Percutaneous Closure of Patent Ductus Arteriosus with Amplatzer Piccolo Occluder device in infants <2 kg

Abstract

Abstract We present our experience of transcatheter patent ductus arteriosus (PDA) closure with AmplatzerTM Piccolo Occluder in infants weighing less than 2 kg. The data of 19 infants <2 kg who underwent transcatheter PDA closure (TCPC) between December 2019 and October 2022 were evaluated retrospectively. The transvenous antegrade approach was performed in 15 patients, guided by fluoroscopy, venous angiography, and transthoracic echocardiography (TTE) with the placement of the entire device within an intraductal position. The retrograde approach via the femoral artery was performed in 4 patients. Transcatheter closure was attempted in 19 babies with a median gestational age of 27 weeks {interquartile range (IQR) 25-28 weeks}, median birth weight 905 g (IQR 770-1180 g) and was successfully performed in 16 (84%). The median procedural age was 28 days (IQR 36-47 days), and the median procedural weight was 1480 g (IQR 1155-1800 g). The median procedure and fluoroscopic time were 35 min (IQR 30-60 min) and 12 min (IQR 7-19 min) respectively. After the unsuccessful procedure, PDA closed spontaneously in three patients in short-term follow-up. Three procedural complications were device embolization, pericardial effusion/cardiac tamponade, and femoral artery thrombosis. In our hospital, TCPC was performed with a high degree of success and an acceptable complication rate in infants <2 kg. Based on our initial experience, early and short-term follow-up is encouraging. Even with less invasive different techniques, the retrograde transarterial approach must be avoided. Mechanical stimulation can effectively promote the closure of the PDA after a failed procedural closure.