Interventional closure of patent ductus arteriosus in infants smaller than 5000 g - single center experience of thirteen consecutive cases over 2 years

Introduction: Occlusion of patent ductus arteriosus (PDA) in small infants is in many centers still a domain of cardiac surgery that can be performed with little technical effort but still bares the risks of any open surgical therapy. Interventional therapy has recently evolved in the field of PDA occlusion. New device technology with miniaturized devices and softer, more flexible equipment require smaller introducer sheathes, may prevent distortion of the anatomy during implantation and therefore is more suitable in smaller infants.

Patients: We report 13 consecutive cases over a 2 year period from 03/2012 to 04/2014 of infants smaller than 5000 g with a hemodynamically relevant PDA who were scheduled for an interventional PDA occlusion. Median age was 111 days (41-133), median weight was 3,7 kg (2,8-4,5).

Results: An interventional closure was achieved in 12 patients. A transpulmonary approach was used in 12 patients, a transaortal approach in 1. In ten patients we used a combination of local anaesthesia and sedation, 3 patients were intubated before the procedure. In 2 cases with very large PDAs we used a pfm PDA-R occluder (7 mm and 8,5 mm), in one patient we used a ADO I 5/4 occluder, in two patients a pfm PDA coil 7/6 and in 7 patients an Amplatzer ADO II AS occluder (3x4/4, 3x5/4, 1x6/3) was used. There was one perforation induced by an exchange wire resulting in pericardial tamponade and urgent surgical repair. No other severe complication and no device related complication occurred.

Conclusions: In many small infants interventional closure of a PDA is feasible with an acceptable risk and can be done in most cases in deep sedation only.