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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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Baspinar O, Narin N, Baykan A, Yildiz K, Pamukcu O, Ozyurt A, Kervancioglu M, Kum YE, Temel MT, Dogan A, Bagli S, Demircan T, Aydin Sahin D, Elmali F, Karadeniz C. Piccolo in transcatheter PDA closure multi-centre study from premature to adolescent children. Cardiol Young 2024; 34:157-162. [PMID: 37283091 DOI: 10.1017/s1047951123001385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this multi-centre study, the mid- to long-term efficacy and safety of the Amplatzer Piccolo Occluder in patent ductus arteriosus closure in premature and term infants as well as children were discussed. Methods. Between 2016 and 2021, 645 patients, 152 of whom were less than 1 month old, underwent ductus closure with the Piccolo device from five different centres in Turkey. The median age of the patients was 2.2 years, and the mean narrowest point of duct diameter was 1.8 mm. Sixty-two patients weighed ≤ 1.5 kg, 90 patients 1.5-3 kg, and the mean follow-up was 20.4 months. In 396, the duct was closed by the retrograde route. Ductal anatomy was Type A in 285, C in 72, E in 171, and F in 64 patients. Fluoroscopy duration was 6.2 min. The procedure success rate was 99.1%. Device embolisation occurred in 13 patients (2%), and 11 were retrieved with a snare. Cardiac perforation and death developed in one premature baby. The left pulmonary artery and the descending aorta stenosis were observed in 3 (0.4%) and in 5 patients (0.5%). Results. Piccolo device is safe and effective in closing ductus in all age groups. It has low profile for use in premature and newborn babies, a small embolisation risk, and a low residual shunt rate after closure. Conclusion. The Piccolo device can be considered as close an ideal occluder. The lower profile, smaller delivery catheter size, and symmetry of this device allow for a venous or arterial approach.
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Affiliation(s)
- Osman Baspinar
- Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Nazmi Narin
- Pediatric Cardiology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Ali Baykan
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Kaan Yildiz
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
| | - Ozge Pamukcu
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Abdullah Ozyurt
- Pediatric Cardiology, Mersin Women's and Children's Hospital, Mersin, Turkey
| | - Mehmet Kervancioglu
- Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Yunus Emre Kum
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | | | - Alper Dogan
- Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Sedat Bagli
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
| | - Tulay Demircan
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, Turkey
| | - Derya Aydin Sahin
- Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Ferhan Elmali
- Biostatistics Department. Izmir Katip Celebi University, Izmir, Turkey
| | - Cem Karadeniz
- Pediatric Cardiology, Tepecik Training and Research Hospital Clinics, İzmir, 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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Wang Z, Wang Q, Zhu X. Iatrogenic or predetermined aortic dysplasia? Cardiol Young 2023; 33:1456-1458. [PMID: 36805879 DOI: 10.1017/s104795112200419x] [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] [Indexed: 02/22/2023]
Abstract
Coarctation of aorta post-transcatheter occlusion of patent ductus arteriosus is rare. We report a special case of infant with patent ductus arteriosus complicated by bicuspid aortic valve, who presented severe coarctation of aorta and aortic valve dysfunction post-patent ductus arteriosus occlusion during follow-up, eventually receiving surgical operations. A genetic rather than iatrogenic predisposition towards post-procedural complications has been discussed.
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Affiliation(s)
- Zhongchao Wang
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Qiguang Wang
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Xianyang Zhu
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang 110016, China
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Salam A, Bautista-Rodriguez C, Karsenty C, Bouvaist H, Piccinelli E, Fraisse A. Transcatheter closure of tubular patent ductus arteriosus using muscular ventricular septal defect devices in infants and small children with congestive heart failure. Arch Cardiovasc Dis 2022; 115:134-141. [DOI: 10.1016/j.acvd.2022.01.003] [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: 07/02/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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Hildebrandt N, Stosic A, Henrich E, Wiedemann N, Wurtinger G, Schneider M. Transvenous embolization of moderate to large patent ductus arteriosus in dogs using the Amplatzer vascular plug II. J Vet Intern Med 2022; 36:20-28. [PMID: 34914141 PMCID: PMC8783350 DOI: 10.1111/jvim.16342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Catheter-based occlusion of patent ductus arteriosus (PDA) can be performed using different devices. Transvenous embolization using the Amplatzer vascular plug II (AVP-II) has been studied in humans, but it has not been described in dogs. OBJECTIVE Evaluate the feasibility and success of transvenous embolization of PDA using the AVP-II in dogs. ANIMALS Nineteen client-owned dogs with left-to-right shunting PDA, with minimal ductal diameter >2.5 mm. METHODS Prospective observational study using AVP-II with transvenous access for PDA closure in dogs. RESULTS Angiography showed a conical ductus with a long (n = 17) or short (n = 2) ampulla. The minimal diameter of the duct was 4.34 ± 1.11 mm, and the maximal diameter of the ampulla was 13.18 ± 3.47 mm. Technical success was achieved in 18 of the 19 (94.7%) patients after the first intervention and in all 19 (100%) patients after the second intervention. Postrelease angiography documented complete occlusion of the PDA in 10 of 19 (52.6%) dogs. Mild flow acceleration or stenosis of the left pulmonary artery was found in 6 and 1 of the 17 analyzed cases, respectively, by Doppler examination. The closure rate 24 hours after intervention was 94.7% (18/19). The remaining dog had a moderate residual shunt, and delayed complete closure after 3 months led to a 100% closure rate. CONCLUSION AND CLINICAL IMPORTANCE The AVP-II is a safe and effective device for transvenous embolization in dogs with moderate to large PDA.
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Affiliation(s)
- Nicolai Hildebrandt
- Small Animal Clinic (Internal Medicine)Justus‐Liebig Universität GiessenGiessenGermany
| | - Andreas Stosic
- Small Animal Clinic (Internal Medicine)Justus‐Liebig Universität GiessenGiessenGermany
| | - Estelle Henrich
- Small Animal Clinic (Internal Medicine)Justus‐Liebig Universität GiessenGiessenGermany
| | - Nicola Wiedemann
- Small Animal Clinic (Internal Medicine)Justus‐Liebig Universität GiessenGiessenGermany
| | - Gabriel Wurtinger
- Small Animal Clinic (Internal Medicine)Justus‐Liebig Universität GiessenGiessenGermany
| | - Matthias Schneider
- Small Animal Clinic (Internal Medicine)Justus‐Liebig Universität GiessenGiessenGermany
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Percutaneous Closure of Patent Ductus Arteriosus in Infants 1.5 kg or Less: A Meta-Analysis. J Pediatr 2021; 230:84-92.e14. [PMID: 33098843 DOI: 10.1016/j.jpeds.2020.10.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. STUDY DESIGN A systematic review and meta-analysis was performed. Data sources included Scopus, Web of Science, Embase, CINAHL, Cochrane, and PubMed from inception to April 2020. Publications were included if they had a clear definition of the intervention as percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. Data extraction was independently performed by multiple observers. Primary outcome was technical success and secondary outcomes were adverse events (AEs). Subgroup analysis was performed in infants ≤6.0 kg. Data were pooled by using a random-effects model. RESULTS We included 28 studies, including 373 infants ≤1.5 kg and 69 studies enrolling 1794 infants ≤6.0 kg. In patients ≤1.5 kg, technical success was 96% (95% CI, 93%-98%; P = .16; I2 = 23%). The overall incidence of AE was 27% (95% CI, 17%-38%; P < .001; I2 = 70%) and major AEs was 8% (95% CI, 5%-10%; P = .63; I2 = 0%). There were 5 deaths related to the procedure (2%; 95% CI, 1%-4%; P = .99; I2 = 0%); 4 of these deaths occurred in infants <0.8 kg. The probability of technical failure was inversely related to age at the time of the procedure (OR, 0.9; 95% CI, 0.830-0.974; P = .009). Weight at intervention has decreased over time and procedural success has increased. CONCLUSIONS Percutaneous patent ductus arteriosus closure is feasible in infants ≤1.5 kg with few major AEs. The procedural success rate is high, despite performing the intervention in smaller patients. PROSPERO REGISTRATION CRD42020145230.
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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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Transcatheter closure of elongated and pulmonary hypertensive patent arterial duct in infants using Amplatzer vascular plug II. Cardiol Young 2020; 30:243-248. [PMID: 31996273 DOI: 10.1017/s1047951120000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the feasibility, efficacy, and safety of Amplatzer vascular plug II in large and elongated ducts in infants. INTRODUCTION Patent arterial duct device closure is technically challenging in infants with large and elongated ducts because Amplatzer duct occluder and Amplatzer duct occluder II have high chances of causing aortic coarctation and left pulmonary artery stenosis, respectively. The Amplatzer vascular plug II being soft with no retention discs on either sides helps in mitigating these problems. METHOD This is a prospective, observational study involving infants with clinical, echocardiographic and angiographic evidence of large left to right shunt. All the children underwent duct closure using Amplatzer vascular plug II. RESULTS Eighteen infants qualified for the study. Mean age and weight were 8.63 ± 3.84 months and 6.3 ± 1.7 kg, respectively. The angiographic mean duct diameter at the pulmonary artery end was 4.66 ± 0.92 mm, and the mean duct length was 9.4 ± 2.48 mm. The size of Amplatzer vascular plug II used varied from 6 mm to 10 mm. Technical success was achieved in 16/18 cases. One patient had device embolisation, and in the other, the device was found to be unstable. The ratio of Amplatzer vascular plug II size to the duct diameter was 1.65 ± 0.27, while the ratio of ductal length to device length was 1.48 ± 0.46 in those with successful outcome. CONCLUSIONS Amplatzer vascular plug II is a safe and effective option in appropriately selected infants with elongated ducts. Diameter and length of Amplatzer vascular plug II vis-a-vis those of the ductus are important determinants of the successful outcome.
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Wang JN, Lin YC, Hsieh ML, Wei YJ, Ju YT, Wu JM. Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants With Very Low Birth Weight. Front Pediatr 2020; 8:615919. [PMID: 33520899 PMCID: PMC7841343 DOI: 10.3389/fped.2020.615919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/10/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature infants. Methods: We performed a retrospective study of infants born with a birth body weight of < 2,000 g and admitted to National Cheng Kung University Hospital from September 2014 to December 2019. Basic demographic and clinical information as well as echocardiographic and angiographic data were recorded. Results: Twenty-five premature infants (11 boys and 14 girls) born at gestational ages ranging between 22 and 35 weeks (mean, 25 weeks) were identified. The mean age at procedure was 34.5 ± 5.5 days, and the mean weight was 1,209 ± 94 g (range, 478-1,980 g). The mean diameter of the PDA was 3.4 ± 0.2 mm (range, 2.0-5.4 mm). The following devices were used in this study: Amplatzer Ductal Occluder II additional size (n = 20), Amplatzer Vascular Plug I (n = 1), and Amplatzer Vascular Plug II (n = 4). Complete closure was achieved in all patients. The mean follow-up period was 30.1 ± 17.3 months (range, 6-68 months). In total, 3 patients had left pulmonary artery (LPA) stenosis and 1 patient had coarctation of the aorta during the follow-up period. Younger procedure age and smaller procedure body weight were significantly associated with these obstructions. Conclusions: Performing transcatheter PDA closure in symptomatic premature infants weighing more than 478 g is feasible using currently available devices; moreover, the procedure serves as an alternative to surgery.
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Affiliation(s)
- Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Min-Ling Hsieh
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Jen Wei
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Tzu Ju
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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Sheth K, Dalvi B. Left pulmonary artery stenting for relief of left pulmonary artery stenosis following ductal closure using Amplatzer Duct Occluder II. Ann Pediatr Cardiol 2019; 12:172-175. [PMID: 31143050 PMCID: PMC6521675 DOI: 10.4103/apc.apc_101_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: 11/24/2022] Open
Abstract
A 6-month-old infant with moderate-sized patent ductus arteriosus (PDA) and inadequate weight gain underwent closure of the duct using Amplatzer Ductal Occluder II (ADO II). She developed severe progressive left pulmonary artery (LPA) stenosis due to protrusion of the disc at the pulmonary end of the ADO II. She was subjected to balloon angioplasty of the LPA stenosis with suboptimal result. Hence, she was subjected to stenting of the LPA using a Formula stent which could be subsequently postdilated to keep up with the growth of the child. Immediate and short-term results were excellent anatomically as well as physiologically.
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Affiliation(s)
- Kshitij Sheth
- Department of Paediatric Cardiac Science, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Department of Paediatric Cardiac Science, Sir H N Reliance Foundation Hospital and Glenmark Cardiac Centre, Mumbai, Maharashtra, India
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Choi GJ, Song J, Kim YS, Lee H, Huh J, Kang IS. Outcomes of transcatheter closure of ductus arteriosus in infants less than 6 months of age: a single-center experience. KOREAN JOURNAL OF PEDIATRICS 2018; 61:397-402. [PMID: 30304903 PMCID: PMC6313084 DOI: 10.3345/kjp.2018.06548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. METHODS We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6-12 months in the same study period were reviewed. RESULTS A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was 3.3±1.5 months, and weight was 5.7±1.3 kg. The duct diameter at the narrowest point was 3.0±0.8 mm as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6-12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P<0.01). CONCLUSION A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.
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Affiliation(s)
- Gwang-Jun Choi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Seul Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heirim Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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Krishnamoorthy KM, Gopalakrishnan A. Cost-effectiveness analysis of devices for closure of patent ductus arteriosus. Ann Pediatr Cardiol 2018; 11:109. [PMID: 29440844 PMCID: PMC5803965 DOI: 10.4103/apc.apc_131_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- K M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India E-mail:
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India E-mail:
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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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16
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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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17
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Gruenstein DH, Ebeid M, Radtke W, Moore P, Holzer R, Justino H. Transcatheter closure of patent ductus arteriosus using the AMPLATZER™ duct occluder II (ADO II). Catheter Cardiovasc Interv 2017; 89:1118-1128. [DOI: 10.1002/ccd.26968] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Makram Ebeid
- Department of Pediatric Cardiology, University of Mississippi Medical Center; Jackson Mississippi
| | - Wolfgang Radtke
- Department of Pediatric Cardiology, Alfred I. duPont Hospital for Children; Wilmington Delaware
| | - Phillip Moore
- Department of Pediatric Cardiology, University of California San Francisco; San Francisco California
| | - Ralf Holzer
- Department of Pediatric Cardiology, Sidra Medical Center; Doha Qatar
| | - Henri Justino
- Department of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine; Houston Texas
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18
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El-Saiedi SA, Attia WA, Sobhy R. Transcatheter Repair of Congenital Heart Defects in the Young. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In recent decades, tremendous medical advances have been made. Therapeutic cardiac catheterisation for repair of congenital heart defects has become the standard mode of therapy. Catheter techniques have progressed. They now provide temporary palliation, prepare the patient for surgical reconstruction, or offer a definitive repair. The main advantages of non-surgical procedures are avoidance of thoracotomy and cardiopulmonary bypass, together with a shorter hospitalisation period and speedier convalescence.
Paediatric interventions include: transcatheter device closure of congenital cardiac defects, balloon angioplasty and valvuloplasty, atrial septostomy, patent ductus arteriosus stenting in the neonatal period, vessel embolisation, and many others. Topping those interventions is the introduction of transcatheter valve replacement. The aim of this article is to review these interventions and present them in a simplified, vibrant, and up-to-date fashion.
In conclusion, paediatric cardiac interventions have established their reliability and ever-expanding scope in the setting of congenital heart disease management. Nevertheless, success is dependent on selecting the proper procedure for each condition, which may also vary with each patient. Thus, it is highly dependent on the experience and expertise of the operator. With the current rate of technological innovation, more and more surgical procedures will eventually be replaced by catheter-based interventions with a great degree of safety and efficacy.
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Affiliation(s)
- Sonia A. El-Saiedi
- Division of Pediatric Cardiology, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Wael A. Attia
- Division of Pediatric Cardiology, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Rodina Sobhy
- Division of Pediatric Cardiology, Department of Pediatrics, Cairo University, Cairo, Egypt
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19
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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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20
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Transcatheter closure of ventricular septal defects using the Amplatzer Duct Occluder II device: a single-center experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:340-347. [PMID: 27980548 PMCID: PMC5133323 DOI: 10.5114/aic.2016.63635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/27/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Off-label use of different devices has been described for percutaneous closure of ventricular septal defects (VSD) because of the unacceptable rate of post-procedure heart block associated with special VSD devices. Aim To describe the early single-center clinical experience with closure of a VSD using the Amplatzer Duct Occluder II (ADO II) device in children. Material and methods Between May 2013 and June 2015, 26 patients between 13 days and 16 years of age underwent percutaneous closure of a VSD with an ADO II device at our institute. The decision to use the ADO II device was based primarily on lower risk of total atrioventricular block (TAVB) after VSD closure reported in the literature, reduction of the cost of the procedure and the need to close symptomatic VSDs in young patients. Results The location of the VSD was perimembranous in 21 patients, postsurgical residual in 2, midmuscular in 2 and apical muscular in 1. Complex procedures including newborn, combined procedures and postsurgical residual VSD were performed in 5 (19%) patients. The median duration of follow-up was 12 months. The complete VSD closure rate was 81% immediately after the procedure, 85% at 24 h, and 93% at the last follow-up. There was no device embolization. During the entire follow-up period, TAVB did not develop. Conclusions The ADO II constitutes a safe and effective therapeutic alternative for morphologically varied VSDs in all pediatric age groups. A larger range of sizes and configurations of this occluder may be required to successfully occlude a wider range of VSDs.
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21
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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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22
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Jin M, Liang YM, Wang XF, Guo BJ, Zheng K, Gu Y, Lyu ZY. A Retrospective Study of 1,526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus. Chin Med J (Engl) 2015; 128:2284-9. [PMID: 26315073 PMCID: PMC4733798 DOI: 10.4103/0366-6999.163398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices. Methods: One thousand five hundred and twenty-six patients (537 boys, 989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications. Results: Median age and median weight were 4.0 years (range: 0.3–52.0 years old) and 15.3 kg (range: 4.5–91.0 kg), respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 mm, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I (ADO I, 1280, 85.8%), Cook detachable coils (116, 7.8%), ADO II (ADO II, 68, 4.6%), muscular VSD occluder (12, 0.8%), and Amplatzer vascular plug (16, 1.0%). Conclusions: Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.
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Affiliation(s)
- Mei Jin
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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23
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Baspinar O, Sahin DA, Sulu A, Irdem A, Gokaslan G, Sivasli E, Kilinc M. Transcatheter closure of patent ductus arteriosus in under 6 kg and premature infants. J Interv Cardiol 2015; 28:180-9. [PMID: 25832591 DOI: 10.1111/joic.12196] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcatheter closure of a patent ductus arteriosus (PDA) has always been considered risky for infants weighing <6 kg and preterms. We present our findings regarding transcatheter closures of PDA. METHODS The inclusion criteria were a weight of <6 kg and the presence of PDA symptoms. The study subjects were divided into two groups: <6 kg and premature infants. RESULTS A total of 69 infants were included. The mean ages and weights of the <6 kg and the preterms were 5.4 ± 2.7 months and 30.3 ± 19.9 days, and 4.6 ± 0.8 and 1.7 ± 0.3 kg, respectively. Type C PDAs were most frequently observed in the premature group, and type A was in <6 kg. Sixteen of the patients were premature infants, and 81.2% of them had an extremely low birth weight. All of the premature infants had comorbidities, and had been receiving respiratory support therapy. Transcatheter closure was successfully completed in 81.2% of the premature infants and 94.3% of the <6-kg infants. Major complications occurred in 4 patients (one death and three device embolizations). The patient's age was found to be the main risk factor. The most frequently used device was the Amplatzer duct occluder II in additional sizes (84.6%) in the preterms and the Amplatzer duct occluder I (34%) and II (34%) in the <6-kg group. CONCLUSION The transcatheter closure of PDA is relatively safe and effective in preterms and in infants <6 kg. The selection of a suitable device based on the type of PDA is critical to the success of the procedure.
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Affiliation(s)
- Osman Baspinar
- Department of Pediatric Cardiology, Gaziantep University, Medical Faculty,, Gaziantep, Turkey
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24
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Abdelbasit MAE, Alwi M, Kandavello G, Che Mood M, Samion H, Hijazi ZM. The new Occlutech® PDA occluder: Initial human experience. Catheter Cardiovasc Interv 2015; 86:94-9. [PMID: 25675888 PMCID: PMC6680177 DOI: 10.1002/ccd.25878] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/05/2015] [Indexed: 11/21/2022]
Abstract
Objectives To evaluate the feasibility, safety, and efficacy of the Occlutech® PDA occluder for closure of patent ductus arteriosus (PDA). Background The Occlutech® PDA occluder is novel, self‐shaping Nitinol wire device with PET (polyethylene terephthalate) patches integrated into the shank of the device to assure a better obturation of the ductus. The Occlutech® PDA occluder has undergone two design modifications. Methods A prospective, non‐randomized pilot study was started in November 2011. Thirty‐three patients were included until April 2013. Patients weighing <6 kg or those with associated cardiac anomalies that required surgery were excluded. All patients were followed up by transthoracic echocardiography at 24 hr, 30 days, 90 days, 180 days, and 360 days after implantation. Residual shunt, left pulmonary artery (LPA) and descending aortic velocities were among the parameters assessed. All occluders were delivered via 6–8 F long sheaths and PDA closures were performed following standard techniques. Results Thirty three patients (20 female/13 male), with a median age of 2 years (6 month to 38 years), and median weight of 9.3 kg (6–69.2 kg) were included. The narrowest median PDA diameter was 3mm (1.8–5.8 mm). All the 33 patients were closed successfully using Occlutech ductal occluder, 16 patients (48.4%) had immediate and complete closure on angiography. Within 24 hr, color Doppler revealed complete closure in 27patients (81.8%), 32patients (97%) at 30 days, and in 100% of patients at 90 days. All patients with a large PDA had immediate residual shunt which was closed at the 90‐day follow‐up. There was no device embolization, hemolysis, or obstruction to the LPA or descending aorta. Conclusion The new Occlutech® PDA is safe and effective. In patients with a large PDA complete closure tended to take longer time. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Mazeni Alwi
- Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Geetha Kandavello
- Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Marhisham Che Mood
- Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Hasri Samion
- Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
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25
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GARAY FRANCISCOJ, AGUIRRE DANIEL, CÁRDENAS LUIS, SPRINGMULLER DANIEL, HEUSSER FELIPE. Use of the Amplatzer Vascular Plug II Device to Occlude Different Types of Patent Ductus Arteriosus in Pediatric Patients. J Interv Cardiol 2015; 28:198-204. [DOI: 10.1111/joic.12188] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - LUIS CÁRDENAS
- Hospital de Niños Dr. Luis Calvo Mackenna; Santiago Chile
| | | | - FELIPE HEUSSER
- Hospital Clínico de la Universidad Católica de Chile; Santiago Chile
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26
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Bruckheimer E, Godfrey M, Dagan T, Levinzon M, Amir G, Birk E. The Amplatzer duct occluder II additional sizes device for transcatheter PDA closure: Initial experience. Catheter Cardiovasc Interv 2014; 83:1097-101. [DOI: 10.1002/ccd.25445] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/28/2013] [Accepted: 02/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Elchanan Bruckheimer
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Max Godfrey
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Tamir Dagan
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Michael Levinzon
- Section of Pediatric Anesthesiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Gabriel Amir
- Section of Pediatric Cardiothoracic Surgery; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Einat Birk
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
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Pepeta L. Ductal closure using the Amplatzer duct occluder type two: experience in Port Elizabeth hospital complex, South Africa: cardiovascular topic. Cardiovasc J Afr 2013; 24:202-7. [PMID: 23812377 PMCID: PMC4986386 DOI: 10.5830/cvja-2013-033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 05/10/2013] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To report outcomes in percutaneous ductal closure using the Amplatzer duct occluder type two (ADO II). METHODS Records of patients admitted for percutaneous closure of patent ductus arteriosus (PDA) were reviewed. RESULTS From May 2009 to July 2012, 36 patients were assigned to closure using the ADO II. There were 21 females and 15 males. The median age was 16.5 (2-233) months; median weight, 8 (3.94-39.2) kg; and median height, 75 (55-166) cm. The mean pulmonary artery pressure was 24.4 (± 10.4) mmHg, the pulmonary blood flow:systemic blood flow (Qp:Qs) ratio was 2.25 (± 1.97), and mean pulmonary resistance (Rp) was 1.87 (± 1.28) Wood units. The mean ductal size was 2.74 (± 1.3) mm. In 30 patients the device was delivered through the pulmonary artery. Thirty-three patients achieved complete closure by discharge (day one). CONCLUSION The ADO II is capable of closing a wide range of ducts in carefully selected patients. Our findings are comparable with other studies regarding ductal closure rates.
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Affiliation(s)
- Lungile Pepeta
- Division of Paediatric Cardiology, Paediatrics and Child Health, Dora Nginza Hospital, Port Elizabeth, Eastern Cape South Africa
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Sungur M, Karakurt C, Ozbarlas N, Baspinar O. Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer duct occluder II additional sizes: Multicenter study. Catheter Cardiovasc Interv 2013; 82:245-52. [DOI: 10.1002/ccd.24905] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/19/2013] [Accepted: 02/26/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Metin Sungur
- Department of Pediatric Cardiology; Ondokuz Mayis University; Samsun Turkey
| | - Cemsit Karakurt
- Department of Pediatric Cardiology; İnönü University; Malatya Turkey
| | - Nazan Ozbarlas
- Department of Pediatric Cardiology; Cukurova University; Adana Turkey
| | - Osman Baspinar
- Department of Pediatric Cardiology; Gaziantep University; Gaziantep Turkey
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29
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Liddy S, Oslizlok P, Walsh KP. Comparison of the results of transcatheter closure of patent ductus arteriosus with newer amplatzer devices. Catheter Cardiovasc Interv 2013; 82:253-9. [DOI: 10.1002/ccd.24768] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 11/13/2012] [Accepted: 11/25/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Stephen Liddy
- Department of Cardiology; St Vincent's University Hospital; Dublin 4 Ireland
| | - Paul Oslizlok
- Cardiac Department; Our Lady's Hospital for Sick Children; Crumlin Dublin Ireland
| | - Kevin P. Walsh
- Cardiac Department; Our Lady's Hospital for Sick Children; Crumlin Dublin Ireland
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