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Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams
Alain Fraisse1,2, Carles Bautista-Rodriguez1,2, Margarita Burmester2,3
1Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.
Insights
Persistent patent ductus arteriosus (PDA) is common in preterm infants. While medical and surgical options exist, transcatheter closure shows promise but requires further study for extremely low birth weight infants.
Area of Science:
- Neonatology
- Pediatric Cardiology
Background:
- Persistent patent ductus arteriosus (PDA) is highly prevalent in preterm infants, particularly those extremely preterm.
- Current management strategies lack consensus regarding treatment indications, timing, and definition of a hemodynamically significant PDA.
Purpose of the Study:
- To review current treatment modalities for PDA in preterm infants.
- To evaluate the safety and efficacy of emerging transcatheter closure techniques for PDA in extremely low birth weight (ELBW) infants.
Main Methods:
- Review of existing literature on medical (NSAIDs, paracetamol) and surgical PDA closure.
- Analysis of recent studies on percutaneous transcatheter PDA closure in preterm and ELBW infants.
Main Results:
- Medical management with NSAIDs has moderate success; paracetamol shows potential but needs further long-term safety data in ELBW infants.
- Surgical ligation carries risks of mortality and co-morbidities.
- Transcatheter PDA closure is technically feasible in ELBW infants, demonstrating high success rates and acceptable complications compared to surgery, with promising early/mid-term outcomes.
Conclusions:
- Paracetamol requires more research for long-term safety and efficacy in ELBW infants before widespread adoption.
- Transcatheter PDA closure is a viable option for ELBW infants but requires validation through prospective, randomized controlled trials against current standards of care.
Abstract:
Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA-when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early- and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.
