HEART DEFECTS
SWITCH TO THE interventional VIEW For more information specific to interventional cardiology regarding PDA closure
PDA Closure in Infants
Constriction of the ductus arteriosus is a critical step in postnatal circulatory transition. If the ductus remains open, PDA occurs, resulting in left-to-right shunting that can create significant challenges, especially in premature infants.
Challenges include6:
- Pulmonary over-circulation in lungs that are already under duress
- Systemic hypoperfusion
As the only PDA closure solution indicated for premature infants ≥ 700g + ≥ 3 days old and proven to deliver safe and effective closure, Amplatzer Piccolo™ Occluder offers new opportunities to care for a wider range of patients than ever before.17
PDA Closure Guidelines in Adults
PDA closure is recommended if left atrial or left ventricular enlargement is present and attributable to the PDA with left-to-right shunt, pulmonary artery systolic pressure < 50% systemic, and pulmonary vascular resistance less than one-third systemic.13
PDA closure may be considered in the presence of a net left-to-right shunt if pulmonary artery systolic pressure is ≥ 50% systemic, and/or pulmonary vascular resistance is greater than one-third systemic.13
Transcatheter PDA closure—eg, with an Amplatzer™ ductus occluder—is the standard of care in most cases.4
PATENT DUCTUS ARTERIOSUS (PDA) CLOSURE IN INFANTS
Narrowing of the ductus arteriosus is a critical step in postnatal circulatory transition. If the ductus remains open, patent ductus arteriosus occurs, resulting in left-to-right shunting that can create significant challenges, especially in premature infants.
Challenges include:6
- Pulmonary over-circulation in lungs that are already under duress
- Systemic hypoperfusion
IRIE PATIENT STORY
“I would definitely consider Abbott’s Piccolo device to be Irie’s life saver.”
Crissa Felkner (Irie’s mom)
Toddler Irie was treated with an Amplatzer Piccolo™ device when she was just 6 weeks old.
Hub
- 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.
- 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.
- Kim LK. Patent ductus arteriosus (PDA). Medscape. emedicine.medscape.com/article/891096-overview. Accessed June 2023.
- 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.
- 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.
- Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation. 2006;114(17):1873-1882. doi.org/10.1161/CIRCULATIONAHA.105.592063
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Ashrafi AH, Levy VY. Management strategies for the preemie ductus. Curr Opin Cardiol. 2019;34(1):41–45. doi.org/10.1097/HCO.0000000000000580.
- Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics. 2010;125(5):1020–1030. doi.org/10.1542/peds.2009-3506.
- Amplatzer Piccolo Occluder Instructions for Use.