Percutaneous Closure of Ductus Arteriosus in Preterm Babies: The Initial Brazilian Experience

Manica, João Luiz Langer; Neves, Juliana Rodrigues; Arrieta, Raul; Abujamra, Pedro; Rossi Filho, Raul Ivo; Giuliano, Luiz Carlos; Coimbra, Germana; Teixeirense, Pablo Tomé; Rossi, João Henrique Aramayo; Costa, Rodrigo Nieckel da; Cristóvão, Salvador André Bavaresco; Pedra, Carlos

doi:10.36660/abc.20210818

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Original Article • Arq. Bras. Cardiol. 119 (3) • Sept 2022 • https://doi.org/10.36660/abc.20210818 linkcopy

Percutaneous Closure of Ductus Arteriosus in Preterm Babies: The Initial Brazilian Experience

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background The presence of patent ductus arteriosus can be as high as 50% in preterm babies. Hemodynamically significant patent ductus arteriosus is a common cause of delayed weaning of respiratory support and an important risk factor of necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia in this population.

Objective The aim of this study is to describe an initial experience of percutaneous closure of the ductus arteriosus in preterm infants weighing less than 2 kg.

Methods This was a prospective study, comprised of 14 consecutive patients submitted to percutaneous closure of ductus arteriosus between March 2020 and February 2021 in 6 institutions in Brazil.

Results Mean gestational age was 28.45±3.14 weeks, mean age at the procedure was 38.85±17.35 days and mean weight was 1.41 ±0.41 kg; 79% of the patients were under mechanical ventilation, and 79% had been submitted, on average, to a 1.5 cycle of non-steroidal anti-inflammatory drugs. Most patients were weaned off of mechanical ventilation in a mean of 12.6 ±7.24 days after the procedure. Success rate was 100%. No procedure-related mortality was observed.

Conclusion This study concluded that percutaneous closure of ductus arteriosus in premature babies below 2 kg has satisfactory results and a low complication rate in this study sample.

Heart Defects, Congenital; Ductus Arteriosus; Catheterization; Infant; Premature; Neonatology

GA (weeks)	BW	Age (days)	Weight (Kg)	MV^*	VAD^†	NSAID cycles^‡	Comorbidities
28.6	0.58	62	0.965	Yes	No	1	BDP^§, HIC^//
29.2	1.01	15	0.92	Yes	Yes	No	AKI^¶in anuria, Genetic syndrome¹, wide IVC^#
26.6	0.82	41	1.15	Yes	No	2	BPD, ICH, exposed B24
32	1.55	33	1.85	Yes	No	2	Suspected dandy-walker
26	0.85	45	1.55	Yes	No	3	BPD
27	0.7	28	1.2	Yes	No	2
26	0.9	32	1.5	Yes	No	2	^**PVS²
25	0.8	45	1.2	Yes	Yes	2	BPD
35	2	55	1.95	No	No	1
35	1.2	58	2.0	No	No	1
28	0.8	45	1.45	Yes	Yes	1	BPD, severe PH^††, Genetic syndrome
27	0.98	7	0.98	Yes	No	No	duodenal atresia
26	0.58	63	2.0	No	No	2	BPD
27	0.78	15	0.96	Yes	Yes	No	tracheoesophageal fistula, gastrostomy
28.46	0.97	38.86	1.41	79%	28%	1.55

ductus arteriosus < diameter (mm)	ductus arteriosus > diameter (mm)	Length	Device	Success	Immediate residual shunt	7-day residual shunt	Major complications	Mild LPA obstruction	Extubation (days)
2	3	5	ADOII AS 0402	Yes	Discreto	No	No	No	7
2.3	3.5	6	ADOII AS 0402	Yes	No	No	No	Yes	No
2	4	4.8	ADOII AS 0402	Yes	No	No	No	No	12
2.5	5.6	6.5	ADOII AS 0402	Yes	No	No	No	No	5
3.5	4.5	5.5	ADOII AS 0504	Yes	No	No	No	No	25
2	3.2	6	ADOII AS 0402	Yes	No	No	No	No	15
3	5	8	ADOII AS 0402	Yes	No	No	No	No	7
3.5	4	12	ADOII AS 0406	Yes	Yes	No	No	Yes	23
3.5	5	10	PICCOLO 0402	Yes	No	No	No	No
3	4	7	ADOII AS 0502	Yes	No	No	No	No
3.5	3.8	6	ADOII AS 0502	Yes	No	No	No	No	No
3.8	3.8	4	PICCOLO 0502	Yes	No	No	No	No	7
3.9	4.2	8	ADOII AS 0502	Yes	No	No	No	No
3.5	3.5	9	PICCOLO 0502	Yes	No	No	No	No	22
3.00	4.08	6.99		100%	14%	0%	0%	14%	13.6

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[TFN1001] GA: gestational age; BW: birth weight;^*MV: mechanical ventilation;^†VAD: vasoactive drug;^‡NSAID: non-steroidal Anti-inflammatory drug;^§BPD: bronchopulmonary dysplasia;^//ICH: intracranial hemorrhage;^¶AKI: acute kidney injury;^#IVC: interventricular communication;^**PVS: pulmonary valve stenosis;^††PH: pulmonary hypertension.¹Diagnosis of Edwards Syndrome 13 days after the procedure.²Pulmonary valvuloplasty performed in the same procedure.