Transumbilical catheter intervention of ductus arteriosus in neonatal swine

The objective of this study is to report a new technique for transcatheter intervention of the ductus arteriosus (DA) through the umbilical artery (UA) in neonatal swine. Transcatheter intervention of the DA in swine is routinely performed via the jugular vein or occasionally the femoral artery accessed via surgical cutdown. Transumbilical catheter intervention is performed in humans. For this study, all procedures were performed under general anesthesia using isoflurane with oxygen for induction and maintenance. Only animals less than 48 h old were used. The UA was cannulated with a 3.5-Fr single-lumen catheter. The catheter was exchanged over a wire for a 4-Fr introducer. A 4-Fr angled catheter was used to cross the DA. Coil occlusion or stent implantation was implemented. UA cannulation was attempted in 30 newborn piglets with the intent to coil occlude or stent the DA. The animals weighed 1.2-1.8 kg (mean 1.49 kg; median 1.4 kg). Umbilical cannulation was successful in 28/30 animals (93%). Successful ductal intervention was achieved in 26 animals (93%). Initially all procedures were performed under general anesthesia and orotracheal intubation; the last 18 were performed using spontaneous mask ventilation. Thus we find that transumbilical DA catheter intervention can be successfully performed. Advantages over traditional methods include avoiding technical problems inherent with traversing right heart structures and surgical wounds. Access to the DA along its natural orientation facilitates intervention.