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Steiner K, Sjöberg G, Karsenty C, Bianco L, Bautista-Rodriguez C, Fraisse A. Mind the gap-missing device on the shelf? Retrospective experience with 5/7 Occlutech duct Occluder. Acta Paediatr 2024; 113:812-817. [PMID: 38149770 DOI: 10.1111/apa.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
AIM To describe our initial experience with the indications and results of the 5/7 Occlutech® duct Occluder (ODO, Occlutech International AB, Helsingborg, Sweden). A small incremental increase in occluder sizes is of utmost importance for successful outcomes, especially in smaller patients in whom protrusion of the distal disk towards the aorta should be minimised. METHODS Retrospective study of all patients undergoing PDA closure with the 5/7 ODO in three institutions since 2018. RESULTS The 5/7 ODO was used in 18 patients with median age and weight at the time of the procedure of 17.5 months (interquartile range 25th to 75th percentile 8 months- 4.4 years) and 13.6 kg (interquartile range 25th to 75th percentile 6.4-22.5 kg) respectively. All cases were successful. There were no cases of device embolisation, haemolysis, or flow disturbance of the LPA or the aorta. CONCLUSIONS This small retrospective study demonstrated an excellent outcome of transcatheter PDA closure with the 5/7 ODO. The device is a beneficial complement to the existing sizes of PDA devices, filling the gap between the 4/6 and 6/8 ODO and avoiding protrusion of a larger disk in the aortic isthmus.
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Affiliation(s)
- Kristoffer Steiner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Clément Karsenty
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse, France
| | - Lisa Bianco
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, London, UK
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, London, UK
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, London, UK
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Ríos-Méndez RE, Araúz-Martínez ME, Oliveros-Rivero JA, Crespo-Gutiérrez YJ, Pérez-Vite YW. [Closure of patent ductus arteriosus with Occlutech TM device, experience in an andean country]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:169-173. [PMID: 38359430 PMCID: PMC11160539 DOI: 10.24875/acm.23000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/26/2023] [Indexed: 02/17/2024] Open
Abstract
Background and Objective To communicate the experience in an Andean country with the OcclutechTM Duct Occluder device for the closure of patent ductus arteriosus. Method observational, retrospective, cross-sectional study with basic statistical analysis. Period: December/2014 to December/2022. Data: medical chart, reports of catheterization. Results Forty-six patients, female 71.3%, male 28.7%; age: 0.6-38 years-old (median [Me]: 5.2); weight: 6.3-60 kg (Me: 16.5). Origin: Andean 91.3%, coast 8.7%. Types of patent ductus arteriosus: E 54.4%, A 32.6%, D 13%. Minimum ductal diameter: 1.8-11.8 mm (Me: 3.5). Mean pulmonary artery pressure prior to occlusion: 14-67 mmHg (Me: 27). Pulmonary vascular resistance index prior to occlusion: 0.28-4.9 WU/m2 (Me: 1.3). Six of them were classified as hypertensive patent ductus arteriosus. Occlusion rate: 47.8% immediate, 81% at 24 hours, 100% after six months. Fluoroscopy time: 2-13.8 minutes (Me: 4). Complications: a migrated device. Follow-up: 1-6.5 years. Conclusions OcclutechTM Duct Occluder device was effective and safe for the closure of patent ductus arteriosus type E, A and D in low-altitude and high-altitude dwellers, whether they were children or adults, even when these ductus arteriosus were hypertensive.
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Affiliation(s)
- Raúl E. Ríos-Méndez
- Servicio de Hemodinamia, Hospital Clínica Kennedy, Guayaquil, Guayas
- Servicio de Consulta Externa, Clínica Especialidades Médicas Santa Lucía, Quito, Pichincha
| | | | | | | | - Yesenia W. Pérez-Vite
- Servicio de Anestesiología, Hospital Clínica Kennedy, Guayaquil, Guayas
- Servicio de Anestesiología Hospital SOLCA, Guayaquil, Guayas. Ecuador
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Subramanian A, Paraswanath BA, Govind Auradkar, Mahimarangaiah J. Does a Change in Device Design Alter Device Size Selection? A Comparison of Conventional and Occlutech Duct Occluder Designs. Heart Lung Circ 2022; 31:1677-1684. [PMID: 36089464 DOI: 10.1016/j.hlc.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/24/2022] [Accepted: 07/16/2022] [Indexed: 12/27/2022]
Abstract
AIM The Occlutech duct occluder (ODO) with a novel design has been available for closure of patent ductus arteriosus (PDA) since 2011. Available data on initial experience with the ODO have shown that operators continue to choose device sizes based on their experience with conventional duct occluders (CDO). This study postulated that occlusion of the pulmonary arterial (PA) end of the ductus should achieve satisfactory PDA closure without additional complications. Accordingly, the size of the ODO was chosen such that the larger PA diameter in the new design exceeded the PA end of the ductus by 2-3 mm and 2-4 mm for normotensive and hypertensive ducts, respectively. It sought to examine the feasibility and safety of such an approach, and compared ODO and CDO devices with respect to device sizes deployed, to ascertain if the newer design had any advantages. METHODS This prospective study enrolled 105 infants, children and a few adults with various duct morphologies and PA pressures for ductal closure using the ODO from 2018-2020. The control group consisted of 105 ducts closed with CDO. A comparison of the two groups with respect to duct diameter and implanted device sizes was performed using appropriate statistical software. RESULTS The study found that 40% of the ducts had moderate-to-severe pulmonary hypertension. Most ducts measured between 3-4 mm in both groups. The mean weight of the subjects in both groups was 12 kg. Although there was no change in the way that duct occluders were chosen in both groups (2-3 mm over the pulmonary artery diameter), ODO could be significantly downsized in most ducts measuring between 2.5-6.4 mm in diameter (p<0.05). CONCLUSIONS This study found successful closure of relatively larger PDA in infants and children using smaller ODO compared with CDO, without embolisation or aortic narrowing. It also demonstrated that a different device size selection technique may be safely employed with the ODO.
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Affiliation(s)
- Anand Subramanian
- Paediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India.
| | - Bharath A Paraswanath
- Paediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Govind Auradkar
- Paediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
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Kim H, Song J, Choi GJ, Huh J, Kang IS. How can stretched ductus diameter be predicted from angiographic diameter? Minerva Pediatr (Torino) 2021; 74:176-180. [PMID: 34128600 DOI: 10.23736/s2724-5276.21.06021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An appropriate size of device for patent ductus arteriosus (PDA) could be chosen by a stretched PDA size. We propose prediction of stretched size from intact PDA size. METHODS A total of 361 patients was enrolled. Intact size was measured on angiography before closure, and stretched size was the narrowest diameter immediately after device implantation. RESULTS The median patient age was 2.8 years. Intact diameter and stretched diameter were 3.6 ± 1.4 mm and 5.1 ± 1.3 mm. The difference and difference ratio were 1.5 ± 0.8 mm and 51.3 ± 38.1% and had negative linear correlations with age (P<0.001). Patients were divided into four groups; < 2 years old (159), 2-15 years old (68), 15 - 40 years old (72), and ≥ 40 years old (62). Among groups, difference and difference ratio were significantly different. Stretched diameter was inferred by the following formulas: stretched diameter = 0.660ⅹintact diameter + 2.791 (<2 years old); = 0.971ⅹintact diameter +0.058ⅹage +1.131 (2-15 years old); = 0.790ⅹintact diameter +2.263 (15 - 40 years old); and = 0.837ⅹintact diameter +1.353ⅹBSA -0.096 (≥40 years old). CONCLUSIONS Stretched PDA diameter can be predicted from intact diameter and might be helpful for safe PDA closure especially in small infants.
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Affiliation(s)
- Hanna Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea -
| | - Gwang-Jun Choi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Corea
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Kanabar K, Bootla D, Kaur N, Pruthvi CR, Krishnappa D, Santosh K, Guleria V, Rohit MK. Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm). Indian Heart J 2020; 72:107-112. [PMID: 32534682 PMCID: PMC7296248 DOI: 10.1016/j.ihj.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/23/2019] [Accepted: 03/28/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Transcatheter closure is the first-choice strategy for the management of appropriate patients with patent ductus arteriosus (PDA). The management of large PDAs is challenging due to the limited available sizes of approved devices and the inherent risks of surgical ligation, especially in adults with calcified PDAs. This study aimed to assess the outcomes of the off-label use of large occluders at a tertiary center. METHODS This retrospective review included patients who underwent transcatheter PDA closure with large occluders (≥16 mm) over 16 years. The baseline patient data, procedural details, angiograms, and immediate outcomes were recorded and patients were followed up at 3, 6, 12 months after the intervention and annually thereafter. RESULTS Of the 685 patients who underwent transcatheter PDA closure, 36 patients (mean age 16.6 ± 12.5 years) needed occluders ≥ 16 mm in size. Cocoon duct occluder, Cera duct occluder, Amplatzer atrial septal occluder (ASO), and Cera muscular ventricular septal defect occluders were used for PDA closure. There was no device embolization, one patient in whom ASO was used had residual shunt with intravascular hemolysis requiring surgery, and one patient had mild left pulmonary artery narrowing after the intervention, which was managed conservatively. No patient had residual shunt and one patient had persistent pulmonary hypertension at an intermediate duration of follow-up. CONCLUSION Transcatheter PDA closure with the use of large devices, which are available in Asia and Europe, is an effective and safe method, especially in adolescents and adults. However, a close follow-up of these patients is mandatory.
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Affiliation(s)
- Kewal Kanabar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Dinakar Bootla
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Navjyot Kaur
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - C R Pruthvi
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Darshan Krishnappa
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vivek Guleria
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Alkashkari W, Albugami S, Alrahimi J, Althobaiti M, Kinsara A, Abousa A, Krimly A, Alzahrani A, Niazi A, Aburemish H. Percutaneous Device Closure of Patent Ductus Arteriosus in Adult Patients with 10-Year Follow-up. Heart Views 2019; 20:139-145. [PMID: 31803369 PMCID: PMC6881868 DOI: 10.4103/heartviews.heartviews_21_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/25/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives: We report our 10-year experience with transcatheter closure of patent ductus arteriosus (PDA) in adult using different closure devices. Background: Transcatheter closure of PDA in adults can be challenging because of frequently associated comorbidities. Reports on immediate and intermediate-term results of PDA closure are excellent. This study aimed to provide the outcomes of PDA closure using different devices on long and very long term follow-up in adults. Materials and Methods: Between September 2009 and December 2018, data were retrospectively reviewed from 27 patients who underwent transcatheter closure of PDA. Outcome parameters were procedural success, procedure-related complications, evidence of residual shunt, and improvement in the signs/symptoms for which the procedure was performed. The mean follow-up interval was 72 months. Results: A device was successfully implanted in 27 of 27 patients (15 females). Median age and weight were 24 years (range: 18–57 years) and 69 kg (range: 53–102 kg), respectively. The mean PDA diameter was 4.1 ± 2.1 mm. Devices used were Amplatzer Duct Occluder (19/27), Occlutech Duct Occluder (6/27), and PFM Nit-Occlud (2/27). Doppler transthoracic echocardiography (TTE) demonstrated 92.6% of full occlusion at day 1, rising to 96.3% at 1 month. Three procedure-related complications occurred with no death. Among symptomatic 26 patients (96.3%), there was marked improvement in symptoms. Among 22 patients (81.5%) for whom the procedure was performed to address left ventricular (LV) enlargement, there was reduction or stabilization in LV size on serial TTEs. Conclusions: Transcatheter closure of PDA in the adult patient appears to be safe and effective.
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Affiliation(s)
- Wail Alkashkari
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Saad Albugami
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Jamilah Alrahimi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Mohammed Althobaiti
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia.,Department of Radiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Abdulhalim Kinsara
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Ahmed Abousa
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Ahmed Krimly
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Atif Alzahrani
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Akram Niazi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Hayam Aburemish
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medical Research, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia.,Department of Pediatric Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
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Prospective evaluation of the feasibility, safety, and efficacy of Cocoon Duct Occluder for transcatheter closure of large patent ductus arteriosus: A single-center study with short- and medium-term follow-up results. Anatol J Cardiol 2019; 18:321-327. [PMID: 29145233 PMCID: PMC5731280 DOI: 10.14744/anatoljcardiol.2017.7814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: To evaluate the feasibility, safety, and efficacy of a novel Cocoon Duct Occluder device for the transcatheter closure (TCC) of large patent ductus arteriosus (PDA). Methods: In this prospective, non-randomized study, consecutive patients with large PDA (narrowest diameter: ≥3.5/4.0 mm in symptomatic/asymptomatic patients, respectively), who underwent TCC with Cocoon Duct Occluder at our institute between November, 2012 and June, 2016 were examined. TCC was performed using the standard technique, and devices were antegradely delivered via 6–10F delivery sheaths. Device embolization, residual shunt, hemolysis, left pulmonary artery (LPA) stenosis, procedural and fluoroscopy time, and mortality were assessed. Patients were followed-up by transthoracic echocardiography with color Doppler imaging at 24 h (D1), 1 month (D30), and 6 months (D180) after implantation. Results: A total of 57 patients (age: 11.7±2.8 years; weight: 22.3±3.5 kg) were enrolled. The mean narrowest diameter was 7.4±0.7 mm. The PDA closure was successfully performed in each patient. Fluoroscopy and procedural time was 6.7±3.2 min and 23.9±2.7 min, respectively. Postprocedural angiography revealed that 49 (85.9%) patients had immediate and complete closure, whereas 8 (14.1%) had residual shunt. Color Doppler imaging at D1 revealed complete closure in 52 (91.3%) patients. At D30, complete closure was reported in all patients and was maintained at D180. Hemolysis, embolization, obstruction of LPA or descending aorta, and death were not reported till D180. Conclusion: TCC using Cocoon Duct Occluder is feasible, safe, and effective in the management of patients with large PDA, with excellent results on short- and medium-term follow-up.
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Godart F, Houeijeh A, Domanski O, Guillaume MP, Brard M, Lucron H. Is the new Occlutech duct occluder an appropriate device for transcatheter closure of patent ductus arteriosus? Int J Cardiol 2018; 261:54-57. [DOI: 10.1016/j.ijcard.2018.03.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022]
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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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Transcatheter Occlusion of the Patent Ductus Arteriosus in 747 Infants <6 kg: Insights From the NCDR IMPACT Registry. JACC Cardiovasc Interv 2017; 10:1729-1737. [PMID: 28823780 DOI: 10.1016/j.jcin.2017.05.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/17/2017] [Accepted: 05/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The authors sought to identify risk factors associated with major adverse events (MAEs) in infants <6 kg undergoing transcatheter patent ductus arteriosus (PDA) occlusion. BACKGROUND Transcatheter PDA occlusion is among the safest of interventional cardiac procedures in adults and older children, but use among infants <6 kg has not been characterized adequately. METHODS Using the IMPACT (IMproving Pediatric and Adult Congenital Treatments) registry, we identified infants <6 kg undergoing transcatheter PDA occlusion (January 1, 2011, to March 1, 2015). Using mixed-effects multivariate regression, the authors assessed characteristics predictive of MAE or composite failure (procedural failure or MAE). Individual safety metrics (e.g., embolization, malposition) were also examined for differences across weight thresholds: extremely low weight (LW) (<2 kg), very LW (2 to <4 kg), and LW (4 to <6 kg). RESULTS Transcatheter PDA occlusion was attempted in 747 infants <6 kg at 73 hospitals. Rate of procedural success was 94.3%. MAEs were observed in 12.6% of cases; the most common events were acute arterial injury and device embolization in 3.5% and 2.4% of cases, respectively. Younger age (<30 days) was associated with greater risk of a MAE (risk ratio: 3.3; 95% confidence interval: 1.5 to 7.6) and composite failure (risk ratio: 3.0; 95% confidence interval: 1.4 to 6.7). Risk of embolization was higher among extremely LW (10.5%) than very LW or LW infants (1.6% and 2.5%, respectively; p = 0.050). CONCLUSIONS Among infants <6 kg, transcatheter PDA occlusion is technically feasible, but risks of MAE are noteworthy. These findings may help inform patient selection and procedural approach for transcatheter PDA occlusion and direct targeted research efforts to support the practice of evidence-based medicine.
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P S, Jose J, George OK. Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults. Indian Heart J 2017; 70:308-315. [PMID: 29716712 PMCID: PMC5993916 DOI: 10.1016/j.ihj.2017.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/18/2017] [Accepted: 08/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. Methods This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Results Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. Conclusions In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.
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Affiliation(s)
- Sudhakar P
- Department of Cardiology, Christian Medical College Hospital, Vellore, India.
| | - John Jose
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
| | - Oommen K George
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
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12
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Pepeta L, Greyling A, Nxele MF, Makrexeni ZM. Patent ductus arteriosus closure using Occlutech ® Duct Occluder, experience in Port Elizabeth, South Africa. Ann Pediatr Cardiol 2017; 10:131-136. [PMID: 28566820 PMCID: PMC5431024 DOI: 10.4103/0974-2069.205144] [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: 12/02/2022] Open
Abstract
Background: Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. Methods: Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. Results: From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1–454 months) and the median weight was 8.5 kg (range 2.5–78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12–100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1–7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. Conclusion: The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients.
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Affiliation(s)
- Lungile Pepeta
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - Adele Greyling
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - Mahlubandile Fintan Nxele
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - Zongezile Masonwabe Makrexeni
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa
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13
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Parekh D, Krajcer Z. Patent ductus arteriosus and pulmonary arterial hypertension: Is it closer to closure? Catheter Cardiovasc Interv 2017; 89:726-727. [DOI: 10.1002/ccd.27011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Dhaval Parekh
- Department of Cardiology; Texas Heart Institute; Houston Texas
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14
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Backes CH, Rivera BK, Bridge JA, Armstrong AK, Boe BA, Berman DP, Fick T, Holzer RJ, Hijazi ZM, Abadir S, Justino H, Bergersen L, Smith CV, Kirpalani H. Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis. Pediatrics 2017; 139:peds.2016-2927. [PMID: 28087683 DOI: 10.1542/peds.2016-2927] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Patent ductus arteriosus (PDA) is a precursor to morbidity and mortality. Percutaneous (catheter-based) closure is the procedure of choice for adults and older children with a PDA, but use during infancy (<1 year) is not well characterized. OBJECTIVE Investigate the technical success and safety of percutaneous PDA closure during infancy. DATA SOURCES Scopus, Web of Science, Embase, PubMed, and Ovid (Medline) were searched through December 2015 with no language restrictions. STUDY SELECTION Publications needed to clearly define the intervention as percutaneous PDA closure during infancy (<1 year of age at intervention) and must have reported adverse events (AEs). DATA EXTRACTION The study was performed according to the Systematic Reviews and Meta-Analysis checklist and registered prospectively. The quality of the selected studies was critically examined. Data extraction and assignment of AE attributability and severity were independently performed by multiple observers. Outcomes were agreed on a priori. Data were pooled by using a random-effects model. RESULTS Thirty-eight studies were included; no randomized controlled trials were found. Technical success of percutaneous PDA closure was 92.2% (95% confidence interval [CI] 88.8-95.0). Overall AE and clinically significant AE incidence was 23.3% (95% CI 16.5-30.8) and 10.1% (95% CI 7.8-12.5), respectively. Significant heterogeneity and publication bias were observed. LIMITATIONS Limitations include lack of comparative studies, lack of standardized AE reporting strategy, and significant heterogeneity in reporting. CONCLUSIONS Percutaneous PDA closure during infancy is feasible and associated with few catastrophic AEs; however, the limitations constrain the interpretability and generalizability of the current findings.
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Affiliation(s)
- Carl H Backes
- Centers for Perinatal Research, .,Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | | | - Jeffrey A Bridge
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Innovation in Pediatric Practice, and
| | - Aimee K Armstrong
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Brian A Boe
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Darren P Berman
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Tyler Fick
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Ralf J Holzer
- Department of Pediatrics, Weill Cornell Medical College, New York, New York.,Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Weill Cornell Medical College, New York, New York.,Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar
| | - Sylvia Abadir
- Department of Pediatric Cardiology, CHU mère-enfant Sainte-Justine, Université de Montréal, Quebec, Canada
| | - Henri Justino
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington; and
| | - Haresh Kirpalani
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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15
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Lehner A, Ulrich S, Happel CM, Fischer M, Kantzis M, Schulze-Neick I, Haas NA. Closure of very large PDA with pulmonary hypertension: Initial clinical case-series with the new Occlutech®PDA occluder. Catheter Cardiovasc Interv 2016; 89:718-725. [DOI: 10.1002/ccd.26856] [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: 06/01/2016] [Revised: 07/19/2016] [Accepted: 10/12/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Christoph M. Happel
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Marinos Kantzis
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Germany
| | - Ingram Schulze-Neick
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Nikolaus A. Haas
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
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16
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Boudjemline Y. Covidien micro vascular plug in congenital heart diseases and vascular anomalies: A new kid on the block for premature babies and older patients. Catheter Cardiovasc Interv 2016; 89:114-119. [PMID: 27392516 DOI: 10.1002/ccd.26622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/13/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the safety, feasibility, and efficacy of the MVP™ microvascular plug(Covidien) for closure of vascular anomalies in patients with congenital heart diseases (CHD). BACKGROUND The MVP™ is a novel device with PTFE integrated. The device has been recently introduced in the radiological field and reported exclusively for neurological anomalies. METHODS All CHD patients receiving the device from April 2015 until July 2015 were included in the study and followed up clinically as well as by transthoracic echocardiography. Standard safety and follow-up such as vascular complications, embolization rate, and residual shunting were assessed. RESULTS Twelve patients with a median age of 2.6-years (0.03-12.6 years) and a mean weight of 13 kg (2.8-34.2 kg) were included. Devices were delivered from the femoral artery in 10 and from the femoral vein in 2 patients. Devices were used for closure of patent ductus arteriosus (PDA) closure (n = 5), aorto-pulmonary collaterals or Blalock-Taussig shunt (n = 5), veno-venous fistula (n = 1), and coronary fistula (n = 1). One device was retrieved before release due to inappropriate size estimation (PDA spasm). The PDA was successfully closed using a PDA device (Lifetech, Medtronic). Immediate angiographic evaluation showed minimal or no shunt in 90% (10/11 patients) and 100% occlusion rate after a mean follow-up of 3.2-months. There was no device embolization, hemolysis, or any other complication following closure. CONCLUSIONS The delivery of new MVP™ micro vascular plug system (Covidien) is safe and effective in patients with CHD for closure of a variety of vascular abnormalities. The low profile of the device and the sheathless nature of the procedure make it particularly interesting for PDA closure in premature babies. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Younes Boudjemline
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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17
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Dedeoglu R, Bilici M, Demir F, Demir F, Acar OÇ, Hallioglu O, Pac A, Kiziltas A, Karabel D, Kula S, Cimen D, Baspinar O, Atik SU, Saltik IL. Short-Term Outcomes of Patent Ductus Arteriosus Closure With New Occlutech® Duct Occluder: A Multicenter Study. J Interv Cardiol 2016; 29:325-31. [PMID: 27090770 DOI: 10.1111/joic.12290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM Over the past 2 decades, transcatheter occlusion of patent ductus arteriosus (PDA) with coils and the duct occluders evolved to be the procedure of choice. A new device, the Occlutech PDA® occluder (ODO) device has been designed. Herein, we aimed to evaluate the characteristics and short-term results of patients who underwent transcatheter closure of PDA using the ODO. METHODS We reviewed the clinical records of 60 patients from different centers in Turkey between December 2013 and January 2016. The medical records were reviewed for demographic characteristics and echocardiographic findings. Device size was selected on the narrowest diameter of PDA. RESULTS The median patient age was 2.5 years (6 months-35 years), and median PDA diameter was 2.5 mm (1.2-11 mm). Fifty-eight of 60 patients (96.6%) had successful ODO implantation. The occlusion rates were 37/58 (63.7%) at the end of the procedure, 51/58 (87.9%) at 24-48 hours post-procedure, and 57/58 (98.2%) on echocardiography at a median follow-up of 7.6 months. CONCLUSION Our results indicate that transcatheter closure of PDA using the ODO is effective. Larger studies and longer follow-up are required to assess whether its shape and longer length make it superior to other duct occluders in large, tubular, or window-type ducts. (J Interven Cardiol 2016;29:325-331).
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Affiliation(s)
- Reyhan Dedeoglu
- Cerrahpasa Medical Faculty, Department of Pediatric Cardiology, İstanbul University, Istanbul, Turkey
| | - Meki Bilici
- Medical Faculty, Department of Pediatric Cardiology, Dicle University, Diyarbakır, Turkey
| | - Fikri Demir
- Medical Faculty, Department of Pediatric Cardiology, Dicle University, Diyarbakır, Turkey
| | - Fadli Demir
- Medical Faculty, Department of Pediatric Cardiology, Çukurova University, Adana, Turkey
| | | | - Olgu Hallioglu
- Medical Faculty, Department of Pediatric Cardiology, Mersin University, Mersin, Turkey
| | - Ayşenur Pac
- Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Alev Kiziltas
- Medical Faculty, Department of Pediatric Cardiology, Başkent University, Adana, Turkey
| | - Duran Karabel
- Medical Faculty, Department of Pediatric Cardiology, Osman Gazi University, Eskisehir, Turkey
| | - Serdar Kula
- Medical Faculty, Department of Pediatric Cardiology, Gazi University, Ankara, Turkey
| | - Derya Cimen
- Medical Faculty, Department of Pediatric Cardiology, Selçuk University, Konya, Turkey
| | - Osman Baspinar
- Medical Faculty, Department of Pediatric Cardiology, Gaziantep University, Gaziantep, Turkey
| | - Sezen Ugan Atik
- Cerrahpasa Medical Faculty, Department of Pediatric Cardiology, İstanbul University, Istanbul, Turkey
| | - Irfan Levent Saltik
- Cerrahpasa Medical Faculty, Department of Pediatric Cardiology, İstanbul University, Istanbul, Turkey
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18
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The new Occlutech(®) patent ductus arteriosus occluder: Single centre experience. Arch Cardiovasc Dis 2016; 109:384-9. [PMID: 26988839 DOI: 10.1016/j.acvd.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transcatheter therapy is the first-line treatment for closure of patent ductus arteriosus (PDA). A range of different devices have been used. AIM To report our experience using the new Occlutech(®) PDA occluder for closure of PDA. METHODS All consecutive patients receiving an Occlutech(®) PDA occluder for closure of PDA from March 2014 to May 2015 were included in the study. Occluders were implanted using a conventional technique. After cardiac catheterization, transthoracic echocardiography was performed sequentially. Residual shunting and procedural and mid-term complications, including embolization, device-induced left pulmonary artery stenosis and aortic coarctation, were systematically assessed and reported. RESULTS Fifty-six patients (35 females) with a median age of 1 year (range: 29 days to 24 years) were included in the study. PDAs were closed successfully using device number 5/3.5 in 17 patients, 6/4 in 28 patients, 7/5 in four patients, 8/6 in six patients and 10/8 in one patient. Post-implantation angiography showed no residual shunt in 10 patients (17.8%), moderate intraprosthetic shunt in 43 patients (76.8%) and severe shunt in three patients (5.4%). One device embolized in the right pulmonary artery 1hour after successful closure; the device was retrieved surgically after unsuccessful snaring. After a mean follow-up of 10 months (range: 3-17.8 months), no residual shunt or device-related complications were noted. CONCLUSION The new Occlutech(®) PDA occluder allows safe and efficient PDA closure, similar to existing devices.
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19
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Backes CH, Cheatham SL, Deyo GM, Leopold S, Ball MK, Smith CV, Garg V, Holzer RJ, Cheatham JP, Berman DP. Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications. J Am Heart Assoc 2016; 5:JAHA.115.002923. [PMID: 26873689 PMCID: PMC4802484 DOI: 10.1161/jaha.115.002923] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg. METHODS AND RESULTS Retrospective analysis (January 2005-January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2-3.9 kg) underwent attempted PDA closure. Twenty-five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01). CONCLUSIONS Among infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.
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Affiliation(s)
- Carl H Backes
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Sharon L Cheatham
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Grace M Deyo
- The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Scott Leopold
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Molly K Ball
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA
| | - Vidu Garg
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Ralf J Holzer
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - John P Cheatham
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Darren P Berman
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
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