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Pediatric Cardiology Dec 2022We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the...
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.
Topics: Infant, Newborn; Infant; Humans; Ductus Arteriosus, Patent; Cardiac Catheterization; Treatment Outcome; Infant, Premature; Septal Occluder Device; Infant, Premature, Diseases; Retrospective Studies
PubMed: 35430709
DOI: 10.1007/s00246-022-02903-2 -
Frontiers in Pediatrics 2020The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature...
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. 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. 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 ( = 20), Amplatzer Vascular Plug I ( = 1), and Amplatzer Vascular Plug II ( = 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. 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.
PubMed: 33520899
DOI: 10.3389/fped.2020.615919 -
The Journal of Pediatrics Jan 2022To assess the rate of spontaneous closure and the incidence of adverse events in infants discharged home with a patent ductus arteriosus.
OBJECTIVES
To assess the rate of spontaneous closure and the incidence of adverse events in infants discharged home with a patent ductus arteriosus.
STUDY DESIGN
In a prospective multicenter study, we enrolled 201 premature infants (gestational age of 23-32 weeks at birth) discharged home with a persistently patent ductus arteriosus (PDA) and followed their PDA status at 6-month intervals through 18 months of age. The primary study outcome was the rate and timing of spontaneous ductal closure. Secondary outcomes included rate of assisted closure and the incidence of serious adverse events.
RESULTS
Spontaneous ductal closure occurred in 95 infants (47%) at 12 months and 117 infants (58%) by 18 months. Seventeen infants (8.4%) received assisted closure with surgical ligation or device assisted occlusion. Three infants died (1.5%). Although infants with spontaneous closure had a higher mean birth weight and gestational age compared with infants with a persistent PDA or assisted closure, we did not identify other factors predictive of spontaneous closure.
CONCLUSIONS
Spontaneous closure of the PDA occurred in slightly less than one-half of premature infants discharged with a patent ductus by 1 year, lower than prior published reports. The high rate of assisted closure and/or adverse events in this population warrants close surveillance following discharge.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT02750228.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Patient Discharge; Prospective Studies
PubMed: 34293369
DOI: 10.1016/j.jpeds.2021.07.035 -
Catheterization and Cardiovascular... Jan 2020Transcatheter closure of patent ductus arteriosus (PDA) in premature infants has been shown to be feasible in small series. Outcomes in larger series are currently...
BACKGROUND
Transcatheter closure of patent ductus arteriosus (PDA) in premature infants has been shown to be feasible in small series. Outcomes in larger series are currently lacking.
MATERIAL
All premature infants (< 36 weeks GA) who underwent transcatheter PDA closure were included in a multicenter French national survey. Demographic data (gestational age [GA], birth weight [BW]) and procedural data (weight [PW], age at procedure [AP], procedural success, fluoroscopy time, and type of device) were collected. Outcomes and procedural complications were reviewed.
RESULTS
Between September 2013 and June 2017, 102 patients were included. In 71 cases, PDA pharmacological closure had been attempted. Mean GA was 27 ± 2.9 weeks. Mean BW and PW were 1,040 ± 715 g and 1,543 ± 698 g, respectively. Mean AP was 39 ± 26 days. Number of premature infants <1 kg, between 1 and 2 kg, and > 2 kg was 21, 59, and 22, respectively. Mean fluoroscopic time was 6.5 min. Success rate was 99%. Device- or procedure-related complications were reported in nine patients (8.9%) including three LPA stenoses (requiring surgery in two and balloon dilatation in one), two neo-coarctations (one requiring subsequent surgery), and three instances of tricuspid valve regurgitation at follow-up. Seven deaths were reported, none being related to the procedure. Mean follow-up was 39.75 ± 13.1 months.
CONCLUSION
In this large series of premature infants undergoing transcatheter PDA closure, it was demonstrated that this procedure can be performed successfully in the vast majority of patients with an acceptable complication rate. Future efforts should focus on minimizing complications, particularly device-related vascular stenoses.
Topics: Birth Weight; Cardiac Catheterization; Ductus Arteriosus, Patent; Fluoroscopy; France; Gestational Age; Health Care Surveys; Hemodynamics; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Radiography, Interventional; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 31609068
DOI: 10.1002/ccd.28502 -
Archives of Cardiovascular Diseases 2021Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature...
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.
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.
Topics: Birth Weight; Cardiac Catheterization; Ductus Arteriosus, Patent; Gestational Age; Heart Injuries; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Paris; Recovery of Function; Septal Occluder Device; Time Factors; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency; Tricuspid Valve Stenosis
PubMed: 34312100
DOI: 10.1016/j.acvd.2021.06.002 -
Seminars in Perinatology Mar 2023Platelet plug formation is critically involved in murine ductus arteriosus closure and thrombocytopenia in preterm infants seems to negatively affect spontaneous and... (Randomized Controlled Trial)
Randomized Controlled Trial
Platelet plug formation is critically involved in murine ductus arteriosus closure and thrombocytopenia in preterm infants seems to negatively affect spontaneous and pharmacologically induced ductal closure. Furthermore, platelet dysfunction may contribute to ductal patency, especially in extremely immature infants. Neonatal platelets likely have multifaceted roles during ductal closure, such as secretion of several signaling molecules and facilitation of specific cell-cell interactions. The only available randomized-controlled trial on platelet transfusions in preterm infants with patent ductus arteriosus demonstrated that a liberal transfusion regimen did not promote ductal closure, but was associated with an increased rate of intraventricular hemorrhage. Herein, we discuss the available mechanistic evidence on the role of platelets in ductus arteriosus closure and their potential clinical implications in preterm infants. We further briefly outline future research directions aimed at a better understanding of platelet-endothelial interactions in neonatal health and disease.
Topics: Infant; Infant, Newborn; Humans; Animals; Mice; Indomethacin; Cyclooxygenase Inhibitors; Ibuprofen; Ductus Arteriosus; Ductus Arteriosus, Patent; Infant, Extremely Premature
PubMed: 36925318
DOI: 10.1016/j.semperi.2023.151719 -
Echocardiography (Mount Kisco, N.Y.) Jul 2008Idiopathic intrauterine closure of the ductus arteriosus, distinct from intrauterine constriction associated with maternal NSAID ingestion or other secondary causes, is... (Review)
Review
Idiopathic intrauterine closure of the ductus arteriosus, distinct from intrauterine constriction associated with maternal NSAID ingestion or other secondary causes, is an uncommon event that often results in significant morbidity and mortality. We report on a 32-week fetus with meconium pseudocyst that presented with idiopathic intrauterine constriction of the ductus arteriosus, and review the literature. We suggest that early diagnosis and judicious obstetrical management, in conjunction with pediatric cardiology consultation based on serial fetal echocardiography, can lead to timely delivery and reversal of the pathophysiology providing the potential for a favorable outcome.
Topics: Ductus Arteriosus, Patent; Humans; Infant, Newborn; Male; Premature Birth; Ultrasonography, Prenatal
PubMed: 18422673
DOI: 10.1111/j.1540-8175.2008.00667.x -
Medicine Mar 2022Our objective was to compare postprocedure hemodynamic decompensation in extremely premature infants who had their patent ductus arteriosus (PDA) closed with surgical...
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.
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Ligation; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 35357352
DOI: 10.1097/MD.0000000000029103 -
Advances in Neonatal Care : Official... Jun 2019Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after... (Review)
Review
BACKGROUND
Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion.
PURPOSE
The purpose of this article is to review pathophysiology and treatment options for PDA.
METHODS
A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2018). Search terms included neonate, PDA, pathophysiology, pharmacotherapy, nursing, ligation, indomethacin, ibuprofen, and acetaminophen (paracetamol).
RESULTS
Optimal treatment remains contentious. Options include conservative/medical, pharmacologic, and surgical management. Conservative/medical management includes mild fluid restriction, increased airway pressures, and supportive care. Pharmacologic treatment is accomplished using indomethacin, ibuprofen, or acetaminophen. Surgical intervention is by direct closure or by percutaneous ligation. Treatment may be prophylactic, presymptomatic, or symptomatic. Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay.
IMPLICATIONS FOR RESEARCH
Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies.
IMPLICATIONS FOR PRACTICE
Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes. For nurses, anticipation of possible side effects is important for performance of focused assessments.
Topics: Cardiovascular Physiological Phenomena; Continuous Positive Airway Pressure; Cyclooxygenase Inhibitors; Diuretics; Ductus Arteriosus; Ductus Arteriosus, Patent; Echocardiography, Doppler; Endovascular Procedures; Fetus; Humans; Infant, Extremely Premature; Infant, Newborn; Ligation; Persistent Fetal Circulation Syndrome; Positive-Pressure Respiration; Respiration, Artificial; Time Factors
PubMed: 30720481
DOI: 10.1097/ANC.0000000000000590