Author + information
- Osman Başpınar,
- Metin Kılınç,
- Ahmet İrdem,
- Derya Aydın Şahin,
- Zatıgül Şafak Taviloğlu and
- Ercan Sivaslı
The aim of this stud was to evaluate our institutional experience of transcatheter closure of PDA at the seriously ill premature babies. Currently available technology is not designed for these age groups. Transcatheter occlusion of PDA at the preterm babies challenges the interventionist.
Eleven seriously ill premature infants underwent PDA closure with different devices, if they still had clinically important PDA, despite appropriate medical treatment. Only venous approach was used in nine patients. The Amplatzer duct occluder (ADO) type II, Cook detachable coil and ADO type II additional sizes were used. Co-morbid problems listed like this: respiratory distress syndrome in 9 patients, necrotizing enterocolitis in 7, intracranial hemorrhage in 7, bronchopulmonary dysplasia in 5, extreme prematüre in 4, intravascular coagulopahty in 3, and renal failure in 2, and pulmonary hemorrhage in 2 patients. All the patients had entubated.
Gestational age of patients was ranged between 26-31 weeks. Mean birth weight was 1120 ± 260 (900-1610) gr, procedural weight was 1870 ± 510 (1190-2820) gr. Mean age of the patient was 36 (14 – 90) day. Mean PDA dimension at the angiography was 2.55 (1–3.5) mm. 4F sheath was used at the all procedures. All implantations were technically successful. Echocardiography confirmed no residual shunts on the following day. During manipulation, cardiac perforation occurred in one patient and the patient was lost. Another patient died six days after procedure because of co-morbid problems. PDAs were completely occluded without significant obstruction of the pulmonary arteries or aorta. Additional sizes were used in 9 times; the others were used once.
At these special age groups, delicate catheter and guidewire manipulation is needed. Especially, the lower profile and symmetry of ADO additional sizes give the opportunity to close PDAs in premature babies Transcatheter technique is possible at the seriously ill preterm infants. And it is a safe alternative to surgical ligation especially for the critically ill patients.