I think that percutaneous closure in these case is safe and easy. I perform the closure.
I think that a small PDA with normal size left cardiac chambers does not need to be closed. There is no hemodynamic advantages and the risk of IE is extremely small. Thus we should not close somenthing just because technically it is easy.
Dear Giovanni. I disagree with your opinion. There is low risk of IE, but the percutaneous occlusion is very easy. I prefer to close the PDA.
The debate is still on concerning closure of PDA. "Guidelines" do support a conservative approach in case of silent ductus, including most of the PDA's smaller than 2 mm in my personal experience. However, one wonders whether these guidelines are really evidence based. I agree that percutaneous closure of a small PDA is easy and safe, although in many cases small PDA's can only be closed by the arterial route, increasing the risk of vascular damage for a very limited benefit regarding the prevention of developing IE in case of a small PDA.
It is a dificult matter to be solved. If it is easy, it is not safe enough because of percuteneous disasters with arterial damage and release of coils, etc. In the other hand, the patient does not show any repercussion and more he is not safe againt bacterial arterities at all after this closure. By all I thing we would be worried what has some repercussin.
I do not recommend closing small PDAs with less than 1.5:1 L to R shunt.
We don't close if no murmur is heard but watching close by echo once a year.
In today's day & time when risk of M&M for closure of pda is zero ,why take a risk of even 0.5%of IE + constant stress on family that pda is open !!!
The risk of an intervention for PDA closure, albeit small, is never zero: anesthetic problems, vascular damage (arterial access for small pda's) embolisation are allways possible.
The debate is even more difficult in low income countries because of the costs involved. We have no cath lab and surgical ligation is the onlyavailable option. So I do not propose surgery if no murmur and no hemodynamic impact.
I understand that if a patient does not present any sign of a determined cardiac anomaly, such as a murmur, cardiomegaly or any symptom, there will be no need for interventions, surgical or percutaneous, in agreement with the majority of experts.
I think that if there is no clínical presentation, and if the echo does not show any evidence of hemodynamic effects, which is probably the case, I would not indicate its closure