A minimally invasive transcatheter implant the size of a pea closes patent ductus arteriosus (PDA) in premature infants.

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

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

“The Piccolo Occluder greatly increases our ability to close PDAs in the tiniest, most medically fragile babies, offering better options for patients who need corrective treatment and are high risk to undergo heart surgery,” said pediatric interventional cardiologist Jeremy Ringewald, MD, of St. Joseph's Children's Hospital (Tampa, FL, USA). “Since the device is implanted through a minimally invasive procedure, many of the premature babies who are critically ill in the neonatal intensive care unit can be weaned from the breathing machine soon after the procedure.”

PDA is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close, remaining patent (open), thus allowing part of the oxygenated blood from the left heart to return to the lungs by flowing from the aorta to the pulmonary artery. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain. With age, the PDA may lead to congestive heart failure (CHF) if left uncorrected. Neonates without adverse symptoms may simply be monitored as outpatients, while symptomatic PDA can be treated with both surgical and non-surgical methods.

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