Ultrasound-Guided Interventional PDA Closure in Premature Babies in the NICU: Methods and Experience on 41 Patients

Background: Percutaneous interventional closure of the patent ductus arteriosus in premature babies is conventionally dependent on radiation and, hence, transportation of the patients to a cath lab. We present the results of an innovative method for ultrasound-guided catheter interventional closure of PDA in premature babies in the NICU.

Method: We developed a method for echocardiographically guided transvenous percutaneous PDA closure in prematurely born babies at various gestational ages. Clinical and interventional details are provided.

Results: Forty-one preterm babies with structurally normal hearts were treated percutaneously for PDA with ultrasound guidance only, the first 5 at the German Heart Center Munich, and the remaining 36 on-site in the treating NICU. The median birth weight of the patients was 755 g, range was 340 to 2,560 g, median weight at intervention was 1,200 g, and range was 730 to 2,800 g. During the intervention, 23 patients were ventilated mechanically, 9 of whom were on HFOV. Ten patients were on noninvasive CPAP and 7 on HFNC. In two patients, the femoral artery was inadvertently punctured and consequently used for the procedure, other than that the intervention was performed via a 4-Fr sheath in the femoral vein. Median procedural time from vessel puncture to removal of sheath was 45 minutes, range of 25 to 195 minutes. Based on the echocardiographic measurement of the PDA, we used 27 4/2 mm, 8 5/2 mm, 4 5/4 mm, and 2 4/4 mm Piccolo devices. The PDA was closed successfully in all patients. A residual shunt persisted for 3 weeks in one patient before complete closure occurred. Two serious complications arose. In one patient, a pericardial effusion had to be drained, another patient needed coarctation-stenting postprocedurally. Additionally, two possible postductal thromboembolic events were noted.

Conclusion: The presented method enabled safe and effective one-site percutaneous closure of the PDA in prematures by means of ultrasound guidance. Continuous refinement and development of the technique can provide an optimal and gentle treatment for PDA in extremely low birth weight infants.

Publication History

Article published online:
28 January 2023