Transcatheter closure of hemodynamically significant patent ductus arteriosus in preterm neonates using the amplatzer piccolo occluder: A real-world single-center experience from India

Background: Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with substantial morbidity, including respiratory failure and prolonged intensive care. Although pharmacological therapy remains the first-line treatment, a subset of infants requires definitive intervention. Methods: In this retrospective observational study, 37 preterm neonates with hsPDA underwent transcatheter closure between January 2021 and December 2025 after failed medical therapy. Procedures were performed via a femoral venous approach using a 4-Fr delivery system. Device selection was guided primarily by transthoracic echocardiography, with selective use of angiography. Results: The median gestational age was 28 weeks (interquartile range [IQR] 27–30), and the median weight at procedure was 1200 g (IQR 950–1400). Procedural success was achieved in all patients, with no device embolization. The median fluoroscopy time was 9.1 min. Rapid clinical improvement was observed, with a median time to extubation of 3 days and a marked reduction in respiratory support requirements. Complications were minimal, and no deaths were related to the procedure. During a median follow-up of 27 months (IQR 7.5–43), no aortic obstruction was observed, and one case of mild left pulmonary artery stenosis improved on follow-up. Conclusion: Transcatheter closure of hsPDA using the Amplatzer Piccolo Occluder is safe and effective in preterm neonates following failed medical therapy and is associated with early respiratory recovery in the real-world clinical practice.