Clinical Outcome at One Year of Age Following Device Closure of Patent Ductus Arteriosus (PDA) in Small Babies
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To the Editor: Patent ductus arteriosus is a common condition in preterm neonates. Management of babies with hemodynamically significant patent ductus arteriosus after unsuccessful medical treatment in small preterm infants has previously been by surgical ligation. Since the first experience of the transcatheter occlusion of Patent ductus arteriosus by Porstmann et al. in 1967 , technical improvements over the years have increased the success rates even in infants [2, 3, 4, 5].
We are reporting the outcome of small babies over six years (June 2004–June 2010) in Oxford who had device closure of ductus arteriosus following failed medical treatment and ongoing respiratory support (invasive/non-invasive) or oxygen dependency. Twenty seven babies (Weight range 1.4 to 6.5 kg) had device closure. Median gestational age was 30 wk (27–35) and corrected age at the time of the procedure was 40 wk (38–52). Twelve babies had transluminal coil device and 15 had plug type device (Amplatz). Twenty four device closures were performed in the cardiac catheterization laboratory under fluoroscopy guidance. Three babies had device closure under echocardiographic guidance in the neonatal unit (smallest weighed 1.4 kg). This is a breakthrough in neonatal medicine. These babies did not have to be transferred to a Catheter lab, had no increased risk of radiation and all had successful duct closures.
There were no complications in 13(48%). Three (11%) had surgical closure following failed device closure (none had embolised) and 11(41%) had impaired perfusion on the same side of femoral access [4/11(37%) needed heparin infusion for 24 h whereas others improved spontaneously]. Twenty one of twenty four (87.5%) had follow up data at 1 y of age. All had normal echocardiogram (except one with Ventricular septal defect). Seventeen (80%) had normal development, 4(20%) had delayed development [2 had mild delay (language delay and mild hearing loss) and 2 had delayed development (one with congenital myotonic dystrophy and the other with post gastroschisis short gut syndrome with left hemiplegia)]. Seven (33%) had chronic lung disease (4 needed home oxygen and 3 had wheezy illness needing inhalers) and 2(10%) had severe Gastro-esophageal reflux.
This is the largest cohort with 23 babies weighing less than 5 kg at the time of the procedure as opposed to all other reported outcomes of children weighing more than 5kg [2, 3, 4]. All babies survived at one year of age.
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