Transcatheter patent ductus arteriosus closure in extremely premature infants

Transcatheter closure of the patent ductus arteriosus (TC-PDA) is feasible in very premature infants, as an alternative to surgical ligation when clinically indicated. TC-PDA can be performed with high procedural success and a low complication rate in these tiny infants, but there are unique considerations that differ from conventional TC-PDA in larger children and adults: The bedside or catheterization-laboratory environment should be optimized for the premature infant; an antegrade approach with complete avoidance of femoral arterial cannulation is recommended due to the very high associated morbidity; fluoroscopy is minimized, primarily guiding catheter and wire movement to reduce radiation exposure; and intraprocedural transthoracic echocardiography is the primary modality to assess device position and vascular obstruction. There are now numerous suitable devices, some of which have been approved for use in this particular patient population. We expect that there will be increasing adoption of TC-PDA as centers understand the procedural techniques, risks, and excellent outcomes that are summarized herein.