Feasibility and safety of closure Patent Ductus Arteriosus (PDA) in premature infants using Amplatzer PDA occluder ADOIIAS

Abstract

Interventional catheterism can be an alternative to surgery for PDA closure. With the new device PDA ADO IISA, we evaluate feasibility and safety to close PDA in low birth weight infants < 2500 g when indicated. In presence of Clinical signs, ultrasounds (US) defined hemodynamic significant PDA (HSPDA) by mean arterial velocity into pulmonary artery branch > 45 cm/sec, absence or reverse flow in the middle cerebral artery, renal and mesenteric arteries and DA diameter. Interventional catheterism was proposed vs. surgery to the parents. Babies are anesthetized and intubated. The procedure is done under fluoroscopy without contrast and US. Through femoral vein access a 4F catheter is positioned in descending aorta and occluder precisely opened under horizontal X-ray and US. Temperature is kept > 36 °C during the procedure. fourteen infants had PDA closure. Mean weight was 1674 g (880–2480), the series started at the highest weight. Mean diameter of the duct was 3,3 mm (2,2–4) and length 5,8 mm (2–11). PDA ADO IISA used were 3 × 4 (2) 4 × 2 (2), 4 × 4 (4), 4 × 6 (2), 5 × 2 (3) and 5 × 6 (1). Two were repositioned and one changed to increase diameter. Mean duration of the entire procedure was 29 minutes (10–90). X-ray exposure was 12 min (3–24) and dose 1,5 gray/cm 2 (0.2–4). Two transitional paraprothetic shunts closed spontaneously after few days. One premature infant already in renal failure, died ten days later despite ductal closure. In the others, the follow-up showed improvement in cerebral and pulmonary blood flows without any hemodynamic problems such as observed after surgical procedures. This preliminary series showed feasibility and safety when combining X-ray and US to close a PDA with PDA ADO IIAS.