Background

Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature infants at Hôpital Necker Enfants Malades, we have changed our technique several times to advance the guidewire through the right heart to avoid tricuspid valve damage.

Aim

To describe the technique we have been using since May 2019, to report our results with a particular focus on tricuspid leaks and to analyse the potential mechanisms of tricuspid lesion development with previous methods.

Methods

All premature infants weighing < 2 kg who underwent transcatheter PAD closure with this new technique were included. Demographic data, procedural data, outcome and procedural complications were reviewed, with particular attention to the occurrence of tricuspid regurgitation.

Results

Between May 2019 and May 2020, 33 patients were included. Median gestational age was 25 weeks. Median birth weight and procedural weight were 690 g (range 490–1065 g; interquartile range [IQR] 620–785 g) and 1160 g (range 900–1900 g; IQR 1030–1300 g), respectively. Median age at procedure was 35 (IQR 30–46) days. PAD anatomy was evaluated on transthoracic echocardiography only. The median duct diameter was 3 (IQR 2.5–3.2) mm at the pulmonary end. Success rate was 100% (defined as successful closure without residual shunt). One patient had a renal vein thrombosis, which fully resolved with low-molecular-weight heparin anticoagulation. No tricuspid regurgitation or stenosis of the left pulmonary artery or the aorta was seen. One patient died of a superior caval vein obstruction with bilateral chylothorax related to a central catheter thrombosis 56 days after the procedure, unrelated to the catheter procedure.

Conclusion

In this prospective study, we describe a new technique to avoid tricuspid valve damage and facilitate delivery of the PAD device.

中文翻译：

---

早产儿经导管未闭动脉导管闭合：一种便于进入未闭动脉导管的新技术，特别有益于三尖瓣

背景

早产儿经导管未闭动脉导管 (PAD) 闭合已被证明是可行的。自从我们在 Hôpital Necker Enfants Malades 对早产儿进行早期经导管 PAD 闭合手术以来，我们已经多次改变我们的技术，将导丝推进到右心以避免三尖瓣损伤。

目的

描述我们自 2019 年 5 月以来一直在使用的技术，报告我们的结果，特别关注三尖瓣泄漏，并用以前的方法分析三尖瓣病变发展的潜在机制。

方法

包括所有体重 <  2  kg 的早产儿，他们使用这种新技术接受了经导管 PAD 封堵术。回顾了人口统计学数据、手术数据、结果和手术并发症，特别注意三尖瓣反流的发生。

结果

2019 年 5 月至 2020 年 5 月期间，纳入了 33 名患者。中位胎龄为 25 周。出生体重和手术体重中位数分别为 690  g（范围 490–1065  g；四分位距 [IQR] 620–785  g）和 1160  g（范围 900–1900  g；IQR 1030–1300 g) 分别。手术时的中位年龄为 35 (IQR 30-46) 天。仅在经胸超声心动图上评估 PAD 解剖结构。肺末端的中位导管直径为 3 (IQR 2.5-3.2) mm。成功率为 100%（定义为成功闭合且无残余分流）。一名患者有肾静脉血栓形成，通过低分子量肝素抗凝治疗完全解决。未见左肺动脉或主动脉三尖瓣反流或狭窄。一名患者在手术后 56 天死于与中心导管血栓形成相关的双侧乳糜胸上腔静脉阻塞，与导管手术无关。

结论

在这项前瞻性研究中，我们描述了一种避免三尖瓣损伤和促进 PAD 装置输送的新技术。