ORIGINAL ARTICLE

Transcatheter Patent Ductus Arteriosus Occlusion in Small Infants

Corresponding Author

Matthew C. Schwartz MD

[email protected]

The Heart Center, Arnold Palmer Hospital for Children, Orlando, Fla, USA

College of Medicine, University of Central Florida, Orlando, Fla, USA

Corresponding Author: Matthew C. Schwartz, MD, The Heart Center, Arnold Palmer Hospital for Children, 92 West Miller Street, Orlando, FL 32806, USA. Tel: 407-649-6907; Fax: 407-481-2035; E-mail: [email protected]Search for more papers by this author

David Nykanen MD,

David Nykanen MD

The Heart Center, Arnold Palmer Hospital for Children, Orlando, Fla, USA

College of Medicine, University of Central Florida, Orlando, Fla, USA

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Lawrence H. Winner PhD,

Lawrence H. Winner PhD

Department of Statistics, University of Florida, Gainesville, Fla, USA

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Jose Perez MD,

Jose Perez MD

Division of Neonatology, Winnie Palmer Hospital, Orlando, Fla, USA

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Michael McMahan MD,

Michael McMahan MD

Division of Neonatology, Winnie Palmer Hospital, Orlando, Fla, USA

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Hamish M. Munro MD, FRCA,

Hamish M. Munro MD, FRCA

Division of Cardiac Anesthesiology, Arnold Palmer Hospital for Children, Orlando, Fla, USA

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Sukumar Suguna Narasimhulu MD,

Sukumar Suguna Narasimhulu MD

College of Medicine, University of Central Florida, Orlando, Fla, USA

Division of Cardiac Intensive Care, Arnold Palmer Hospital for Children, Orlando, Fla, USA

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Matthew C. Schwartz MD,

Corresponding Author

Matthew C. Schwartz MD

[email protected]

The Heart Center, Arnold Palmer Hospital for Children, Orlando, Fla, USA

College of Medicine, University of Central Florida, Orlando, Fla, USA

David Nykanen MD,

David Nykanen MD

The Heart Center, Arnold Palmer Hospital for Children, Orlando, Fla, USA

College of Medicine, University of Central Florida, Orlando, Fla, USA

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Lawrence H. Winner PhD,

Lawrence H. Winner PhD

Department of Statistics, University of Florida, Gainesville, Fla, USA

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Jose Perez MD,

Jose Perez MD

Division of Neonatology, Winnie Palmer Hospital, Orlando, Fla, USA

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Michael McMahan MD,

Michael McMahan MD

Division of Neonatology, Winnie Palmer Hospital, Orlando, Fla, USA

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Hamish M. Munro MD, FRCA,

Hamish M. Munro MD, FRCA

Division of Cardiac Anesthesiology, Arnold Palmer Hospital for Children, Orlando, Fla, USA

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Sukumar Suguna Narasimhulu MD,

Sukumar Suguna Narasimhulu MD

College of Medicine, University of Central Florida, Orlando, Fla, USA

Division of Cardiac Intensive Care, Arnold Palmer Hospital for Children, Orlando, Fla, USA

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First published: 26 May 2016

https://doi.org/10.1111/chd.12360

Citations: 9

Conflict of interest: The authors have no financial relationships or conflicts of interest to disclose.

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Abstract

Background

Transcatheter patent ductus arteriosus (PDA) occlusion is feasible in small infants and may improve lung function in symptomatic patients. We aimed to describe transcatheter PDA closure in small infants including predictors of technical success and rate of complication and to identify factors associated with improved respiratory status after closure.

Methods

All patients in the NICU at our center who were referred for transcatheter PDA occlusion between 1/2010 and 11/2014 were retrospectively identified. Relevant details were extracted. Additionally, a modification of the respiratory severity score (RSS) (FiO₂ × mean airway pressure) was used to characterize degree of pulmonary support before and at intervals after catheterization.

Results

Twenty patients were identified with median age of 96 days (13–247) and weight of 3.1 kg (1.7–4.7). The PDA was type F morphology in 14 (70%) patients. The PDA was successfully occluded in 16 (80%) patients. Ratio of minimum PDA diameter/length was >0.5 in all unsuccessful attempts and <0.4 in all successful cases (P = .01). Of the 16 cases of occlusion, Amplatzer Vascular Plug II was used in 15 (94%). No deaths or pulse loss occurred. Five (25%) patients required blood transfusion and transfusion was associated with lower hemoglobin (P = .049), lower weight (P = .008), and lower aortic pressure (P = .04). Excluding 1 patient with significant congenital heart disease, the RSS improved at 3 days in 9 (60%) patients and at 7 days in 12 (80%) compared with preintervention value. Patient factors were not associated with improved RSS at 3 or 7 days.

Conclusions

In our cohort of symptomatic infants, transcatheter PDA occlusion was successful in most and a ratio of minimum PDA diameter/length of <0.4 was predictive of technical success. Using a surrogate for pulmonary support, the majority of patients were on less support 7 days after closure.

References

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Volume11, Issue6

November/December 2016

Pages 647-655

Transcatheter Patent Ductus Arteriosus Occlusion in Small Infants

Abstract

Background

Methods

Results

Conclusions

References

Citing Literature

References

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Transcatheter Patent Ductus Arteriosus Occlusion in Small Infants

Abstract

Background

Methods

Results

Conclusions

References

Citing Literature

References

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