During intrauterine life, ductus arteriosus permits blood to flow from the pulmonary artery to the aorta, bypassing the unoxygenated lungs. A large patent ductus arteriosus (PDA) eventually can lead to pulmonary hypertension and infective endocarditis. The Amplatzer Piccolo™ Occluder is the world's first medical device that offers hope to premature infants and newborns who need corrective treatment for PDA. What is Patent Ductus Arteriosus (PDA) and what are its complications? The ductus arteriosus is a vessel leading from the bifurcation of the pulmonary artery to the aorta just distal to the left subclavian artery (Fig.1)(1)(2). During intrauterine life, it permits blood to flow from the pulmonary artery to the aorta, bypassing the unoxygenated lungs(1)(2) .Normally, the vascular channel is open in the fetus but closes immediately after birth in response to increased arterial oxygenation, decreased pulmonary vascular resistance, and declining local levels of prostaglandin E2(2). It produces harsh,“machinery-like” murmurs(1). A small patent ductus arteriosus (PDA) generally causes no symptoms, although larger defects eventually can lead to Eisenmenger syndrome (pulmonary hypertension and and reversal of the shunt into a cyanotic right-to-left shunt following a long-standing left-to-right cardiac shunt caused by a congenital heart defect with cyanosis and congestive heart failure)(1)(2). High-pressure shunts also predispose patients to developing infective endocarditis (1)(2). Figure 1. Patent Ductus Arteriosus (on the right). Image adapted from (1). The current management of PDA: In the absence of severe pulmonary vascular disease and predominant left-to-right shunting of blood, the patent ductus should be surgically ligated or divided(1). Transcatheter closure has become common for appropriately shaped defects(1). Operation should be deferred for several months in patients treated successfully for infective endocarditis because the ductus may remain somewhat edematous and friable(1). Figure 2. The Amplatzer Piccolo Occluder. Image adapted from (3). FDA-approved device for treatment of PDA: The Amplatzer Piccolo™ Occluder is the world's first medical device that can be implanted in the tiniest babies (weighing as little as two pounds) using a minimally invasive procedure to treat patent ductus arteriosus, or PDA offering hope to premature infants and newborns who need corrective treatment, and who may be non-responsive to medical management and high risk to undergo corrective surgery(3)(4). The Amplatzer Piccolo Occluder is a self-expanding, wire mesh device that is inserted through a small incision in the leg and guided through vessels to the heart, where it is placed to seal the opening in the heart(3). Several hundred young patients have already received the device in trials that led to the approval(3). “My daughter has improved to the point where she has no limitations. She’s just a normal toddler.”- said Irie's mother Crissa Felkner, a 37-year old title agent from Lancaster, Ohio, whose daughter was born 13 weeks early on Aug. 3, 2017 with the condition(3)(4). ✵COPYRIGHT: This article is the property of We Speak Science, a non-profit institution co-founded by Dr. Detina Zalli and Dr. Argita Zalli. The article is written by Rina Mehmeti, University of Prishtina, Kosovo. ✵References: Stephen L. Hauser, Dennis L. Kasper, MD,Anthony S. Fauci, MD, Dan L. Longo, MD, J. Larry Jameson MD, PhD, Dan L. Longo, MD, Joseph Loscalzo, MD, PhD (2018). Harrison’s principles of internal medicine; Congenital Heart Disease in the Adults. 20th McGraw-Hill Education Vinay Kumar, Abul K. Abbas, Jon C. Aster (2015). Robbins and Cotran Pathologic Basis of Disease; Congenital Heart Disease. 9thedition. Elsevier https://abbott.mediaroom.com/2019-01-14-FDA-Approves-Worlds-First-Device-for-Treatment-of-Premature-Babies-and-Newborns-with-an-Opening-in-Their-Hearts-a-Common-Congenital-Defect https://www.medscape.com/viewarticle/907697
