510 grams. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2019.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sathanandam SK, Gutfinger D, O'Brien L, Forbes TJ, Gillespie MJ, Berman DP, Armstrong AK, Shahanavaz S, Jones TK, Morray BH, Rockefeller TA, Justino H, Nykanen DG, Zahn EM. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv 2020; 96:1266-1276. [PMID: 32433821 PMCID: PMC7754477 DOI: 10.1002/ccd.28973] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 01/08/2023]
Abstract
Objectives Characterize the safety and effectiveness of the Amplatzer Piccolo Occluder for patent ductus arteriosus (PDA) closure. Background The presence of a hemodynamically significant PDA has been associated with an increased risk of morbidity and mortality in children born premature. Methods This was a single arm, prospective, multicenter, non‐randomized study to evaluate the Amplatzer Piccolo Occluder to treat PDA in patients ≥700 g. From June 2017 to February 2019, 200 patients were enrolled at nine centers, with 100 patients weighing ≤2 kg. Primary effectiveness endpoint was the rate of PDA closure at 6‐month follow‐up. Primary safety endpoint was the rate of major complications through 6 months. Secondary endpoint was rate of significant pulmonary or aortic obstruction through 6 months' follow‐up. Results The implant success rate was 95.5% (191/200) overall and 99% in patients ≤2 kg (99/100). The primary effectiveness endpoint was achieved in 99.4% of implanted patients. Four patients experienced a primary safety endpoint event (2 transfusions, 1 hemolysis, and 1 aortic obstruction). There were no branch pulmonary artery obstructions. Five patients, all ≤2 kg, were noted to have worsening of tricuspid regurgitation (TR) after the procedure. None of the TR incidences manifested clinically. The Amplatzer Piccolo Occluder received FDA approval in January 2019 and became the first device approved for PDA closure in patients ≥700 g. Conclusions This study supports the safety and effectiveness of the Amplatzer Piccolo Occluder, particularly in patients between 700 g and 2 kg where there is currently a significant unmet need in the United States. ClinicalTrials.gov identifier: NCT03055858.
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Affiliation(s)
- Shyam K Sathanandam
- LeBonheur Children's Hospital, University of Tennessee, Memphis, Tennessee, USA
| | - Dan Gutfinger
- Abbott Structural Heart, Santa Clara, California, USA
| | - Laura O'Brien
- Abbott Structural Heart, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | | | | | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Tomasulo CE, Gillespie MJ, Munson D, Demkin T, O'Byrne ML, Dori Y, Smith CL, Rome JJ, Glatz AC. Incidence and fate of device-related left pulmonary artery stenosis and aortic coarctation in small infants undergoing transcatheter patent ductus arteriosus closure. Catheter Cardiovasc Interv 2020; 96:889-897. [PMID: 32339400 DOI: 10.1002/ccd.28942] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate short- and middle-term outcomes after transcatheter patent ductus arteriosus (TC-PDA) closure in small infants, specifically device-related left pulmonary artery (LPA) stenosis and aortic coarctation, risk factors, and changes over time. BACKGROUND Recent studies have demonstrated successful transcatheter PDA (TC-PDA) closure in small infants. LPA stenosis and aortic coarctation have been seen after TC-PDA, but it is not clear whether device-related LPA/aortic obstruction persists. METHODS A single-center retrospective study of infants ≤4 kg who underwent TC-PDA closure from February 1, 2007 to September 1, 2018 was performed, evaluating the incidence and risk factors for LPA stenosis and coarctation. RESULTS Forty-four patients underwent successful TC-PDA with Amplatzer Vascular Plug II (AVPII; n = 30), Amplatzer Duct Occluder II-Additional Sizes (n = 10), Amplatzer Duct Occluder I (n = 3), and coil-filled AVPI (n = 1) devices, all via an antegrade approach. Median birthweight and procedural weight were 890 g (range: 490-3,250) and 2.8 kg (range: 1.2-4.0), respectively. Median follow-up was 0.7 years (range: 2 days-7 years). Thirty-eight patients had post-procedure echocardiograms assessing LPA/aortic obstruction. Of those, 17 had LPA flow acceleration/stenosis (≥1.5 m/s), which improved or resolved in all patients with available follow-up; 3 developed mild coarctation (>2 m/s), which improved in the two with more than short-term follow-up; 4 developed mild flow acceleration (1.5-2 m/s) in the descending aorta, which resolved in three and increased in one (2.4 m/s). Flow acceleration in the LPA was associated with younger procedural age, larger PDA minimal diameter, and placement of a device other than the AVPII. There was no device-related mortality or need for reintervention. CONCLUSION TC-PDA in small infants is effective, without significant complications. Device-related LPA/aortic obstruction can improve with time/growth.
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Affiliation(s)
- Catherine E Tomasulo
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Munson
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Taylor Demkin
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Improved ventilation in premature babies after transcatheter versus surgical closure of patent ductus arteriosus. Int J Cardiol 2020; 311:22-27. [PMID: 32253052 DOI: 10.1016/j.ijcard.2020.03.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/08/2020] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
AIMS Patent ductus arteriosus (PDA) is common in preterm infants and can contribute to morbidity and mortality. We aimed to compare results and outcome of transcatheter closure using the Amplatzer Piccolo Occluder versus surgical closure in 2 matched groups of preterm infants weighing <3000 g. METHODS AND RESULTS A total of 147 babies from three tertiary centres were retrospectively analysed. Sixty-four babies undergoing catheter closure were compared with 83 matched surgical cases. Patent ductus arteriosus closure was successful in all cases. During neonatal unit course, mortality was 6.3% (n = 4) after catheterization and 12% (n = 10) after surgery (p = 0.24). Median duration of mechanical ventilation was shorter after catheterisation than after surgery (3 vs 5 days, p = 0.035). Before 4 weeks of age the difference between transcatheter and surgical closure for mechanical ventilation was even more pronounced (3 vs 9 days, p = 0.022). Additionally, when catheterisation was performed before 4 weeks, babies were discharged home earlier as compared to those who underwent closure later in life (39+1 vs. 42+1 weeks, p = 0.021). Such difference was not found in the surgical group. CONCLUSIONS Transcatheter closure of patent ductus arteriosus is safe, effective and is associated with shorter mechanical ventilation than after surgery. Hospital stay might be shorter when performed earlier in life.
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Wang JN, Lin YC, Hsieh ML, Wei YJ, Ju YT, Wu JM. Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants With Very Low Birth Weight. Front Pediatr 2020; 8:615919. [PMID: 33520899 PMCID: PMC7841343 DOI: 10.3389/fped.2020.615919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/10/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature infants. Methods: We performed a retrospective study of infants born with a birth body weight of < 2,000 g and admitted to National Cheng Kung University Hospital from September 2014 to December 2019. Basic demographic and clinical information as well as echocardiographic and angiographic data were recorded. Results: Twenty-five premature infants (11 boys and 14 girls) born at gestational ages ranging between 22 and 35 weeks (mean, 25 weeks) were identified. The mean age at procedure was 34.5 ± 5.5 days, and the mean weight was 1,209 ± 94 g (range, 478-1,980 g). The mean diameter of the PDA was 3.4 ± 0.2 mm (range, 2.0-5.4 mm). The following devices were used in this study: Amplatzer Ductal Occluder II additional size (n = 20), Amplatzer Vascular Plug I (n = 1), and Amplatzer Vascular Plug II (n = 4). Complete closure was achieved in all patients. The mean follow-up period was 30.1 ± 17.3 months (range, 6-68 months). In total, 3 patients had left pulmonary artery (LPA) stenosis and 1 patient had coarctation of the aorta during the follow-up period. Younger procedure age and smaller procedure body weight were significantly associated with these obstructions. Conclusions: Performing transcatheter PDA closure in symptomatic premature infants weighing more than 478 g is feasible using currently available devices; moreover, the procedure serves as an alternative to surgery.
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Affiliation(s)
- Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Min-Ling Hsieh
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Jen Wei
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Tzu Ju
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Fraisse A, Bautista-Rodriguez C, Burmester M, Lane M, Singh Y. Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams. Front Pediatr 2020; 8:558256. [PMID: 33072674 PMCID: PMC7536298 DOI: 10.3389/fped.2020.558256] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA-when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early- and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.
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Affiliation(s)
- Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Margarita Burmester
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Pediatric Cardiac Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Mary Lane
- Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Yogen Singh
- Department of Pediatrics-Pediatric Cardiology and Neonatal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Fraisse A, Michielon G, Kempny A. What is the role of video-assisted thoracoscopy for patent ductus arteriosus ligation in the era of transcatheter closure? J Thorac Dis 2019; 11:4090-4091. [PMID: 31737289 DOI: 10.21037/jtd.2019.10.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Guido Michielon
- National Heart and Lung Institute, Imperial College London, London, UK.,Congenital Cardiac Surgery Service, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
| | - Aleksander Kempny
- National Heart and Lung Institute, Imperial College London, London, UK.,Adult Congenital Heart Disease Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
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Kim HS, Schechter MA, Manning PB, Eghtesady P, Balzer DT, Shahanavaz S, Rockefeller TA, Abarbanell AM. Surgical Versus Percutaneous Closure of PDA in Preterm Infants: Procedural Charges and Outcomes. J Surg Res 2019; 243:41-46. [DOI: 10.1016/j.jss.2019.04.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/14/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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Patent ductus arteriosus in preterm infants: is early transcatheter closure a paradigm shift? J Perinatol 2019; 39:1449-1461. [PMID: 31562396 DOI: 10.1038/s41372-019-0506-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Abstract
The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain owing the lack of evidence for long-term benefits and the limited analyses of the complications of medical and surgical interventions to date. In recent years, devices suitable to plug the PDA of premature infants (including extremely low birthweight, <1000 g) have become available and several trials have demonstrated successful and safe transcatheter PDA closure (TCPC) in this population. Whether TCPC represents a paradigm shift in PDA management that will result in improved short- and long-term outcomes, less bronchopulmonary dysplasia, improved neurodevelopment, or better long term renal function remains to be seen. Careful rigorous study of the potential benefits of TCPC in this highly vulnerable population in the context of well-designed adequately powered trials is needed prior to widespread adoption of this approach.
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Malekzadeh‐Milani S, Akhavi A, Douchin S, Dauphin C, Chalard A, Mauran P, Bouvaist H, Bonnet D, Boudjemline Y. Percutaneous closure of patent ductus arteriosus in premature infants: A French national survey. Catheter Cardiovasc Interv 2019; 95:71-77. [DOI: 10.1002/ccd.28502] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/01/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Sophie Malekzadeh‐Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker Enfants malades Paris France
| | - Ahmad Akhavi
- Cardiologie pédiatrique et congénitaleCHU Reims Reims France
| | | | - Claire Dauphin
- Cardiology DepartmentCHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Aurélie Chalard
- Cardiology DepartmentCHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Pierre Mauran
- Cardiologie pédiatrique et congénitaleCHU Reims Reims France
| | | | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker Enfants malades Paris France
| | - Younes Boudjemline
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker Enfants malades Paris France
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39
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Backes CH, Giesinger RE, Rivera BK, Berman DP, Smith CV, Cua CL, Kelleher KJ, McNamara PJ, Slaughter JL. Percutaneous Closure of the Patent Ductus Arteriosus in Very Low Weight Infants: Considerations Following US Food and Drug Administration Approval of a Novel Device. J Pediatr 2019; 213:218-221. [PMID: 31255391 DOI: 10.1016/j.jpeds.2019.05.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Carl H Backes
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH; The Heart Center at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH.
| | | | - Brian K Rivera
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Darren P Berman
- The Heart Center at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Clifford L Cua
- The Heart Center at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kelly J Kelleher
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Jonathan L Slaughter
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH
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40
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McNamara PJ, Giesinger RE, Backes CH. Cardiac catheterisation for closure of patent ductus arteriosus. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:290-292. [DOI: 10.1016/s2352-4642(19)30088-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
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41
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Berry JM, Hiremath G, Heal E, Bass JL. Echocardiographic imaging of the Medtronic Micro Vascular Plug
™
during off label placement in the premature infant with patent ductus arteriosus. Echocardiography 2019; 36:944-947. [DOI: 10.1111/echo.14335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- James M. Berry
- Masonic Children's HospitalUniversity of Minnesota Minneapolis Minnesota
| | | | - Elisabeth Heal
- Masonic Children's HospitalUniversity of Minnesota Minneapolis Minnesota
| | - John L. Bass
- Masonic Children's HospitalUniversity of Minnesota Minneapolis Minnesota
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42
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Lee JA. Practice for preterm patent ductus arteriosus; focusing on the hemodynamic significance and the impact on the neonatal outcomes. KOREAN JOURNAL OF PEDIATRICS 2019; 62:245-251. [PMID: 30999726 PMCID: PMC6642924 DOI: 10.3345/kjp.2018.07213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/06/2019] [Indexed: 12/11/2022]
Abstract
Hemodynamically significant preterm patent ductus arteriosus (PDA) affects mortality; comorbidities such as necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia; and adverse long-term neurodevelopmental outcomes in preterm infants, particularly in very low birth weight infants. However, recent studies have indicated that there is no consensus on the causal relationship between PDA and neonatal outcomes, the benefit of PDA treatment, the factors guiding the need for treatment, and optimal treatment strategies. Such uncertainty has resulted in wide variations in practice for treating preterm PDA between units, regions, and nations. Nowadays, there has been a paradigm shift to more conservative treatment for preterm PDA, and suggestions regarding selective management of preterm PDA considering risk factors and hemodynamic significance are increasing. Neonatologist-performed echocardiography and advances in modalities to assess hemodynamic significance such as biologic markers and near-infrared spectroscopy also help improve the efficacy of selective treatment of preterm PDA.
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Affiliation(s)
- Jin A Lee
- Division of Neonatology, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Division of Neonatology, Department of Pediatrics, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
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43
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VanLoozen D, Sandoval JP, Delaney JW, Pedra C, Calamita P, Dalvi B, Kenny D, Cleary A, Amin Z. Use of Amplatzer vascular plugs and Amplatzer duct occluder II additional sizes for occlusion of patent ductus arteriosus: A multi-institutional study. Catheter Cardiovasc Interv 2018; 92:1323-1328. [PMID: 30196542 DOI: 10.1002/ccd.27824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/22/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Variable patent ductus arteriosus (PDA) morphology and the need to close PDAs in small size patients has led physicians to use Amplatzer Vascular Plugs (AVP) and recently available Amplatzer Duct Occluder II - Additional Sizes (ADO II AS). The purpose of this study was to analyze the safety, efficacy, and complication rates of the ADO II AS and AVPs, specifically AVP II. METHODS All patients undergoing PDA closure with an AVP or ADO II AS from 2011 to 2016 were included. Clinical, echocardiographic, and angiographic data were collected and reviewed. RESULTS Four hundred and sixty-nine patients were included. Median age was 27 months (0.75-852) and the median weight was 11.4 kg (1-92). There were 51 patients ≤5 kg. Type A PDA was most common in 48% (n = 225), followed by type E (27.5%, n = 129), type D (13%, n = 61), type C (10.2%, n = 48), and type B (1.3%, n = 6). Devices included AVP II (n = 421), ADO II AS (n = 30), and AVP IV (n = 18), left pulmonary artery stenosis occurred in 4.3% (n = 20). One patient required surgery for severe stenosis; the remaining cases were mild and required no intervention. Device embolization occurred in 3 patients (10%) with the ADO II AS. Successful device closure was achieved in 98.9% of cases. CONCLUSIONS The AVP II was highly effective for closing PDAs in smaller babies with varying morphologies and is safe when used in small sized patients with relatively low risk of complications. More studies are warranted to clarify the risks of ADO II AS.
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Affiliation(s)
- Dennis VanLoozen
- Department of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, Augusta, Georgia
| | - Juan Pablo Sandoval
- Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
| | - Jeffrey W Delaney
- Department of Pediatric Cardiology, University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, Nebraska
| | - Carlos Pedra
- Department of pediatric cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Paulo Calamita
- Department of pediatric cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Bharat Dalvi
- Department of Cardiology, Glenmark Cardiac Centre, Mumbai, Maharashtra, India
| | - Damien Kenny
- Department of Cardiology and Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Aoife Cleary
- Department of Cardiology and Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Zahid Amin
- Department of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, Augusta, Georgia
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Liu J, Gao L, Tan HL, Zheng QH, Liu L, Wang Z. Transcatheter closure through single venous approach for young children with patent ductus arteriosus: A retrospective study of 686 cases. Medicine (Baltimore) 2018; 97:e11958. [PMID: 30170394 PMCID: PMC6393149 DOI: 10.1097/md.0000000000011958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective is to explore the feasibility and safety of transcatheter closure of patent ductus arteriosus (PDA) through single venous approach in Chinese young children.A total of 1088 patients aged between 9 months old to 3 years old who underwent transcatheter closure of PDA from May 2004 to May 2015 were retrospectively reviewed. All the procedures were under ultrasound monitoring. The shape and size of PDA as well as immediate therapeutic results were recorded by angiography and ultrasonography. The size of occluder was individually selected according to the smallest diameter of the PDAs. Echocardiography was respectively performed 3 days, 1month, 6 months, and 12 months after the procedure to evaluate the outcomes.Among the total 1088 children, transcatheter closure of PDA was accomplished through single venous approach that was performed in 686 cases. The average weight and age of the children were 10.9 ± 3.6 kg (5.0-14.3 kg) and 1.8 ± 1.6 years (9 months-3 years), respectively. The fluoroscopic time was about 5.1 to 11.6 minutes. Successful device placement with the initially selected occluder was achieved in 662 cases. In other 14 cases, the procedure was eventually completed after being replaced with a larger occluder; while in the other 10 cases, smaller occluders were applied to replace the initial ones. Technically, all the procedures were successfully performed. All the patients were followed up for 15.6 ± 8.2 years. No serious complications and death were observed during the follow-up.Transcatheter closure of PDA with occluder by single venous approach is an effective and reliable method in vast majority of young children.
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Weisz DE, Giesinger RE. Surgical management of a patent ductus arteriosus: Is this still an option? Semin Fetal Neonatal Med 2018; 23:255-266. [PMID: 29636280 DOI: 10.1016/j.siny.2018.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The evolution of neonatal intensive care over the past decade has seen the role of surgical patent ductus arteriosus (PDA) ligation in preterm infants both decrease in scope and become laden with uncertainty. Associations of ligation with adverse neonatal and neurodevelopmental outcomes have rendered the ligation decision more challenging for clinicians and have been associated with a decline in surgical treatment, but these findings may be due to bias from confounding by indication in observational studies rather than a causal detrimental effect of ligation. Accordingly, ligation may still be indicated for infants with large ductal shunts and moderate-severe respiratory insufficiency in whom the prospect of timely spontaneous closure appears low. Ultimately a randomized trial of surgical ligation versus conservative management is necessary to assess the efficacy of this invasive intervention in a population of extremely preterm infants with large ductal shunts. Simultaneously, the transcatheter approach to ductal closure in the very immature infant represents an exciting therapeutic alternative but which is still in its infancy. Insights into the pathophysiology of postoperative cardiorespiratory deterioration, including the importance of left ventricular afterload, may help clinicians avoid instability and mitigate a potentially injurious aspect of surgical treatment. This review examines the evidence regarding the benefits and risks of PDA surgery in preterm neonates and provides a pathophysiology-based management paradigm to guide perioperative care in high-risk infants.
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Affiliation(s)
- Dany E Weisz
- Department of Paediatrics, University of Toronto, Toronto, Canada; Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Regan E Giesinger
- Department of Paediatrics, University of Toronto, Toronto, Canada; Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
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46
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Pavlek LR, Slaughter JL, Berman DP, Backes CH. Catheter-based closure of the patent ductus arteriosus in lower weight infants. Semin Perinatol 2018; 42:262-268. [PMID: 29909074 DOI: 10.1053/j.semperi.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight (<6kg) infants is growing. Among these smaller infants, the goals of this review are to: (1) provide an overview of the procedure; (2) review the types of PDA closure devices; (3) review the technical success (feasibility); (4) review the risks (safety profile); (5) discuss the quality of evidence on procedural efficacy; (6) consider areas for future research. The review provided herein suggests that catheter-based PDA closure is technically feasible, but the lack of comparative trials precludes determination of the optimal strategy for ductal closure in this subgroup of infants.
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Affiliation(s)
- Leeann R Pavlek
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Jonathan L Slaughter
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics at The Ohio State University Wexner Medical Center, Columbus, OH
| | - Darren P Berman
- Department of Pediatrics at The Ohio State University Wexner Medical Center, Columbus, OH; Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Carl H Backes
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics at The Ohio State University Wexner Medical Center, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH.
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Transcatheter Closure of Arterial Duct in Infants < 6 kg: Amplatzer Duct Occluder Type I vs Amplatzer Duct Occluder II Additional Sizes. Pediatr Cardiol 2018; 39:627-632. [PMID: 29453685 DOI: 10.1007/s00246-018-1828-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
Transcatheter closure of arterial duct (AD) remains challenging in low-weight patients and using Amplatzer Duct Occluder devices is still considered off-label in infants < 6 kg. This study aimed to report a large, single-center experience of percutaneous AD closure in infants < 6 kg as well as to compare the most frequently used devices, Amplatzer Duct Occluder type I (ADO I) and Amplatzer Duct Occluder type II Additional Sizes devices (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN, USA). From March 2000 to March 2017, among the 762 patients submitted to percutaneous closure of AD at our Institution, 33 were infants < 6 kg (age 4.8 ± 2.1 months; weight 5.0 ± 0.9 kg). Fourteen patients (45%) underwent ADO I (Group I) and 19 patients ADO II-AS (Group II) device implantation. AD diameter was 2.6 ± 0.8 (range 1.5-4.0) mm resulting in QP/QS of 2.6 ± 0.0.9 (range 1.1-4.5). Successful device deployment was achieved in all patients without procedural morbidity or mortality. Procedural and fluoroscopy times were not significantly different between the groups. However, total X-ray absorbed dose was significantly higher in Group I (121 ± 69 vs 29 ± 16 mGy/cm2, p < 0.01). Immediate, 24 h, and mid-term (46 ± 37 months, median 39) complete occlusion were recorded in 72.7, 90.9, and 97% of patients, respectively without significant difference between the groups. In conclusion, transcatheter closure of AD with Amplatzer Duct Occluder devices is feasible, safe, and effective also in infants less than 6 kg, without significant difference between the most commonly used devices, namely, ADO I and ADO II-AS.
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48
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Surgical Ligation Versus Percutaneous Closure of Patent Ductus Arteriosus in Very Low-Weight Preterm Infants: Which are the Real Benefits of the Percutaneous Approach? Pediatr Cardiol 2018; 39:398-410. [PMID: 29119215 DOI: 10.1007/s00246-017-1768-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
Percutaneous treatment of patent ductus arteriosus (PDA) in extreme premature infants is technically difficult, and therefore, often not consider as an alternative to surgery. The main objective of our work was to compare respiratory status prior and post ductal closure and morbi-mortality, in our series of preterm infants with percutaneous PDA closure versus surgical ligation in the same time-period. Retrospective review of all premature infants submitted to percutaneous and surgical PDA closure from January 2011 to December 2016. All the antenatal, perinatal, and postnatal characteristics were collected. The main outcome was the assessment of the pulmonary status before and after ductal closure using a pulmonary score. Secondary outcomes included moderate-severe disability in neurodevelopment, death before discharge, moderate-severe chronic lung disease, and morbidity at discharge. 25 patients with a mean weight of 1330 g (± 280) underwent percutaneous closure of PDA with ADO-II-AS, and a total of 53 underwent surgical ligation. 28/53 with similar gestational age, birth weight, and procedure weight to those in the percutaneous group, were selected to perform the comparative study. Ductal closure (percutaneous and surgical) resulted in improved respiratory status. However, percutaneous group achieved a fastest respiratory improvement, than surgical group. The surgical closure group associated higher morbidity among survivors (HIV, number of sepsis, need, and duration of inotropics post-interventionism). The incidence of recurrent laryngeal nerve palsy among the surgical group was 17%. Percutaneous closure of PDA in carefully selected low-weight preterm infants is a safe and reliable alternative to surgical ligation.
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