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Transcatheter management of patent ductus arteriosus in sick ventilated small infants

Bhava R J Kannan1, Sivadasan Radha Anil, Sumanta Shekar Padhi

  • 1Department of Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi.

Indian Heart Journal
|December 9, 2004
PubMed

Insights

Transcatheter coil closure effectively treated large patent ductus arteriosus in ventilated infants. This minimally invasive procedure offers a promising alternative to surgery for critically ill neonates.

Area of Science:

  • Pediatric Cardiology
  • Interventional Cardiology
  • Neonatology

Background:

  • Large patent ductus arteriosus (PDA) in infants can lead to congestive heart failure and necessitate mechanical ventilation.
  • Surgical intervention is the traditional approach for PDA in this vulnerable population.
  • This study explores transcatheter coil closure as an alternative treatment for PDA in mechanically ventilated infants.

Observation:

  • Five infants (960g-4.1kg, 17 days-3.5 months) with PDA, congestive heart failure, and pneumonia required mechanical ventilation.
  • Echocardiography confirmed PDA (1.8-4.2 mm) with adequate ampulla in all cases.
  • Coil closure was performed using bioptome-assisted delivery.

Findings:

  • Successful PDA closure was achieved in all five infants.
  • Two instances of coil embolization occurred but were successfully retrieved and redeployed.
  • All infants were weaned off mechanical ventilation within 24-72 hours.
  • One preterm infant experienced a transient Doppler gradient, which resolved over time.
  • No significant pulmonary artery obstruction was observed, and all infants were asymptomatic at 3-month follow-up.

Implications:

  • Transcatheter coil closure is feasible for moderate-to-large PDAs in sick, ventilated infants under 5kg.
  • This technique presents a potentially less morbid alternative to surgical PDA closure in selected high-risk neonates.
  • Successful coil closure can facilitate faster recovery and extubation in critically ill infants.
Abstract

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