Objective To evaluate feasibility and safety of patent ductus arteriosus (PDA) occlusion in very low birth weight newborns < 2500 g when surgery was indicated by PDA occluder under X ray and ultrasounds
Methods After ultrasound evaluation and Ibuprofen treatment when required, significant haemodynamic PDA were defined by high flow in pulmonary artery branch >45 cm/sec, absence or reverse flow in middle cerebral artery, renal and mesenteric arteries, left to right shunt, and DA diameter. Interventional catheterism was proposed as first option. Babies were anaesthetised with ketamine and sufenta. Femoral vein access by 4F Desilets. A catheter was positionned in descending thoracic aorta and the PDA II AS occluder positionned under horizontal X ray and ultrasound. Temperature was kept between 35.5 and 36°C along the procedure.
Results Twelve newborns had a PDA closure. Mean weight was 1740 g (850–2480). The series started at the highest weight. Mean diameter of the duct was 3,3 mm (2,2–4) and length 6 (2–11). PDA ADO IISA used were 3 × 4(2) 4 × 2(1), 4 × 4(4), 4 × 6(2), 5 × 2(2) and 5 × 6(1). Two were repositioned. Mean duration of the entire procedure was 32 min (10–90). X ray exposure was 12 min (3–24) and dose 1,5 grey/cm2 (0.2–4). Two transitional paraprothetic shunts closed spontaneously after few days. One premature infant already in renal failure, died ten days later despite ductal closure. In the others the follow up showed improvement in cerebral and pulmonary blood flows without any haemodynamic problems such as observed after surgical procedures.
Conclusion This preliminary series showed feasibility and safety when combining X-ray and US to close a PDA with PDA ADO IIAS.