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Yucel IK, Epcacan S, Bulut MO, Demir IH, Surucu M, Yilmaz EH, Kardas M, Kanlioglu P, Celebi A. A Challenging Interventional Procedure: Transcatheter Closure of Tubular Patent Ductus Arteriosus in Patients with Pulmonary Hypertension. Pediatr Cardiol 2024; 45:1636-1651. [PMID: 37474608 DOI: 10.1007/s00246-023-03240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
Transcatheter closure of the tubular ducts remains the most challenging procedure, with higher complication rates than other types. This study evaluates the characteristics of transcatheter closure of tubular ducts with pulmonary hypertension. 73 patients with tubular ducts who underwent cardiac catheterization for transcatheter PDA closure were analyzed. The mean age and weight were 1.93 ± 2.68 years and 8.83 ± 6.14 kg, respectively. Transcatheter closure was attempted in 72 patients. Four cases (5.5%) were referred to surgery, while the procedure was completed in the remaining (94.5%). Amplatzer duct occluder (ADO) I or Cardiofix duct occluder (CDO) was the most commonly used devices. However, the use of Amplatzer vascular plug (AVP) II raised in recent years. The most common concern was aortic protrusion/stenosis in ADO I/CDO devices, but most regressed during follow-up. Iatrogenic coarctation of the aorta was observed in two with ADO I/CDO. Embolization of the device to the pulmonary artery was observed in three with CDO, AVP II, and AVP I. Significant left pulmonary artery stenosis requiring stenting developed in one after closure with an MVSDO device. Tubular ducts are highly associated with pulmonary arterial hypertension, and transcatheter closure of them is still challenging despite the developing device armamentarium. Although ADO I or similar devices are widely used, off-label devices are usually needed at increasing rates. The AVP II device is unsuitable for short tubular ducts but seems the best option for long ones.
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Affiliation(s)
- Ilker Kemal Yucel
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Serdar Epcacan
- Department of Pediatric Cardiology, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Mustafa Orhan Bulut
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Halil Demir
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Surucu
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emine Hekim Yilmaz
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Kardas
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Pinar Kanlioglu
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Yıldız K, Kir M, Prencuva P, Genc HZ, Celiktepe V, Bozyer HE, Akcura YD, Bardak H, Bayam YS, Unal N. Transcatheter Patent Ductus Arteriosus Closure in Children With Different Devices and Long-Term Results. Cureus 2023; 15:e46504. [PMID: 37808606 PMCID: PMC10551573 DOI: 10.7759/cureus.46504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION With the development of transcatheter interventional techniques and the introduction of next-generation duct occluder devices, transcatheter closure has become the first treatment option for patent ductus arteriosus (PDA) in pediatric patients. In this study, we compared the effectiveness and safety of different devices for transcatheter PDA closure in pediatric patients, focusing on long-term outcomes. METHODS A total of 235 patients aged 0-18 years who underwent transcatheter PDA closure at a tertiary care center between January 2005 and February 2020 were included. The medical records of the cases were retrospectively evaluated. RESULTS The median age of the patients was 2.3 years (range: 3.5 months to 17 years), with a mean weight of 12.8 kg (range: 5.7-43.2 kg). The mean PDA diameter at its narrowest point was 2.9 mm (range: 2.2-5.1 mm). Ductal anatomy was as follows: Type A in 98 (41.7%) patients, Type E in 36 (15.6%) patients, Type C in 32 (13.5%) patients, Type F in 27 (11.4%) patients, Type D in 23 (9.7%) patients, and Type B in 19 (8.1%) patients. Arterial access was used in 138 (57.1%) patients, venous + arterial access in 58 (24.6%) patients, and venous access only in 39 (16.5%) patients. Closure was performed with Amplatzer Duct Occluder (ADO; AGA Medical Corp., Golden Valley, MN, USA) II in 151 (64.2%) cases, ADO I in 43 (18.2%) cases, and coils in 41 (17.4%) cases. The mean fluoroscopy time and mean procedural time were 10.3 ± 4.2 minutes and 41 ± 7.2 minutes, respectively. The mean radiation dose was 1364 ± 497 cGy/min. The early closure rate after the procedure was 92%, while residual shunting on the first day post-procedure was observed in 1.8% of cases, decreasing to 0.1% at the one-month follow-up. The overall procedural success rate for all cases was 96.0%. The mean follow-up duration was 9.7 years (range: 2.9-13.8 years). CONCLUSION For percutaneous PDA closure, ADO I devices are preferred for larger defects, whereas ADO II devices are prioritized for small- to medium-sized defects instead of coils.
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Affiliation(s)
- Kaan Yıldız
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Mustafa Kir
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Pinar Prencuva
- Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Halise Z Genc
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Veysel Celiktepe
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Hazer E Bozyer
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Yagmur D Akcura
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Huseyin Bardak
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Yunus S Bayam
- Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
| | - Nurettin Unal
- Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR
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Zhou Z, Gu Y, Zheng H, Li S, Xu L, Liu Q, Wan J, Lv J, Song H, Yan C, Hu H, Zhang G, Xu Z, Jin J. Transcatheter Closure of Patent Ductus Arteriosus via Different Approaches. Front Cardiovasc Med 2022; 8:797905. [PMID: 35083302 PMCID: PMC8784679 DOI: 10.3389/fcvm.2021.797905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background: There have been marked advances in devices such as Amplatzer Duct Occluder II (ADO-II) or vascular plug through 5Fr delivery sheath for closure of patent ductus arteriosus (PDA) in the past five decades, making it possible for cardiologists to deliver occluders via different approaches. However, comparisons of these different approaches have not been reported. Therefore, the aim of this study was to summarize and compare the advantages of different approaches for PDA closure, and to guide clinical strategies. Methods: This retrospective study included all patients undergoing transcatheter closure of PDA from 2019 to 2020. Patients were matched by 1:1 propensity score matching (PSM). The retrograde femoral artery approach (FAA) and simple vein approach (SVA) groups were compared with the conventional arteriovenous approach (CAA). Results: The average age of the 476 patients was 21.05 ± 21.15 years. Their average weight was 38.23 ± 24.1 kg and average height was 130.14 ± 34.45 cm. The mean diameter of the PDA was 4.29 ± 2.25 mm. There were 127 men and 349 women, comprising 205 adults and 271 children. Among them, 197 patients underwent CAA, 223 underwent SVA, and 56 underwent retrograde FAA. The diameter in the FAA group was smaller than that in the other two groups, but was similar in adults and children. In the PSM comparison of CAA and SVA, 136 patients with CAA and 136 patients with SVA were recruited. Simple vein approach was associated with markedly reduced length of hospital stay, length of operation, and contrast medium usage as compared with CAA (all P < 0.05). In the PSM comparison of FAA and CAA, 30 patients with CAA and 30 patients with FAA were recruited. The operation duration was longer in the CAA than in the FAA group. There were no significant differences in postoperative complications among groups. Conclusion: Patent ductus arteriosus closure by using the SVA and FAA is safe and effective, and has certain advantages in some respects as compared with CAA.
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Affiliation(s)
- Zeming Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuanrui Gu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Vascular Surgery, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hong Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- *Correspondence: Hong Zheng
| | - Shiguo Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Liang Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qiong Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Junyi Wan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jianhua Lv
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huijun Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chaowu Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Haibo Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Gejun Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhongying Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinglin Jin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Thrombocytopenia associated with transcatheter closure of giant patent ductus arteriosus. Cardiol Young 2020; 30:1896-1901. [PMID: 33046148 DOI: 10.1017/s1047951120003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Thrombocytopenia occasionally occurs following the closure of some giant patent ductus arteriosus cases. Unfortunately, there is no associated research describing the associated risk factors for thrombocytopenia post-procedure. METHODS We reviewed all patients who received occluders with sizes ≥10/12 mm between January 2013 and June 2019. All the data and information on the characteristics of the patients and their follow-up were recorded. Univariate analysis, receiver operating characteristic curves, and linear regression were used to analyse the risk factors for thrombocytopenia and the predictors of hospitalisation stay. RESULTS Finally, 32 patients (17.5%) suffered from thrombocytopenia. Univariate analysis revealed the ratio between occluder disc size (mm) and body weight (kg) (1.71 ± 0.51 versus 1.35 ± 0.53) as an independent predictive factor for thrombocytopenia, and the area under the curve of the ratio of occluder size and body weight for predicting thrombocytopenia post-closure was 0.691 (95% confidence interval: 0.589-0.792, p = 0.001). The best cut-off value for the ratio of occluder size and weight was 1.5895, with a sensitivity and specificity of 68.8 and 66.9%, respectively. Each unit of the ratio of occluder size and body weight predicted an average hospitalisation stay of 2.856 days (95% confidence interval: 1.380-4.332). Treatment with medication did not reduce the hospitalisation stay or benefit platelet restoration. CONCLUSION Once the ratio of occluder size and body weight is greater than 1.6, thrombocytopenia always exists. Every unit of the ratio of occluder size and body weight represents an additional 3 days of hospitalisation. Treatment does not reduce the duration of hospitalisation.
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Transcatheter Closure of Patent Ductus Arteriosus under Echocardiography Guidance: A Randomized Controlled Noninferiority Trial. J Interv Cardiol 2020; 2020:4357017. [PMID: 33093816 PMCID: PMC7556051 DOI: 10.1155/2020/4357017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Percutaneous occlusion under fluoroscopy guidance has become the preferred method for the treatment of patent ductus arteriosus (PDA). To avoid radiation exposure and contrast agent use, PDA occlusion under transthoracic echocardiography (TTE) guidance was conducted. Objectives We assessed the hypothesis that the success rate of percutaneous PDA occlusion under TTE was noninferior to that under fluoroscopy guidance. Methods In this single-center trial, 100 patients were randomly assigned in a 1 : 1 ratio to the TTE group (n = 50) or to the fluoroscopy group (n = 50). The primary endpoint was the success rate of occlusion, with the noninferiority margin set at 8% for the between-group difference in intention-to-treat analysis. Secondary endpoints were hospitalization duration, cost, procedure time, and rate of adverse events including occluder migration, hemolysis, peripheral vascular complications, and residual shunt at 1-month and 12-month follow-up. Results Patient, defect, and device characteristics were similarly distributed between groups. The success rate of occlusion was 98% for the TTE group and 100% for the fluoroscopy group (absolute difference: -2%; 95% confidence interval: -5.9% to 1.9%). Cost and procedure duration were significantly lower in the TTE group, without adverse events in either group at a median of 12.0 months (range, 10.0-15.5 months) of follow-up. Conclusion Percutaneous PDA occlusion can be performed via TTE guidance safely and effectively, and the success rate of the TTE-guided procedure was noninferior to that under fluoroscopy guidance, with reduced cost and procedure time. The trial is registered with http://www.chictr.org.cn (ChiCTR-ICR-15006334).
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Suwitri NPE, Yantie NPVK, Gunawijaya E. Short-term follow-up after percutaneous patent ductus arteriosus occlusion between low and high weight pediatric patients: a single center experience. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.204154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Device occlusion is a preferred treatment for patent ductus arteriosus (PDA) in adult and children patients; however, the exact limit of body weight requirement has not been established. This study aimed to describe the outcome and safety of transcatheter PDA occlusion in low and high weight pediatric patients.
METHODS This was a retrospective study in Sanglah Hospital, Denpasar, Bali, Indonesia, in patients aged <12 years who had undergone transcatheter PDA occlusions from 2010 to 2017. Data were obtained from the registry including baseline characteristics (age, sex, body weight, and height), procedural-specific data (PDA characteristics, pulmonary and systemic pressures, and flow ratio intra-procedure), and procedural complications. Success rate and adverse events at 24 hours, 1 month, and 3 months after the procedure were assessed.
RESULTS A total of 175 subjects were grouped into two categories: low weight, ?6 kg (n = 50) and high weight, >6 kg (n = 125). The success rates (complete closure) in the ?6 and >6 kg groups were, 90.0% and 75.9% at 24 hours follow-up, 92.9% and 85.5% at 1 month, and 95.8% and 91.1% at 3 months, respectively. Major complications related to the procedure in patients ?6 kg included transient dysrhythmia (n = 6) and massive bleeding (n = 2), and complications in patients >6 kg were transient dysrhythmia (n = 14), massive bleeding (n = 1), embolization (n = 1), and death (n = 1).
CONCLUSIONS Transcatheter PDA occlusion had similar success rate and safety in both low and high weight pediatric patients.
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Maksymenko AV, Kuzmenko YL, Dovhaliuk AA, Motrechko OO, Herrmann FE, Haas NA, Lehner A. Percutaneous closure of patent ductus arteriosus with the Nit-Occlud ® patent ductus arteriosus device in 268 consecutive cases. Ann Pediatr Cardiol 2019; 12:206-211. [PMID: 31516276 PMCID: PMC6716305 DOI: 10.4103/apc.apc_151_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The pfm Nit-Occlud® patent ductus arteriosus (PDA) device is well established for interventional closure of PDA. However, there are still limited data concerning its efficacy and follow-up in larger patient groups. Aims This study aimed to evaluate the safety and efficacy of the Nit-Occlud® PDA device, implanted both through transpulmonary and transaortic approach, in a large cohort. Methods From July 2008 to December 2015, 268 consecutive patients were admitted for transcatheter closure of a PDA and were treated with the Nit-Occlud® coil. Clinical, echocardiographic, and angiographic data were evaluated. Results The median age was 5.2 years (range, 5 months to 62 years), and the median weight was 19.3 kg (range: 5.5-97 kg). Ten (3.7%) patients had weight <10 kg. The most common ductus types treated were Krichenko Type E and A (44.0% and 33.2%, respectively). Twelve (4.5%) patients were treated for residual shunting after surgical PDA closure. The median diameter at the narrowest point was 1.5 mm (range: 0.4-4 mm), the median size of the ampulla was 5 mm (range: 1-15 mm), and the median length was 9 mm (range: 2-25 mm). Device implantation could be successfully achieved in all cases. Closure rates documented immediately after the procedure, at 3-10 days, 1 month, and 6 months after intervention were 62%, 95.1%, 97.8%, and 98.5%, respectively. With the exception of one minor thromboembolic event, there were no procedure-related complications. Conclusion Closure of PDA with various anatomic variations and sizes can be performed effectively and safely using the Nit-Occlud® coil.
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Affiliation(s)
- Andrii V Maksymenko
- Department of Interventional Cardiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Yulia L Kuzmenko
- Department of Interventional Cardiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Arkadii A Dovhaliuk
- P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Oleksandra O Motrechko
- Department of Interventional Cardiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Florian E Herrmann
- Department of Cardiac Surgery, Ludwig Maximilians University, Klinikum der Universität München, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilians University, Klinikum der Universität München, Munich, Germany
| | - Anja Lehner
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilians University, Klinikum der Universität München, Munich, Germany
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Transcatheter Closure of Arterial Duct in Infants < 6 kg: Amplatzer Duct Occluder Type I vs Amplatzer Duct Occluder II Additional Sizes. Pediatr Cardiol 2018; 39:627-632. [PMID: 29453685 DOI: 10.1007/s00246-018-1828-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
Transcatheter closure of arterial duct (AD) remains challenging in low-weight patients and using Amplatzer Duct Occluder devices is still considered off-label in infants < 6 kg. This study aimed to report a large, single-center experience of percutaneous AD closure in infants < 6 kg as well as to compare the most frequently used devices, Amplatzer Duct Occluder type I (ADO I) and Amplatzer Duct Occluder type II Additional Sizes devices (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN, USA). From March 2000 to March 2017, among the 762 patients submitted to percutaneous closure of AD at our Institution, 33 were infants < 6 kg (age 4.8 ± 2.1 months; weight 5.0 ± 0.9 kg). Fourteen patients (45%) underwent ADO I (Group I) and 19 patients ADO II-AS (Group II) device implantation. AD diameter was 2.6 ± 0.8 (range 1.5-4.0) mm resulting in QP/QS of 2.6 ± 0.0.9 (range 1.1-4.5). Successful device deployment was achieved in all patients without procedural morbidity or mortality. Procedural and fluoroscopy times were not significantly different between the groups. However, total X-ray absorbed dose was significantly higher in Group I (121 ± 69 vs 29 ± 16 mGy/cm2, p < 0.01). Immediate, 24 h, and mid-term (46 ± 37 months, median 39) complete occlusion were recorded in 72.7, 90.9, and 97% of patients, respectively without significant difference between the groups. In conclusion, transcatheter closure of AD with Amplatzer Duct Occluder devices is feasible, safe, and effective also in infants less than 6 kg, without significant difference between the most commonly used devices, namely, ADO I and ADO II-AS.
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Bilici M, Demir F, Akın A, Türe M, Balık H, Kuyumcu M. Transcatheter Closure of Patent Ductus Arteriosus in Children with the Occlutech Duct Occluder. Pediatr Cardiol 2017; 38:1598-1605. [PMID: 28828684 DOI: 10.1007/s00246-017-1702-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
Abstract
The aim of this study was to evaluate the feasibility, efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with the Occlutech duct occluder (ODO) in children. We reviewed the clinical records of 71 patients who underwent percutaneous closure of PDA with an ODO between September 2014 and August 2016. The Occlutech duct occluder was applied to 71 patients during the study period (September 2014-August 2016), and the results were analyzed in this study. Forty-two of the patients were female and 29 male. The median age was 20.5 months (range, 6-194 months) and median weight was 16 kg (range, 6-68 kg). The PDA was classified as type A in 54 patients (76.1%), type E in 14 (19.7%), type C in 2 (2.8%) and type B in 1 (1.4%) based on the Krichenko classification. A standard ODO device was used for the transcatheter closure procedure in 66 patients and the long-shank ODO device in 5. In the echocardiographic measurement of PDA, the median smallest diameter was 2.7 mm (range, 1.5-7.0 mm), and in the angiographic measurement, the median smallest diameter was 2.5 mm (range, 1.5-6.5 mm). All 71 patients underwent successful PDA closure with the ODO. Angiography following the procedure showed complete closure in 47 patients (66.2%), mild residual shunt in 13 patients (18.3%) and a trivial shunt in 11 patients (15.5%). Color flow Doppler echocardiogpaphy at 24 h post-implantation showed that complete closure was achieved in 65 patients (91.5%), and 6 patients (8.5%) had mild residual shunt. All patients (100%) had complete closure at 30 days of follow-up. The results of this study showed that the Occlutech PDA occluder device is safe and effective in the closure of PDA. As the pulmonary artery side of the device is wider than the aortic side, protrusion toward the aortic side and embolization are prevented, but there is residual shunt in the early period, although this residual shunt disappeared after a few months.
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Affiliation(s)
- Meki Bilici
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey.
| | - Fikri Demir
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey
| | - Alper Akın
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey
| | - Mehmet Türe
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey
| | - Hasan Balık
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey
| | - Mahir Kuyumcu
- Department of Anesthesiology, Dicle University Medical Faculty, Sur, Diyarbakir, Turkey
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Kang SL, Jivanji S, Mehta C, Tometzki AJ, Derrick G, Yates R, Khambadkone S, de Giovanni J, Stumper O, Dhillon R, Bhole V, Slavik Z, Rigby M, Noonan P, Smith B, Knight B, Richens T, Wilson N, Walsh K, James A, Thomson J, Bentham J, Hayes N, Nazir S, Adwani S, Shauq A, Ramaraj R, Duke C, Taliotis D, Kudumula V, Yong SF, Morgan G, Rosenthal E, Krasemann T, Qureshi S, Crossland D, Hermuzi T, Martin RP. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv 2017; 90:1135-1144. [PMID: 28799706 DOI: 10.1002/ccd.27212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 06/25/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to report our national experience with transcatheter patent ductus arteriosus (PDA) occlusion in infants weighing <6 kg. BACKGROUND The technique of transcatheter PDA closure has evolved in the past two decades and is increasingly used in smaller patients but data on safety and efficacy are limited. METHODS Patients weighing < 6 kg in whom transcatheter PDA occlusion was attempted in 13 tertiary paediatric cardiology units in the United Kingdom and Ireland were retrospectively analyzed to review the outcome and complications. RESULTS A total of 408 patients underwent attempted transcatheter PDA closure between January 2004 and December 2014. The mean weight at catheterization was 4.9 ± 1.0 kg and mean age was 5.7 ± 3.0 months. Successful device implantation was achieved in 374 (92%) patients without major complication and of these, complete occlusion was achieved in 356 (95%) patients at last available follow-up. Device embolization occurred in 20 cases (5%). The incidence of device related obstruction to the left pulmonary artery or aorta and access related peripheral vascular injury were low. There were no deaths related to the procedure. CONCLUSIONS Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.
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Affiliation(s)
- Sok-Leng Kang
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Salim Jivanji
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Chetan Mehta
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Andrew J Tometzki
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Graham Derrick
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Robert Yates
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Sachin Khambadkone
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Joseph de Giovanni
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Oliver Stumper
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Rami Dhillon
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Vinay Bhole
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Zdenek Slavik
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Michael Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Patrick Noonan
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Ben Smith
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Brodie Knight
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Trevor Richens
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Neil Wilson
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Kevin Walsh
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - Adam James
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - John Thomson
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Jamie Bentham
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Nicholas Hayes
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Sajid Nazir
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Satish Adwani
- Department of Paediatric Cardiology, Oxford University Hospitals, Oxford, England, United Kingdom
| | - Arjamand Shauq
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Ram Ramaraj
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Christopher Duke
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Demetris Taliotis
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Vikram Kudumula
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - San-Fui Yong
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Gareth Morgan
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Eric Rosenthal
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Shakeel Qureshi
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - David Crossland
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Tony Hermuzi
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Robin P Martin
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
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11
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El-Saiedi SA, El Sisi AM, Mandour RS, Abdel-Aziz DM, Attia WA. Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients. Ann Pediatr Cardiol 2017; 10:144-151. [PMID: 28566822 PMCID: PMC5431026 DOI: 10.4103/0974-2069.205138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims: In this study, we examined the differences in cost and effectiveness of various devices used for the closure of small to medium sized patent ductus arteriosus (PDA). Setting and Design: We retrospectively studied 116 patients who underwent closure of small PDAs between January 2010 and January 2015. Subjects and Methods: Three types of devices were used: the Amplatzer duct occluder (ADO) II, the cook detachable coil and the Nit Occlud coil (NOC). Immediate and late complications were recorded and patients were followed up for 3 months after the procedure. Statistical Methods: All statistical calculations were performed using Statistical Package for the Social Science software. P <0.05 were considered significant. Results: We successfully deployed ADO II devices in 33 out of 35 cases, cook detachable coils in 36 out of 40 cases and NOCs in 38 out of 41 cases. In the remaining nine cases, the first device was unsuitable or embolized and required retrieval and replacement with another device. Eleven patients (9.5%) developed vascular complications and required anticoagulation therapy. Patients who had hemolysis or vascular complications remained longer in the intensive care unit, with consequently higher total cost (P = 0.016). Also, the need for a second device increased the cost per patient. Conclusions: The cook detachable coil is the most cost-effective device for closure of small-to medium-sized PDAs. Calculations of the incremental cost-effectiveness. (ICE) revealed that the Cook detachable coil had less ICE than the ADO II and NOC. The NOC was more effective with fewer complications.
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Affiliation(s)
- Sonia A El-Saiedi
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Amal M El Sisi
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Rodina Sobhy Mandour
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Doaa M Abdel-Aziz
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Wael A Attia
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
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12
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Góreczny S, Dryżek P, Morgan GJ, Mazurek-Kula A, Moll JJ, Moll JA, Qureshi S, Moszura T. Fenestration closure with Amplatzer Duct Occluder II in patients after total cavo-pulmonary connection. Arch Med Sci 2017; 13:337-345. [PMID: 28261286 PMCID: PMC5332453 DOI: 10.5114/aoms.2016.61836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/16/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Creation of a fenestration during completion of a total cavopulmonary connection (TCPC) has been associated with a reduction in early mortality and morbidity. However, the long-term benefits are negated by an associated limitation in exercise tolerance and the potential risks of thrombo-embolic complications. We sought to describe the safety and efficacy of an Amplatzer Duct Occluder II (ADO II) for transcatheter fenestration closure following TCPC. MATERIAL AND METHODS Between January 2000 and July 2014, 102 patients underwent percutaneous closure of extra-cardiac TCPC fenestrations with a range of devices. Patients in whom fenestration closure was performed with an ADO II and who had at least 6 months of follow-up were included in this study. RESULTS Forty-seven patients had successful fenestration occlusion with an ADO II. The mean oxygen saturation and mean systemic venous pressures increased from 84.8 ±6.1% before to 97.6 ±2.9% (p < 0.001) after and from 14.2 ±2.15 mm Hg before to 15.6 ±2.2 mm Hg after closure (p < 0.001). Eight patients developed heart failure symptoms, managed by optimization of medical therapy, with 1 patient requiring device removal to reopen the fenestration. Color Doppler transthoracic echocardiography demonstrated residual flow across the device in 18 (38%), 10 (22%), 5 (11%) and 4 (9%) patients before discharge, at 1 and 6 months, and at the latest outpatient visit, respectively. CONCLUSIONS The ADO II can be safely and effectively used to close fenestrations in extra-cardiac type Fontan completions. Many of the design features of this device confer potential benefit in this population.
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Affiliation(s)
- Sebastian Góreczny
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Paweł Dryżek
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Gareth J. Morgan
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Anna Mazurek-Kula
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Jacek J. Moll
- Department of Cardiac Surgery, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Jadwiga A. Moll
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Shakeel Qureshi
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tomasz Moszura
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
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13
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Mahmoud HT, Santoro G, Gaio G, D'Aiello FA, Capogrosso C, Palladino MT, Russo MG. Single-center experience in percutaneous closure of arterial duct with Amplatzer duct Occluder II additional sizes. Catheter Cardiovasc Interv 2016; 89:1045-1050. [DOI: 10.1002/ccd.26860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Heba Talat Mahmoud
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
| | - Giuseppe Santoro
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
| | - Gianpiero Gaio
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
| | - Fabio Angelo D'Aiello
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
| | - Cristina Capogrosso
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
| | - Maria Teresa Palladino
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
| | - Maria Giovanna Russo
- Department of Paediatric Cardiology, A.O.R.N. “Ospedali dei Colli”; 2nd University of Naples; Naples Italy
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14
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Pan XB, Ouyang WB, Wang SZ, Liu Y, Zhang DW, Zhang FW, Pang KJ, Zhang Z, Hu SS. Transthoracic Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Occlusion: A New Strategy for Interventional Treatment. Echocardiography 2016; 33:1040-5. [PMID: 27038152 DOI: 10.1111/echo.13207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Percutaneous patent ductus arteriosus (PDA) occlusion has become the preferred therapeutic option, which uses fluoroscopy as the guidance. To reduce the x-ray exposure, PDA occlusion using the Amplatzer Duct Occluder II (ADO II) under guidance of transthoracic echocardiography only was conducted. This single center study aims to access the safety and efficiency of this new strategy. METHODS AND RESULTS From June 2013 to May 2015, 63 consecutive PDA patients underwent transthoracic echocardiography-guided PDA occlusion through the femoral artery. Outpatient follow-up was conducted at 1, 3, and 6 months, and yearly. Sixty-two patients successfully underwent echocardiography-guided percutaneous PDA occlusion. One patient was converted to minimally invasive transthoracic occlusion due to failure of delivery sheath passage through tortuous PDA. Mean procedure duration was 24.3 ± 7.0 minutes; ADO II diameter averaged 4.6 ± 0.9 mm; 8 cases showed traces of residual shunt immediately after operation which resolved after 24 hours; and mean hospital stay was 3.4 ± 0.5 days. There was no occluder migration, hemolysis, pericardial effusion, pulmonary branch or aortic stenosis at mean 13.5 ± 4.8 months follow-up. CONCLUSIONS This study demonstrated that percutaneous PDA occlusion can be successfully performed under guidance of transthoracic echocardiography only and appears safe and effective while avoiding radiation and contrast agent use.
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Affiliation(s)
- Xiang-Bin Pan
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen-Bin Ouyang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shou-Zheng Wang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yao Liu
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Da-Wei Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng-Wen Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kun-Jing Pang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhe Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sheng-Shou Hu
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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15
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Lam JY, Lopushinsky SR, Ma IW, Dicke F, Brindle ME. Treatment Options for Pediatric Patent Ductus Arteriosus. Chest 2015; 148:784-793. [DOI: 10.1378/chest.14-2997] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Masri S, El Rassi I, Arabi M, Tabbakh A, Bitar F. Percutaneous closure of patent ductus arteriosus in children using amplatzer duct occluder II: relationship between PDA type and risk of device protrusion into the descending aorta. Catheter Cardiovasc Interv 2015; 86:E66-72. [PMID: 26032159 DOI: 10.1002/ccd.25940] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/02/2015] [Accepted: 03/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of Amplatzer Duct Occluder II (ADOII) among the various patent ductus arteriosus (PDA) types, and to assess the association between development of aortic obstruction and the PDA type in terms of measurable parameters as the device angulation and distance of upper end protrusion into the aortic lumen. METHODS Retrospective cohort study involving 50 consecutive subjects who underwent ADO II device closure of PDA. RESULTS The median age and weight at intervention were 13 months (5.5 months to 18 years) and 11 (6-67) kg respectively. The median smallest ductal diameter by angiography was 3.2 (1.9-5.4) mm. Thirty two patients had type A PDA, 5 had type C, 5 had type D, and 8 had type E. Residual shunt was seen in only 1 patient who had a tubular PDA and resolved within 2 months of the procedure. No device embolization or pulmonary side protrusion were noted. There was a 16% aortic protrusion rate. The median distance of protrusion of the upper end of the device into the aortic lumen was 3.1 (0-9) mm and the median angle formed between the aortic end of the device and the PDA take-off was 10.4 (0-80.6) degrees. These latter parameters of aortic obstruction were significantly higher in the non-conical PDA group as compared to the conical PDA. Nevertheless, there was no significant coarctation due to aortic retention disc protrusion. CONCLUSION Device closure of PDA using the ADO II is a safe procedure for chosen types of PDA. We demonstrated a novel technique for objective assessment of device protrusion into the descending aorta based on measurable parameters. ADOII device closure of non-conical PDAs warrants closer follow ups.
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Affiliation(s)
- Samer Masri
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Division of Pediatric and Congenital Cardiac Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Anas Tabbakh
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
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