Figure 3.

Ultrasound Guidance of Transcatheter PDA Closure in ELBW Infants

(A to C) Last-Minute pre-procedural echocardiography. In the catheterization laboratory, before starting the case, a last-Minute echocardiography defines the best ultrasound window and carefully measures the ductal length and the minimal ductal diameter. Here is a large, left-to-right shunting, patent ductus arteriosus in an ex-24 weeker premature infant, with a procedural weight of 740 g (A). The minimal ductal diameter is measured at 2.6 mm (B), with a ductal length of 8.7 mm (C). (D to G) Real-time echocardiographic guidance. Ultrasound check of a well-positioned 4/2 Amplatzer Piccolo Occluder device, with no residual shunt (D and F) and no device-induced left pulmonary artery obstruction (D and E) (Vmax 1.9 m/s) or descending aorta obstruction (F and G) (Vmax 0.8 m/s). Note that the procedure is performed in an infant on high-frequency jet ventilation.