Small heart implant closes congenital heart defects – Surgical techniques

Image: The Amplatzer Piccolo Occluder PDA closure device (Photo courtesy of Abbott)

Minimally invasive pea-sized transcatheter implant shuts off ductus arteriosus (PDA) in premature infants.

The Amplatzer Piccolo Occluder from Abbott (Abbott Park, IL, USA) is a PDA closure device made of a self-expanding single-layer nickel-titanium wire mesh. The obturator is inserted percutaneously and guided into the aortic or pulmonary artery via an anterograde (venous) approach, which is recommended for newborns weighing less than two kilograms, or via a retrograde (arterial) approach. The Amplatzer Piccolo is intended for infants weighing over 700 grams and over three days of age.

The tightly woven device closes the congenital shunt immediately after placement and then integrates completely into the tissue, avoiding the need for additional PDA-related procedures. Features include hollow wire treatment to reduce nickel leaching, extremely low profile delivery that facilitates delivery into small vessels using a 4 F catheter, a symmetrical design that provides procedural flexibility and predictable placement thanks to a disc size that facilitates positioning in the duct.

“The Piccolo Occluder dramatically increases our ability to shut off PDAs in the smallest and most medically fragile babies, providing better options for patients who need corrective treatment and who are at high risk of undergoing heart surgery, ”said Jeremy Ringewald, pediatric interventional cardiologist, of St. Joseph’s Children’s Hospital (Tampa, FL, USA). “Because the device is implanted using a minimally invasive procedure, many critically ill premature babies in the neonatal intensive care unit may be weaned from the respiratory system soon after the procedure. “

APD is a congenital heart disease in which the newborn baby ductus arteriosus fails to close, remaining permeable (open), allowing some of the oxygenated blood from the left heart to return to the lungs by flowing from the aorta to the pulmonary artery. The first symptoms are rare, but during the first year of life they include increased work of breathing and poor weight gain. With age, PDA can lead to congestive heart failure (CHF) if it is not corrected. Newborns without unwanted symptoms can simply be monitored on an outpatient basis, while symptomatic PDA can be treated by both surgical and non-surgical methods.

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