Starting Small: A Case Report on the First Percutaneous PDA Closure in a Preterm Neonate in Khyber Pakhtunkhwa.

Abstract

Background: Patent ductus arteriosus (PDA) is a common cardiovascular condition in preterm infants, particularly those with extremely low birth weight (ELBW). If left untreated, a hemodynamically significant PDA (hsPDA) can lead to serious complications such as heart failure, respiratory distress, and poor weight gain. The Amplatzer Piccolo Occluder offers a minimally invasive transcatheter alternative to surgical ligation for infants weighing ≥700 g, reducing procedural risks and improving clinical outcomes.

Case Presentation: We report the case of a female infant born at 32 weeks of gestation with a birth weight of 1.2 kg, who developed symptoms of congestive heart failure, feeding difficulties, and failure to thrive. Echocardiography confirmed a hemodynamically significant PDA unresponsive to pharmacologic management. The infant was referred for transcatheter PDA closure.

Management and Results: A percutaneous closure was successfully performed on the 29th day of life using a 5×4 mm Amplatzer Piccolo Occluder via the femoral approach. The procedure was guided by fluoroscopy and echocardiography and conducted without the use of contrast due to impaired renal function. The intervention was uneventful, with no procedural complications. The infant was extubated on the sixth post-procedure day and exhibited significant clinical improvement, including adequate weight gain and resolution of apnea. At the one-month follow-up, the infant remained stable with no residual shunt or adverse effects.

Conclusion: This case highlights the safety, feasibility, and effectiveness of using the Amplatzer Piccolo Occluder for PDA closure in ELBW infants, even in resource-limited settings. To the best of our knowledge, this represents the first reported use of the device in Pakistan and at our institution, marking a significant advancement in neonatal cardiac care.