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.
Highlights
There has been a growing interest in utilizing transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants as a less invasive alternative to surgical ligation and a more effective treatment option compared to medical therapy [1–3]
In 2020 a panel of interventional congenital cardiologists, echocardiography imaging cardiologists, and representatives from the device manufacturer convened to review and analyze a series of transcatheter PDA closure cases performed in ELBW infants using the Amplatzer Piccolo Occluder where key adverse events occurred
Recapturing only the proximal portion of the device and redeploying using a “packing-type” approach can be effective for left pulmonary artery (LPA) protrusion, but less likely to work for an aortic obstruction where complete device recapture is recommended
Summary
There has been a growing interest in utilizing transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants as a less invasive alternative to surgical ligation and a more effective treatment option compared to medical therapy [1–3]. The incidence of periprocedural complications is relatively low, there is opportunity to reduce the event rates further by defining guidelines for the prevention and management of adverse events. In 2020 a panel of interventional congenital cardiologists, echocardiography imaging cardiologists, and representatives from the device manufacturer convened to review and analyze a series of transcatheter PDA closure cases performed in ELBW infants using the Amplatzer Piccolo Occluder where key adverse events occurred. Based on this analysis insights into the mechanism of these adverse events were gained and guidelines for the prevention and management of these complications were developed by the panel.
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