Transcatheter closure of hemodynamically significant patent ductus arteriosus in a 700-g preterm neonate with perforated necrotizing enterocolitis and intestinal stoma: Intervention at the lower limit of device indications

Reports of transcatheter patent ductus arteriosus (PDA) closure at the lower limit of approved device indications in the setting of recent necrotizing enterocolitis (NEC) and intestinal stoma are exceedingly limited. We report a female infant born at 24 + 5 weeks’ gestation with a birth weight of 600 g who developed a persistent hemodynamically significant PDA refractory to pharmacologic therapy. Her clinical course was complicated by NEC with mid-jejunal perforation requiring stoma formation. Transcatheter PDA closure was performed at a weight of 700 g on day 35 of life using an Amplatzer Piccolo™ Occluder (Abbott Structural Heart, Plymouth, MN, USA), without immediate complications. Postprocedurally, the infant demonstrated progressive respiratory and nutritional improvement, achieving room air by day 71 following device closure. Follow-up echocardiography confirmed complete ductal occlusion, preserved biventricular function, and no significant obstruction to the aorta or pulmonary arteries. This case demonstrates the feasibility of transcatheter PDA closure at the lower limit of device indications in a complex clinical context rarely described.