Objective: Surgical closure of patent ductus arteriosus (PDA) has been considered the only way to rescue preterm neonates following nonsteroidal anti-inflammatory drugs closure failure. However, PDA closure by catheter-based interventions has become another therapeutic choice. The aim of this report was to investigate the timing and treatment methods for hemodynamically significant PDA (hsPDA) in preterm neonates.
Methods: We retrospectively studied 4 ventilator-dependent preterm neonate cases with hsPDA who had an urgent need of PDA closure and who attended our hospital between October 2016 and March 2018. We assessed the efficacy and safety of transcatheter closure of the hsPDA, and evaluated the dependence of the infants on mechanical ventilation.
Results: The 4 infants with hsPDA underwent successful transcatheter closures. Two infants were weaned from the ventilatory support within 24 hours after the closure. Those 2 preterm neonates demonstrated normal growth and development during the postoperative follow-up. However, the other 2 infants still needed ventilatory support beyond 48 hours post procedure. One of them presented a bronchial stenosis, underwent a bronchial stent placement by bronchoscopy 10 days after the PDA closure, and was only then finally withdrawn from the ventilatory support. The other infant had a severe bronchomalacia and was only weaned from the ventilator 36 days post PDA closure.
Conclusion: Transcatheter closure could be an acceptable alternative to surgical ligation when medication treatment fails to close hsPDAs in ventilator-dependent preterm neonates. This intervention should be considered to minimize mechanical ventilation duration, reduce the incidence of bronchopulmonary dysplasia, and improve the prognoses of these infants.