Patent Ductus Arteriosus in Preterm Infants and Innovative Cardiac Interventions

Management of patent ductus arteriosus (PDA) in preterm infants has long been a challenging and controversial topic for neonatologists and cardiologists. Until recently, surgical ligation was the only available therapeutic option that could definitively close a PDA. A lack of proven benefit and concern for patient morbidity have led to a decrease in the number of surgical ligation procedures in the United States per year. There has been significant growth in the field of interventional cardiology in terms of technique and device availability for the purpose of PDA occlusion. Recent studies have demonstrated that transcatheter (TC) PDA closure is feasible and safe in patients weighing as low as 700 g. This review will describe the current strategy for the identification of a hemodynamically significant PDA, as well as the controversy that exists among medical, surgical, and conservative management strategies, and will specifically focus on the innovative TC techniques and devices available for preterm infants. We will also discuss the importance of large randomized trials to evaluate TC PDA closure compared with conservative medical management.