Interventioneller Verschluss eines persistierenden Ductus arteriosus: Neue Möglichkeiten für Frühgeborene und Kinder mit einem Körpergewicht < 6 kg

Background: A large persistent patent ductus arteriosus (PDA) in a symptomatic premature or newborn infant is to be regarded as an expression of the premature birth, which must per se be primarily treated. The PDA may persist, however, despite optimal neonatological therapy and specific pharmacological intervention, as a hemodynamically relevant connection between the aorta and the pulmonary artery stem. In this case the clinical symptoms depend on the extent of the shunt and pulmonary flooding or pulmonary pressure elevation and other concomitant phenomena may result. When preterm and newborn infants are clinically compromised by a large PDA, surgical closure is so far the only alternative to pharmacological treatment.

Aim: This study investigated whether interventional PDA closure is as effective and safe in preterm infants, full term infants and children weighing < 6 kg as in children with greater body weight.

Material and methods: In a retrospective analysis the experiences of two centers which performed interventional PDA closure in preterm and full-term infants and in children with body weight of < 6 kg in the years 2004–2013 were studied.

Results: A total of 68 children weighing < 6 kg and with a hemodynamically relevant PDA were included in the analysis: 10 patients were preterm infants, 33 ex-preterm and 25 term. In all preterm and ex-preterm infants attempts to induce PDA closure by pharmacological means had been unsuccessful and in 62 out of 68 (91.2 %) of the infants interventional PDA closure was possible. The smallest patient weighed 2.2 kg, the median weight of the cohort was 3.7 kg (range 2.2–5.93 kg), preterm infants 2.4 kg (range 2.21–2.81 kg) and ex-preterm infants 3.3 kg (range 2.3–5.7 kg). The devices implanted most frequently (22 times) were the ADO II additional size (ADO II AS) and the AVP II (20 times). The most effective procedure was closure with an ADO II AS device, for which the initial closure rate was > 95 %. Device-associated complications were low at 3 % and there were no mortalities.

Discussion: Interventional PDA closure in children (preterm and full term infants) with a hemodynamically relevant PDA and associated clinical symptoms represents a safe and efficient therapy option after the conservative options have been exhausted. The procedure can be applied safely and successfully in children weighing less than 6 kg and as little as 2 kg.