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Patent Ductus Arteriosus in Premature Babies
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Patent Ductus Arteriosus in Premature Babies

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Pediatric Cardiology and Congenital Heart Disease".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 13435

Special Issue Editors

Dr. Gianfranco Butera

E-Mail Website
Guest Editor
Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Ospedale Pediatrico Bambino Gesù IRCCS, 20097 Rome, Italy
Interests: pediatric cardiology; congenital cardiology; adults with congenital heart disease; interventional cardiology in congenital heart disease; transcatheter pulmonary valve implantation; septal defects; aortic coarctation
Prof. Dr. Alain Fraisse

E-Mail Website
Co-Guest Editor
1. Paediatric Cardiology Services, Royal Brompton Hospital, London SW3 6NP, UK
2. National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
Interests: interventional catheterisation; paediatric cardiology; pulmonary hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The ductus arteriosus is essential during fetal life and should close after birth. However, in premature babies, it remains open in up to 50% of subjects born at less than 29 weeks of gestational age. A large variety of complications may occur because of PDA, including bronchopulmonary dysplasia, necrotizing enterocolitis, pulmonary hypertension, intraventricular hemorrhage, sepsis, pulmonary over-circulation, heart failure and infective endo- carditis. The mortality risk in infants born before 29 weeks of gestation increases 8-fold if PDA has been described. Medical treatment is the first-line therapy; however, when it fails, mechanical closure must be considered. Options include surgical closure and transcatheter occlusion. Percutaneous closure of the PDA was first described over 20 years ago, but small and extremely low birth weight (ELBW) premature babies have been excluded in the past because of their small size, the lack of appropriate devices, and the assumed higher risk. Recently, technical advances have allowed the development of properly designed devices and delivery systems to perform this procedure safely and consistently. Transcatheter closure of the patent ductus arteriosus is nowadays feasible in very premature infants, when clinically indicated, with high procedural success and a low complication rate. In this Special Issue, unresolved issues and some specific technical tips and tricks will be discussed. Ideally, being able to avoid opening the chest and other traumatic procedures will have the major advantage of reducing the rate of post-procedural complications. A major cultural change in the neonatological approach to this clinical situation is the major step needed to provide this approach to a wider population, as waiting for a longer period after the failure of medical treatments may hinder the potential advantages that PDA closure may provide. 

Dr. Gianfranco Butera
Prof. Dr. Alain Fraisse
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • patent ductus arteriosus
  • closure
  • premies
  • premature babies
  • transcatheter
  • devices
  • surgery

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Published Papers (5 papers)

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Research

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10 pages, 831 KiB  
Article
Who Still Gets Ligated? Reasons for Persistence of Surgical Ligation of the Patent Ductus Arteriosus Following Availability of Transcatheter Device Occlusion for Premature Neonates
by Julia K. Hoffmann, Zahra Khazal, Wievineke Apers, Puneet Sharma, Constance G. Weismann, Kira Kaganov, Craig R. Wheeler, Michael Farias, Diego Porras, Philip Levy and Sarah U. Morton
J. Cardiovasc. Dev. Dis. 2024, 11(5), 132; https://doi.org/10.3390/jcdd11050132 - 23 Apr 2024
Viewed by 1214
Abstract
(1) Background: To identify reasons for the persistence of surgical ligation of the patent ductus arteriosus (PDA) in premature infants after the 2019 Food and Drug Administration (FDA) approval of transcatheter device closure; (2) Methods: We performed a 10-year (2014–2023) single-institution retrospective study [...] Read more.
(1) Background: To identify reasons for the persistence of surgical ligation of the patent ductus arteriosus (PDA) in premature infants after the 2019 Food and Drug Administration (FDA) approval of transcatheter device closure; (2) Methods: We performed a 10-year (2014–2023) single-institution retrospective study of premature infants (<37 weeks) and compared clinical characteristics and neonatal morbidities between neonates that underwent surgical ligation before (epoch 1) and after (epoch 2) FDA approval of transcatheter closure; (3) Results: We identified 120 premature infants that underwent surgical ligation (n = 94 before, n = 26 after FDA approval). Unfavorable PDA morphology, active infection, and recent abdominal pathology were the most common reasons for surgical ligation over device occlusion in epoch 2. There were no differences in demographics, age at closure, or outcomes between infants who received surgical ligation in the two epochs; (4) Conclusions: Despite increasing trends for transcatheter PDA closure in premature infants, surgical ligation persists due to unfavorable ductal morphology, active infection, or abdominal pathology. Full article
(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)
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11 pages, 672 KiB  
Article
Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome
by Natsumi Kikuchi, Taichiro Goto, Nobuyuki Katsumata, Yasushi Murakami, Tamao Shinohara, Yuki Maebayashi, Aiko Sakakibara, Chisato Saito, Yohei Hasebe, Minako Hoshiai, Atsushi Nemoto and Atsushi Naito
J. Cardiovasc. Dev. Dis. 2024, 11(1), 26; https://doi.org/10.3390/jcdd11010026 - 16 Jan 2024
Cited by 3 | Viewed by 3509
Abstract
In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm [...] Read more.
In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011–2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson’s correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the “posture/motor” sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis. Full article
(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)
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Review

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13 pages, 946 KiB  
Review
Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants
by Belinda Chan and Yogen Singh
J. Cardiovasc. Dev. Dis. 2024, 11(1), 7; https://doi.org/10.3390/jcdd11010007 - 25 Dec 2023
Cited by 1 | Viewed by 3718
Abstract
There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. The decision to treat requires a thorough understanding of the clinical status of the patient, clinical evaluation [...] Read more.
There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. The decision to treat requires a thorough understanding of the clinical status of the patient, clinical evaluation of PDA, echocardiographic diagnosis, and hemodynamic impact of ductal shunt on the pulmonary and systemic circulation. In this article, updated evidence on the efficacy and adverse effects of pharmacological treatment options and expectant management are presented, while highlighting the long-term benefits of PDA treatment remains equivocal and controversial. The authors propose a schematic targeted PDA treatment approach based on gestational and chronological age for practical clinical use, and they emphasize important future directions including advancement in PDA device closure techniques, diagnostic echo-parameters, hemodynamic evaluation to assess the impact on other organs, and understanding the long-term outcomes. Full article
(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)
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10 pages, 5824 KiB  
Review
The Transcatheter Closure of Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants: Technique and Results
by Alban-Elouen Baruteau, Alain Fraisse, Gianfranco Butera and Carles Bautista-Rodriguez
J. Cardiovasc. Dev. Dis. 2023, 10(12), 476; https://doi.org/10.3390/jcdd10120476 - 27 Nov 2023
Cited by 2 | Viewed by 2176
Abstract
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered [...] Read more.
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered as first-line therapy, although it carries a limited success rate and potential severe adverse events. In recent years, transcatheter patent ductus arteriosus closure has fast developed and become widely accepted as a safe and efficient alternative to surgical ductal ligation in extremely low birth weight infants >700 g, using most often the dedicated Amplatzer Piccolo Occluder device. This article aims to provide an appraisal of the patients’ selection process, and a step-by-step description of the procedure as well as a comprehensive review of its outcomes. Full article
(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)
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16 pages, 3134 KiB  
Review
Transport and Anaesthesia Consideration for Transcatheter Patent Ductus Arteriosus Closure in Premature Infants
by Tuan Chen Aw, Belinda Chan and Yogen Singh
J. Cardiovasc. Dev. Dis. 2023, 10(9), 377; https://doi.org/10.3390/jcdd10090377 - 1 Sep 2023
Cited by 4 | Viewed by 2104
Abstract
Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and [...] Read more.
Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications. Full article
(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)
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