Bringing the Cath Lab to the Neonatal Intensive Care Unit (NICU): A Three-Case Series About Bedside Echocardiography-Guided Transcatheter Patent Ductus Arteriosus Closure in Extreme Low Birth Weight Infants

Patent ductus arteriosus (PDA) remains a significant driver of morbidity in extreme low birth weight (ELBW) infants. Pharmacological closure often fails or is contraindicated, while surgical ligation carries significant perioperative and postoperative risks. Recent advances in device technology have enabled transcatheter PDA closure in very small infants, including procedures performed at the bedside in the neonatal intensive care unit (NICU). We report a case series of three ELBW infants (gestational age 24-27 weeks; weight at procedure 1.0-1.28 kg) who successfully underwent bedside transcatheter PDA closure using the Amplatzer Piccolo Occluder (Abbott Structural Heart, Plymouth, MN) under echocardiographic guidance in the NICU. These infants remained ventilator dependent due to hemodynamically significant PDA (hsPDA) and had failed medical therapy. Technical success was achieved in all cases without immediate device-related complications; two infants demonstrated significant respiratory improvement with successful extubation following the procedure. One infant, despite successful PDA device occlusion, passed away due to complications related to extreme prematurity, necrotizing enterocolitis, and nosocomial sepsis. This case series highlights the feasibility, safety, and potential respiratory benefits of bedside transcatheter PDA device occlusion in ELBW infants when performed by an experienced multidisciplinary team.