John P Breinholt
University of Texas McGovern Medical School, USA
Title: The patent ductus arteriosus of premature neonates should be closed via transcatheter techniques instead of surgical ligation
Biography
Biography: John P Breinholt
Abstract
The patent ductus arteriosus (PDA) of premature neonates continues to be a significant clinical problem contributing importantly to both morbidity and mortality. Surgical ligation and medical therapy both have their drawbacks. Medical therapy has a high failure rate and is associated with the renal dysfunction and gastrointestinal morbidities. Surgical ligation has a high success rate, but has been associated with pneumothorax, phrenic nerve palsy and vocal cord paralysis, and scoliosis. While transcatheter PDA closure has been performed for nearly 40 years, it has largely been reserved for children >5 kg. We have focused on the safety and efficacy of PDA device closure in premature neonates <3 kg. The hospital records and catheterization reports of premature neonates were reviewed with attention to procedural details, complications, and short term outcomes. We recorded the results of neonates
who received one of two commercially available devices for PDA closure, with a focus on a newly available microvascular plug that enables delivery via a microcatheter. The device is delivered with fluoroscopy and echocardiographic guidance. Complete closure was achieved in all patients. All patients survived the procedure and are currently living. There have been no instances left pulmonary artery obstruction or coarctation of the aorta. This preliminary study demonstrates that transcatheter PDA closure can be successfully performed in preterm neonates using currently available technology with a high success rate and a low incidence of complications. We also describe a novel transvenous approach using a combination of echocardiography and fluoroscopy to avoid arterial access in this fragile patient population.