b'ONE IN FIVE PREMATURE INFANTS HAVE PDA.Before birth, the aorta and pulmonary artery are connected by the ductus arteriosusa channel essential to fetal blood circulation. This duct closes shortly after birth in most infants. But the likelihood of spontaneous closure is less than 15% in extremely low birthweight infants born prior to 24 weeks.That makes PDA one of the most common heart problems in premature infants. Nearlyone in five will have a PDA. They should be evaluated thoroughly to see if they have a hemodynamically significant PDA that is causing them harm or delaying their growth.Left untreated, PDA can cause signs of heart failure and eventually lead to chronic lungdisease and pulmonary hypertension. GOING BEYOND MEDICATION AND SURGERY.In premature infants, clinically significant PDAs are usually treated with a combination of fluid restriction and diuresis, as well as intravenous indomethacin or ibuprofen. Some preemie babies may need respiratory support with nasal cannula or positive pressure ventilation. Medical therapy is successful for about 50 to 65% of patients. Patients who fail medical therapy were previously referred for surgical ligation.Both options can have drawbacks. Because of their vasoconstrictive properties, indomethacin and ibuprofen can have serious side effects, including kidney failure, intestinal ischemia and bleeding. Surgical ligation has fallen out of favor because of its risks and long-term side effects, including neurological disability. Neonatal Division Chief, Dr. Rashmin Savani: We bring together neonatologists, cardiologists, interventional cardiologists and cardiac surgeons to treat PDA in the least-invasive Recognizing the need, Dr. Reddy began searching for a transcatheter option for extremelyand most-effective way, so children can grow up healthy and lead their best possible lives.premature infants. He gleaned best practices from the experience of his peers and incorporated those within MVP plug treatment protocols. He started the Preemie Duct Occlusion Program (PDOP) in December 2017. FASTER, SAFER PDA CLOSURE.We currently have two device options for PDA device closure in extremely premature babies, Dr. Reddy opened the first specialized hybrid catheterizationlab/MRI suite in Texas at Childrens Health. Dr. Reddy says. We started the program with the microvascular plugs that were used off-label for PDA closures. Following FDA approval in January 2019, we successfully used the Piccollo device for PDA closure in a set of twin brothers. These devices can be advanced through 1- to 2-mm catheters that are well-tolerated by premature babies.Because these devices are deployed in a minimally invasive procedure, many infants are able to be weaned from artificial respirator support soon after the procedure. The procedure also offers fewer risks and shorter recovery than lateral thoracotomy/duct ligation.PUSHING THE BOUNDARIES.So far, weve implanted PDA closure devices in more than 60 premature babies, including Austen. She recovered quickly after the procedure and has been hitting her developmental milestones. As devices and techniques advance, transcatheter closure of PDA could become the first-line treatment for even the most premature infants.The devices have made transcatheter closures possible, but its our teams collaboration that really makes the difference, says Dr. Savani. We bring together neonatologists, cardiologists, interventional cardiologists and cardiac surgeons to treat PDA in the least invasive and most effective way, so children can grow up healthy and lead their best possible lives.'