Childrenâ€™s Healthcare of Atlanta has begun performing PDA closures in premature infants smaller than 1kg via a cardiac catheter procedure instead of invasive surgery. Recently, Dr. R. Allen Ligon, a cardiologist at Childrenâ€™s Healthcare of Atlantaâ€™s Heart Center, and the Children’s Cardiac Cath Lab team successfully completed a PDA closure in a 22.3-week premature infant weighing 690 grams (about 1.5 pounds).
All babies in utero have a vessel called the ductus arteriosus, which closes after birth in most cases. However, babies born prematurely often have this vessel remain open, which is referred to as a patent ductus arteriosus (PDA). The PDA can cause serious complications for premature infants as it allows excess blood to flow to the lungs, which are already underdeveloped in these infants, leading to further lung damage as well as other potentially devastating effects to other organs in the body.
Dr. Ligon and the team performed the PDA closure in a 690-gram infant by accessing a vein in the childâ€™s groin/leg, then navigating the catheter and PDA closure device up into the heart.
â€œThis [690-gram infant] is the second baby weighing less than 1kg weâ€™ve done and the smallest child weâ€™ve performed the procedure on at Childrenâ€™s Heart Center,â€ said Dr. Ligon.
Typically, if the infant is resistant to medicine, physicians would resolve a PDA by surgically inserting a clip to prevent blood flow through the vessel. However, the surgical procedure is very risky for premature infants, especially those weighing 2kg or less because of their medical fragility. The risks only increase if the baby weighs 1kg or less.
â€œWhen surgery is performed, the surgeon cuts the skin, spreads the ribcage of the patient and goes into the chest cavity to place a clip. A preemie baby doesnâ€™t tolerate that very well,â€ said Dr. Ligon. â€œWith this new procedure done via catheter, we place the device with no cutting and no stitching. Itâ€™s like a shot and if you can do this, it significantly helps these babies by taking this extra strain off their lungs and preventing other serious medical issues common in preemies.â€
Dr. Ligon carefully placed the device within the PDA to create a controlled clot and close the artery â€“ something that can lead to life-threatening complications including obstructing the aorta or pulmonary arteries if the device is even 1 or 2 millimeters off in placement. This catheter-based procedure for premature infants of this small stature with a PDA is very new with Dr. Ligon only have received FDA approval for use in January 2019. As the child grows, their tissue will grow over the PDA closure device and it will become part of their body.