News | Congenital Heart | January 04, 2017

New Nonsurgical Repair of the Most Common Extremely Premature Newborn Heart Defect Shown Effective

Catheter-based intervention successfully treats patent ductus arteriosus in 21 of 24 study subjects

extremely premature newborns, patent ductus arteriosus, PDA, hole in the heart, nonsurgical repair, catheter-based intervention

January 4, 2017 — A new minimally invasive technique for repairing the most common cardiac birth defect in extremely premature newborns can be performed safely with a high success rate in babies as small as 755 grams – about 1.6 pounds – only a few days after birth.

The study, published in the Journal of the American College of Cardiology: Cardiovascular Interventions, details the results of a catheter-based approach to repairing patent ductus arteriosus (PDA), commonly referred to as “a hole in the heart.”

“If left untreated, PDA can cause heart failure and lifelong complications,” said Evan M. Zahn, MD, an expert in congenital heart disease and director of the Cedars-Sinai Heart Institute’s Guerin Family Congenital Heart Program. “Current treatment options are not optimal and are fraught with complications.”

Before birth, a fetus’ blood does not need to go to its lungs to get oxygenated because the mother’s own blood circulation supplies oxygen. Key to this process is the ductus arteriosus, a connection between the heart’s two major arteries that allows the fetus’ blood to bypass its lungs. After birth, however, the baby needs to breathe on its own, so this connection naturally closes. When closure fails, patent ductus arteriosus ensues, leading to difficulty with breathing and feeding, brain hemorrhages and death of premature infants in some cases.

Medication therapy is successful in less than 60 percent of newborns with PDA but can cause side effects such as kidney failure and bleeding, Zahn said. Surgery has its own short-term risks, and recent evidence suggests that long-term outcomes after surgery for premature babies with PDA may be worse than previously thought.

Zahn, an expert in catheter-based cardiac interventions, and pediatric cardiac surgeon Alistair Phillips, M.D., co-director of the Guerin Family Congenital Heart Program, developed a minimally invasive, transcatheter procedure for premature infant PDA closure. Guided by ultrasound waves, the physician guides a catheter through a vein in the leg to the heart and closes the hole. The procedure can be performed at the bedside in the medical center’s Neonatal Intensive Care Unit and takes only a few minutes.

In the study, 24 extremely premature infants born at just 24 to 32 weeks’ gestation underwent the procedure, which was successful in 21 of the babies. The three babies whose individual anatomy precluded successful device closure later underwent successful surgical closure. Because of the fragility of some of the babies in the study, several of the procedures were performed at the patient’s bedside instead of an operating room.

“The development of catheter-based procedures for infants is a sea change in the treatment of congenital heart disease,” said Eduardo Marbán, M.D., Ph.D., director of the Cedars-Sinai Heart Institute. “As Dr. Zahn and his team further develop these techniques, parents will no longer have to choose between the risks of surgery and the risks of medications, and babies will get a healthier start in life.”

Although PDA usually is diagnosed at birth, some older children and adults have the condition for years before symptoms are noticed and diagnosed, Zahn said.

“We can use these same techniques on older children and adults with congenital heart disease,” he said. “It is always better for the patient when we can treat a condition without subjecting the patient to the risks and discomfort of surgery.”

For more information: www.interventions.onlinejacc.org

Related Content

Shockwave Launches Coronary Intravascular Lithotripsy in Europe
News | Cath Lab | May 30, 2018
Shockwave Medical recently announced the European commercial availability of Intravascular Lithotripsy (IVL) for...
FFR software on the GE Centricity CVIS. A trial from the 2018 EuroPCR meeting showed FFR improves long-term outcomes.
News | Cath Lab | May 29, 2018
May 29, 2018 — Ongoing controversy exists regarding the role of percutaneous coronary intervention (PCI) for stable c
SCAI Updates Consensus on Length of Stay for Percutaneous Coronary Intervention
News | Cath Lab | May 15, 2018
Revised guidelines incorporating new data on discharge criteria for patients undergoing elective percutaneous coronary...
No Benefit Found Using Sodium Bicarbonate, Acetylcysteine to Prevent Kidney Injury, the result of the PRESERVE Trial to prevent acute kidney injury (AKI), presented at SCAI 2018.  #SCAI, #SCAI2018,
Feature | Cath Lab | May 15, 2018
May 15, 2018 – The large-scale, international randomized PRESERVE clinical trial found high-risk patients for renal c
Angiogram of a STEMI patient.
News | Cath Lab | May 15, 2018
May 15, 2018 — A contemporary, real-world analysis shows lower mortality rates when culprit-only intervention is used
Recent Acquisitions Eroding Prices in Billion Dollar European Interventional Cardiology cath lab Market.
Feature | Cath Lab | May 07, 2018 | Simon Trinh and Jeffrey Wong
The European interventional cardiology market is currently valued at nearly $1.4 billion.
Videos | Cath Lab | May 07, 2018
Imran Ahmad, M.D., medical director of interventional cardiology, explains some of the new technologies his labs have
360 Photos | Cath Lab | April 20, 2018
A 360 degree view of the newest cath lab at Northwestern Medicine Central DuPage Hospital in Winfield, Ill., located
SCAI Announces Global Lecture Series for 2018 Scientific Sessions
News | Cath Lab | April 18, 2018
Many of the world’s leading interventional cardiologists and cardiovascular professionals will convene in San Diego,...
Serial coronary angiograms of the representative case treated with shockwave intravascular lithotripsy.

Figure 1. Serial coronary angiograms of the representative case treated with shockwave intravascular lithotripsy.

Feature | Cath Lab | April 16, 2018 | Azeem Latib, M.D.
Over the last decade, there have been considerable developments in procedural techniques and technology facilitating
Overlay Init