DefinePK

Research Objective

To describe a case of percutaneous device closure of patent ductus arteriosus (PDA) in a 1.3 kg infant and highlight advancing techniques and the possibility of managing this condition in high-risk low birth weight neonates.

Methodology

Case report detailing a transcatheter closure of PDA in a neonate weighing 1.3 kg. The procedure involved right femoral vein approach, use of a 5F sheath, a 4F JR with terumo wire to cross the PDA, and subsequent use of a 5F pigtail for delineation. A size 5/4 mm ADO II device was deployed under simultaneous echocardiographic and fluoroscopic guidance.

Methodology Flowchart

                        graph TD;
    A["Patient Presentation with PDA Symptoms"] --> B["Echocardiographic and Clinical Assessment"];
    B --> C["Diagnosis of Hemodynamically Significant PDA"];
    C --> D["Admission for Transcatheter PDA Device Closure"];
    D --> E["Femoral Vein Access and Sheath Insertion"];
    E --> F["Crossing PDA with Wire and Catheter"];
    F --> G["Delineation of PDA with Contrast"];
    G --> H["Device Selection and Loading"];
    H --> I["Device Deployment under Echo/Fluoro Guidance"];
    I --> J["Successful Occlusion of PDA"];
    J --> K["Post-procedure Monitoring"];
    K --> L["Discharge and Follow-up"];                    

Discussion

Transcatheter closure of PDA in very low birth weight neonates presents challenges including difficult vascular access and the need for careful device selection. The ADO II device was used due to the unavailability of the Amplatzer Piccolo Occluder in Pakistan. The discussion emphasizes the importance of a multidisciplinary approach, minimizing radiation exposure, and meticulous follow-up.

Key Findings

Successful percutaneous device closure of PDA in a 1.3 kg infant. Post-procedure, the infant showed marked clinical improvement and echocardiography confirmed a well-placed device with no leak and reduced gradient across the descending aorta.

Conclusion

Transcatheter closure of PDA is a feasible and effective treatment option for very low birth weight neonates, even in resource-limited settings, with appropriate technique and device selection.

Fact Check

1. Patent ductus arteriosus (PDA) constitutes 5%-10% of all congenital heart diseases. (Confirmed in abstract and introduction).
2. The infant in the case report weighed 1.3 kg at the time of the procedure. (Confirmed in title, abstract, and case report).
3. The gradient across the descending aorta reduced from 19 mmHg immediately post-procedure to 9 mmHg at a 2-week follow-up. (Confirmed in case report).

Mind Map