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Coil closure of a large patent arterial duct in a low‐birthweight infant

A premature male infant was born at 35 weeks and 4 days and weighed 2214 g. Heart murmur, tachypnea with respiratory rates of 50–60 breaths/minute and poor feeding were all noted, and he was admitted to the Shimane Prefectural Central Hospital at 2 days after birth. Non-restrictive PDA and mild mitral regurgitation were diagnosed by echocardiogram on admission. The arterial duct showed no tendency to close. Despite restriction of fluid intake, tachypnea and increased pulmonary vasculature on chest roentgenograms became more severe from 9 days after birth. His respiratory rates increased to 70–90 breaths/min at 10 days after birth. Administration of diuretics was started, but tachypnea persisted. He was not gaining weight. Indomethacin was not given for the following three reasons: (i) his gestational age was near full-term; (ii) 2 weeks had elapsed since birth; and (iii) a premature infant with poor condition after administration of indomethacin died in our department 3 months before this case. The color flow mapping 17 days after birth showed massive PDA shunt flow (Fig. 1), and an increase in the severity of mitral regurgitation. We selected transcatheter PDA coil closure for the following two reasons: (i) a less invasive therapeutic option was preferable because of his low bodyweight; and (ii) if we could not perform transcatheter PDA coil closure, preoperative and perioperative management would be facilitated by temporary closure of the PDA with an angiographic balloon catheter. Informed consent was obtained from the parents the day before the intervention. Transcatheter coil closure was attempted when he was 21 days of age and weighed 2174 g.