Abstract 13990: Early Clinical Experience of Trans-Catheter Closure of Patent Ductus Arteriosus in Extremely Premature Neonates
Introduction: Children born prematurely often have a patent ductus arteriosus (PDA). Surgical ligation of the PDA is standard when pharmacologic therapy fails. Trans-catheter closure of PDA (TCCPDA) in premature neonates is a relatively new technique.
Hypothesis: To describe our early clinical experience of TCCPDA in premature neonates who require positive pressure ventilation (PPV) and to identify risk factors for poor respiratory outcomes.
Methods: A retrospective review was performed. A respiratory severity score (RSS) was calculated for all patients. The change in the RSS post-procedure and the time taken for return to pre-procedure RSS were used as outcome variables. Patients with pulmonary artery systolic pressure >50% of the systolic blood pressure were considered to have pulmonary hypertension (PHT).
Results: Thirty premature neonates (25.7±2.8 weeks’ gestation, birth weight=756±284 g) that were PPV dependent with or without PHT were referred for TCCPDA at 55.5±32.2 days of age, weighing 1.67±0.54 Kg. Procedures were performed using only femoral venous access under echo and fluoroscopic guidance. The device used for closure included the 4mm Amplatzer Vascular Plug-II (AVP-II) in 10, 6 mm AVP-II in 10, 8mm AVP-II in 3, 4mm AVP-4 in 1 and MVP-5Q device in 6 patients. The procedure and fluoroscopic times were 83.7±56.8 and 12.8±11.6 minutes respectively. The radiation and contrast doses were 52.8±34.2 mGy and 2.8±1.5 mL/Kg respectively. The baseline RSS and QP:QS ratio were 3.9±3.3 and 2.2±0.8 respectively. The presence of PHT was the only predictor for a longer time to return to pre-procedure RSS (18 vs. 87 hours; OR=5.4, 95% CI:2.2-9.4, P<0.001) with a 68.8±32.6% increase in RSS (P<0.01). There was one procedure-related mortality. One patient, weighing1.06 Kg, developed left pulmonary artery stenosis following device closure. The device embolized in another patient 6 hours post-procedure. Both these devices were snared and retrieved. No other complications were noted during the procedure or on follow-up (mean 1.8 ± 0.8 years). No patients had residual PDA on follow-up echocardiogram.
Conclusions: It is feasible to perform trans-catheter closure of PDAs in premature neonates. Presence of PHT prolongs the need for PPV after PDA closure.
- Pediatric cardiology
- Pulmonary hypertension
- Structural heart disease intervention
- Ductus arteriosus
Author Disclosures: R. Philip: None. K. Balduf: None. K. Washington: None. S. Chilakala: None. A. Arevalo: None. T. Fagan: None. B. Waller: None. S. Sathanandam: None.
- © 2016 by American Heart Association, Inc.