To define characteristics and complications of ex-premature Scottish children having transcatheter closure of a persistent patent ductus arteriosus (PDA).Method
Retrospective analysis of cases from a national interventional paediatric cardiac centre at the Royal Hospital for Sick Children (RHSC), Glasgow from 2001–2010. Cases with significant cardiac or congenital abnormalities excluded. Information on demographics, co morbidities, closure indication and procedural complications obtained.Results
275 children underwent transcatheter PDA closure. 64 (22%) were born prematurely. Referral rates based on preterm births from 11 health boards varied: 3% (median), (inter quartile range 1.5–4.6%). Reasons for closure: clinical features of PDA (100%), left heart enlargement (59%), “failure to thrive” (25%), mitral regurgitation (15%), cardiac failure (12.5%), pulmonary hypertension (6%). Co-morbidities: chronic lung disease (12.5%), pulmonary hypertension (6.3%), domiciliaryoxygen (6.3%), long term parenteral nutrition (1.5%) and nasogastric feeding (3%). Age at closure: 1.5 years, (IQR 0.8–2.5), birth gestation: 28 weeks, (IQR 26–30), birth weight: 1.1 kg (IQR 0.9–1.4), length of stay: 2 nights (IQR 2–3). Closure successful in 92% (93% >6 months and 88% <6 months). Complications occurred in 28%, (50% under 6 months, 25% over 6 months) and included device malposition (8), lower limb ischaemia requiring heparin (5), thrombolytics (2) and fasciotomy (1).Conclusion
There are no large studies of transcatheter PDA closure in ex-preterm infants. Our population had a high incidence of comorbidities with persistent PDA. Transcatheter closure was effective but had a high complication rate. Findings of this study should be considered when planning PDA management.