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A Global Perspective on PDA Management in the Extremely Premature: Shifting Trend Toward Transcatheter Closure
Journal article   Open access   Peer reviewed

A Global Perspective on PDA Management in the Extremely Premature: Shifting Trend Toward Transcatheter Closure

Shyam Sathanandam, Patrick McNamara, Carlos Pedra, Katsuaki Toyoshima, Sophie Malekzadeh-Milani, Juliana Patkai, Osman Baspinar, Hasan Uslu, Worakan Promphan, Meera Khorana, …
Journal of the Society for Cardiovascular Angiography & Interventions, Vol.2(4), 100968
01/01/2023
DOI: 10.1016/j.jscai.2023.100968
PMCID: PMC11307882
PMID: 39131651
url
https://doi.org/10.1016/j.jscai.2023.100968View
Published (Version of record) Open Access

Abstract

Patent ductus arteriosus (PDA) is a frequently encountered defect in infants born extremely premature (≤26 weeks gestation). Historically, closure of the PDA was performed using cyclooxygenase inhibitor medications or by surgical ligations. However, the benefits of PDA closure using these therapies have never been demonstrated, albeit studies have previously not focused on the extremely premature infants. Therefore, there was a worldwide trend toward conservative management of the PDA. With improved survival of extremely premature infants, comorbidities associated with the PDA has increased, resulting in finding alternate treatments such as transcatheter patent ductus arteriosus closure (TCPC) for this population. Currently, there is a renewed interest toward selective treatment of the PDA in this high-risk cohort of small infants. This Comprehensive Review article inspects the globally changing trends in the management of the PDA in premature infants, with a special focus on the rising adoption of TCPC. Moreover, this article compiles data from several neonatal networks worldwide to help understand the problem at hand. Understanding the current management of premature infants and their outcomes is fundamentally essential if pediatric cardiologists are to offer TCPC as a viable therapeutic option for this population. This article aims to serve as a guide for pediatric cardiologists on this topic by compiling the results on landmark clinical trials on PDA management and the controversies that arise from these trials. Comparative outcomes from several countries are presented, including interpretations and opinions of the data from experts globally. This is a step toward coming to a global consensus in PDA management in premature infants.
 global perspective patent ductus arteriosus prematurity transcatheter occlusion

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