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Published on: February 8, 2022
Left Pulmonary Artery Occlusion Following Device Closure of Patent Ductus Arteriosus in Premature Infants
Jesus C Jaile1, Ernest Siwik1, Sergio Bartakian1
1Division of Cardiology, Children's Hospital of New Orleans/LSU Health Sciences Center, New Orleans, Louisiana.
Insights
Two premature infants experienced left pulmonary artery occlusion after patent ductus arteriosus closure with the Amplatzer Piccolo Occluder. This highlights the need for careful device selection and increased echocardiographic surveillance in neonates.
Area of Science:
- Neonatal cardiology
- Pediatric interventional procedures
Background:
- The Amplatzer Piccolo Occluder is a new device for patent ductus arteriosus (PDA) closure in neonates.
- This study reports the first cases of left pulmonary artery (LPA) occlusion after Piccolo device use.
Purpose of the Study:
- To report rare but severe complications of LPA occlusion following PDA device closure in premature infants.
- To provide recommendations for preventing and monitoring this complication.
Main Methods:
- Retrospective chart analysis of PDA closures using the Piccolo device.
- Review of cases involving LPA occlusion.
Main Results:
- Two cases of complete LPA occlusion occurred in over 50 Piccolo device closures (4% complication rate).
- The complication rate is comparable to or lower than other published data.
Conclusions:
- Severe LPA obstruction is a rare complication of PDA device closure in premature infants.
- Recommendations include using the shortest possible device and increasing echocardiographic surveillance to weekly intervals if obstruction is noted.
Background:
Device closure of a patent ductus arteriosus (PDA) is rapidly evolving, with the Amplatzer Piccolo Occluder (Abbott) receiving US Food and Drug Administration approval and becoming the first device approved for PDA closure in patients ≥700 g. We report on the first known cases of complete left pulmonary artery (LPA) occlusion following Piccolo closure of a PDA in premature infants.
Methods:
Retrospective chart analysis of PDA closures.
Results:
We have performed over 50 cases of Piccolo device closure of the PDA in preterm neonates in the past 2 years, with these 2 cases representing our only complications (4%). This represents a total complication rate similar to or lower than most centers that have published data for this procedure.
Conclusions:
Although rare, severe LPA obstruction can be seen in premature infants following device closure of the PDA. The Piccolo device is designed to ideally remain entirely intraductal. Although our device selection appeared to provide a device short enough for the given ductal length, we recommend, whenever possible, giving consideration to using the shortest possible device. We also recommend increasing the frequency of echocardiographic surveillance to weekly studies if at any time the imaging demonstrates an increase in the degree of obstruction/turbulence.
