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CONGENITAL
HEART DEFECTS

SWITCH TO THE interventional VIEW    For more information specific to interventional cardiology regarding PDA closure

Echocardiography and/or angiography can differentiate between patent ductus arteriosus and coronary arteriovenous fistulas, which can have a similar presentation.

Patent ductus arteriosus treatment

The Krichenko classification of patent ductus arteriosus, based on angiography, includes 6 types:
 

PATENT DUCTUS ARTERIOSUS

TYPE A: CONICAL

TYPE D: COMPLEX

TYPE B: WINDOW

TYPE E: ELONGATED

TYPE C: TUBULAR

TYPE F: FETAL

The patent ductus arteriosus can range from a small hemodynamically insignificant lesion that is not heard on auscultation to one that without intervention is large enough to cause congestive heart failure and pulmonary hypertension.4,8


PATENT DUCTUS ARTERIOSUS TREATMENT OPTIONS8–12

OBSERVATION

Doctor monitors the baby's heart
to evaluate whether the open blood vessel
is closing properly.

MEDICATION THERAPY

Premature infants can take an intravenous
medication (Indomethacin, Acetaminophen, or Ibuprofen)
that may help close PDA.

TRANSCATHETER CLOSURE
The Amplatzer Piccolo™ Occluder is precisely placed
in the duct to ensure effective closure.

SURGICAL LIGATION

Surgeon binds the ductus with a simple ligature
during open heart surgery.

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References
  1. Sathanandam SK, Gutfinger D, O’Brien L et al. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv. 2020;96(6):1266–1276. doi.org/10.1002/ccd.28973.
  2. Dice JE, Bhatia J. Patent ductus arteriosus: an overview. J Pediatr Pharmacol Ther. 2007;12(3):138–146. doi.org/10.5863/1551-6776-12.3.138.
  3. Kim LK. Patent ductus arteriosus (PDA). Medscape. emedicine.medscape.com/article/891096-overview. Accessed June 2023.
  4. Baruteau A-E, Hascoët S, Baruteau J et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis. 2014;107(2):122–132. doi.org/10.1016/j.acvd.2014.01.008.
  5. Tripathi A, Black GB, Park Y-M M et al. Prevalence and management of patent ductus arteriosus in a pediatric Medicaid cohort. Clin Cardiol. 2013;36(9):502–506. doi.org/10.1002/clc.22150.
  6. Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation. 2006;114(17):1873-1882. doi.org/10.1161/CIRCULATIONAHA.105.592063
  7. Philip R, Waller BR III, Agrawal V et al. Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device. Catheter Cardiovasc Interv. 2016;87(2): 310–317. doi.org/10.1002/ccd.26287.
  8. Gillam-Krakauer M, Reese J. Diagnosis and management of patent ductus arteriosus. NeoReviews 2018;19(7):e394–e402. doi.org/10.1542/neo.19-7-e394.
  9. Chaudhary N, Filipov P, Bhutada A et al. Controversies in the management of patent ductus arteriosus in preterm infants. J Neonatal Biol. 2016;5(4):1000238. doi.org/10.4172/2167-0897.1000238. www.walshmedicalmedia.com/open-access/controversies-in-the-management-of-patent-ductus-arteriosusin- preterminfants-2167-0897-1000238.pdf. Accessed June 2023.
  10. Nady ME, Amrousy DE, Salah N et al. Transcatheter versus surgical closure of patent ductus ateriosus in pediatric patients: A systematic review with meta-analysis. SM J Pediatr Surg. 2017;3(4):1054. www.jsmcentral.org/sm-pediatric-surgery/fulltext_smjps-v3-1054.pdf. Accessed June 2023.
  11. Zahn EM, Peck D, Phillips A et al. Transcatheter closure of patent ductus arteriosus in extremely premature newborns: Early results and midterm follow-up. JACC Cardiovasc Interv. 2016;9(23):2429–2437. doi.org/10.1016/j.jcin.2016.09.019.
  12. Van Overmeire B, Smets K, Lecoutere D et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med. 2000;343(10):674–681. doi.org/10.1056/NEJM200009073431001.
  13. Stout KK, Daniels CJ, Aboulhosn JA et al. 2018 AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(14):e698–e800. doi.org/10.1161/ CIR.0000000000000603.
  14. Warnes CA, Williams RG, Bashore TM et al. ACC/AHA 2008 Guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol. 2008;52(23):e143– e263. doi.org/10.1016/j.jacc.2008.10.001.
  15. Ashrafi AH, Levy VY. Management strategies for the preemie ductus. Curr Opin Cardiol. 2019;34(1):41–45. doi.org/10.1097/HCO.0000000000000580.
  16. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics. 2010;125(5):1020–1030. doi.org/10.1542/peds.2009-3506.
  17. Amplatzer Piccolo Occluder Instructions for Use.

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