Abstract

Objectives: To report the outcomes of echocardiography-guided transcatheter device closure of hemodynamically significant patent ductus arteriosus (PDA) in preterm neonates at City Children's Hospital, and to describe the procedural characteristics and complications of this technique.

Methods: We retrospectively reviewed 15 preterm neonates with hemodynamically significant PDA who underwent echocardiography-guided transcatheter device closure at City Children's Hospital between January 2024 and May 2025, after failure of medical therapy with ibuprofen.

Results: Mean gestational age was 31.1 ± 2.5 weeks (minimum 27 weeks and 4 days) and mean birth weight was 1.91 ± 0.68 kg (minimum 1.2 kg); 4 patients (26.7%) were male and 11 (73.3%) were female. All patients had pulmonary edema (22.2% on nasal continuous positive airway pressure, 77.8% on mechanical ventilation), necrotizing enterocolitis, and left heart dilatation before the procedure, after a mean of 26 ± 5 days of medical treatment including two doses of ibuprofen in all patients. All procedures were performed via the right femoral vein under transthoracic echocardiographic guidance only, with a mean procedure time of 50 minutes; devices used included the Amplatzer Piccolo 5/4 (66.7%), Piccolo 5/2 (13.3%), Amplatzer Duct Occluder II 3/4 (13.3%), and Amplatzer Vascular Plug II 6/6 (6.7%). The device was successfully implanted in all 15 patients (100%). A trivial residual shunt occurred in 3 patients (20%), resolving spontaneously within one week; no device migration or impingement on surrounding structures was observed, and no other complications occurred. Thirteen patients (86.7%) were successfully extubated and discharged; two patients (13.3%) died of neonatal sepsis unrelated to the procedure.

Conclusion: Echocardiography-guided transcatheter device closure of PDA, performed entirely by transthoracic echocardiography without fluoroscopy, is a feasible, effective, and minimally invasive treatment option for hemodynamically significant PDA in preterm neonates, including extremely low birth weight infants, with a high technical success rate and low procedure-related complication rate.