Development of catheter-based treatment of patent ductus arteriosus: A medium-sized centre experience

• Published in: Archives of cardiovascular diseases Vol. 102; no. 2; pp. 111 - 118
• Main Authors: Saliba, Zakhia, El-rassi, Issam, Helou, Dina, Abou-Jaoudeh, Pauline, Chehab, Ghassan, Daou, Linda, Khater, Daniele, Gerbaka, Bernard, Jebara, Victor
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Masson SAS 01.02.2009; Elsevier
• Subjects: Adolescent; Adult; Age Distribution; Aged; Amplatzer; Aortography; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Canal artériel; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiology. Vascular system; Cardiovascular; Child; Child, Preschool; Coil; Complication; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Ductus; Ductus Arteriosus, Patent - pathology; Ductus Arteriosus, Patent - therapy; Heart; Humans; Infant; Internal Medicine; Magnetic Resonance Angiography; Medical sciences; Middle Aged; Migration; Prosthesis Design; Treatment Outcome; Young Adult; Ductus; Complication; Canal artériel; Migration; Amplatzer; Coil; Human; Catheter; Persistence of ductus arteriosus; Instrumentation therapy; Cardiovascular disease; Ductus arteriosus; Instrumental obliteration; Percutaneous route; Treatment; Congenital cardiopathy; Cardiology
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2008.11.001

Summary Background Despite the availability of effective devices, percutaneous closure of patent ductus arteriosus (PDA) can be challenging in some situations. Aim To describe our initial experience of percutaneous PDA closure. Methods Between 2001 and 2007, 73 consecutive patients aged 3 months to 70 years underwent transcatheter PDA closure. An Amplatzer duct occluder (ADO) was chosen for ducts greater than 2 mm ( n = 50) and a Detachable coil (DC) for smaller ducts ( n = 23). Results The diameter of the ducts ranged from 1 to 7.2 (mean 2.9 ± 1.3) mm. The prostheses were implanted successfully in all patients. The complete closure rate reached 98% in the ADO group and 100% in the DC group at 12 months. Four (5.4%) patients showed asymptomatic device protrusion: three patients (5, 6 and 10 kg) into the aortic isthmus and one patient (7 kg) into the pulmonary artery (PA). One patient (7 kg) experienced transient severe bradycardia due to pulmonary air embolism. Another patient (3.3 kg) had a permanent asymptomatic occlusion of the femoral artery. In a third patient (17 kg), the ADO migrated asymptomatically into the descending aorta and was discovered 12 months later. Conclusion Even during the learning curve, percutaneous PDA closure can give excellent results. Strict adherence to protocols and careful follow-up assessments are mandatory. In small infants, the use of the ADO may lead to obstruction in the aorta or PA, or to device migration. Cautious surveillance for untoward events is essential, especially in small infants with large ducts.