1
|
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.
Collapse
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
| |
Collapse
|
2
|
Morray BH, Sathanandam SK, Forbes T, Gillespie M, Berman D, Armstrong AK, Shahanavaz S, Jones T, Rockefeller T, Justino H, Nykanen D, Weiler C, Gutfinger D, Zahn EM. 3-year follow-up of a prospective, multicenter study of the Amplatzer Piccolo™ Occluder for transcatheter patent ductus arteriosus closure in children ≥ 700 grams. J Perinatol 2023; 43:1238-1244. [PMID: 37587183 PMCID: PMC10541325 DOI: 10.1038/s41372-023-01741-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study describes 3-year follow-up of 200 infants weighing ≥ 700 grams who underwent transcatheter patent ductus arteriosus (PDA) closure with the Amplatzer Piccolo™ Occluder. STUDY DESIGN Between June 2017 and February 2019, 200 children were enrolled in this U.S. study (NCT03055858). PDA closure, survival, and device- or procedure-related events were evaluated. A total of 156 of the available 182 patients (86%) completed the study. RESULTS The implant success rate was 95.5% (191/200). At 3 years, PDA closure was observed in 100% (33/33) of patients. Survival was >95% with 9 reported deaths. No deaths were adjudicated as device- or procedure-related. Notable events included aortic obstruction (2) requiring stent placement and tricuspid regurgitation (5), for which no interventions were required. CONCLUSIONS This follow-up study demonstrates high rates of PDA closure, low serious complication rates, and survival > 95% at 3 years. The Amplatzer Piccolo™ Occluder is a safe and effective therapy for PDA treatment in premature infants. CLINICALTRIALS gov identifier: NCT0305585.
Collapse
Affiliation(s)
- Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.
| | | | - Thomas Forbes
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Darren Berman
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | | | - Thomas Jones
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | | | | | | | | | | | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
3
|
Linnane N, Kenny DP, Hijazi ZM. Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies. Expert Rev Cardiovasc Ther 2023; 21:329-336. [PMID: 37114439 DOI: 10.1080/14779072.2023.2208862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION With the advent of improved neonatal care, increasingly vulnerable higher-risk patients with complex congenital heart anomalies are presenting for intervention. This group of patients will always have a higher risk of an adverse event during a procedure but by recognising this risk and with the introduction risk scoring systems and thus the development of novel lower risk procedures, the rate of adverse events can be reduced. AREA COVERED This article reviews risk scoring systems for congenital catheterization and demonstrates how they can be used to reduce the rate of adverse events. Then novel low risk strategies are discussed for low weight infants e.g. patent ductus arteriosus (PDA) stent insertion; premature infants e.g. PDA device closure; and transcatheter pulmonary valve replacement. Finally, how risk is assessed and managed within the inherent bias of an institution is discussed. EXPERT OPINION There has been a remarkable improvement in the rate of adverse events in congenital cardiac interventions but now, as the benchmark of mortality rate is switched to morbidity and quality of life, continued innovation into lower risk strategies and understanding inherent bias when assessing risk will be key to continuing this improvement.
Collapse
Affiliation(s)
- N Linnane
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - D P Kenny
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Z M Hijazi
- Department of Cardiovascular Diseases, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, New York, NY, USA
- Jordan University, Amman, Jordan
| |
Collapse
|
4
|
Shibbani K, Mohammad Nijres B, McLennan D, Bischoff AR, Giesinger R, McNamara PJ, Klein J, Windsor J, Aldoss O. Feasibility, Safety, and Short‐Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High‐Frequency Jet Ventilation. J Am Heart Assoc 2022; 11:e025343. [PMID: 35574958 PMCID: PMC9238575 DOI: 10.1161/jaha.122.025343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure. Methods and Results This is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes. Conclusions Transcatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.
Collapse
Affiliation(s)
- Kamel Shibbani
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Bassel Mohammad Nijres
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Daniel McLennan
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | | | - Regan Giesinger
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Patrick J. McNamara
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Jonathan Klein
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Jimmy Windsor
- Division of Pediatric Anesthesia University of Iowa Carver College of Medicine Iowa City IA
| | - Osamah Aldoss
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| |
Collapse
|
5
|
Grunenwald Gronier C, Benbrik N, Romefort B, Prigent S, Hauet Q, Baruteau AE. Off-label use of Lifetech KONAR-MF™ ventricular septal defect occluder for large patent ductus arteriosus closure in <6 kg infants. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2021.100316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
6
|
Barcroft M, McKee C, Berman DP, Taylor RA, Rivera BK, Slaughter JL, El-Khuffash A, Backes CH, Backes CH. Percutaneous Closure of Patent Ductus Arteriosus. Clin Perinatol 2022; 49:149-166. [PMID: 35209997 PMCID: PMC8887783 DOI: 10.1016/j.clp.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneous-based patent ductus arteriosus closure is technically feasible among infants less than 1.5 kg. However, marked heterogeneity in the type and nature of adverse events obscures current safety profile assessments. Although data on the risks of postdevice closure syndrome remain promising, a lack of comparative trials of surgical ductal ligation and inconsistent surveillance across published studies obscure confidence in present estimates of safety and efficacy. To minimize risk and yield the greatest benefits, clinical studies of patent ductus arteriosus treatment should consider incorporating more robust assessments to ensure that infants at greatest risk for adverse ductal consequences are included.
Collapse
Affiliation(s)
- Megan Barcroft
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christopher McKee
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Anesthesiology, Nationwide Children’s Hospital, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Darren P. Berman
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Rachel A. Taylor
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Brian K. Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Jonathan L. Slaughter
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital; Dublin, Ireland,Department of Paediatrics; The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carl H. Backes
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | | |
Collapse
|
7
|
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]
|
8
|
Pinto FF. Percutaneous closure of patent ductus arteriosus: A standard procedure with new perspectives. Rev Port Cardiol 2021; 40:569-571. [PMID: 34392899 DOI: 10.1016/j.repce.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fátima F Pinto
- Universidade NOVA de Lisboa, Serviço de Cardiologia Pediátrica, Centro de Referência de Cardiopatias Congénitas, CHULC, EPE - Hospital de Santa Marta, Portugal.
| |
Collapse
|
9
|
Scerbo D, Cua CL, Rivera BK, Marzec LC, Smith CV, Slaughter JL, Berman DP, Backes CH. Percutaneous Closure of the Patent Ductus Arteriosus in Very-Low-Weight Infants. Neoreviews 2021; 21:e469-e478. [PMID: 32611564 DOI: 10.1542/neo.21-7-e469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In view of the known complications of drug therapy and open surgical ligation, and the potential for prolonged patent ductus arteriosus (PDA) exposure to be harmful, health care practitioners have sought new approaches to achieve definitive ductal closure. Interest in percutaneous (catheter-based) PDA closure has emerged within the neonatal community as a viable treatment option, because it has been fueled by recent procedural and device modifications, as well as mounting feasibility and safety data. Herein, we provide a contemporary review of percutaneous PDA closure among infants at the crux of the medical debate-very-low-weight infants (≤1,500 g), including: 1) characterization of traditional PDA treatments (drug therapy, open surgical ligation) and conservative (nonintervention) management options; 2) a general overview of the major procedural steps of percutaneous ductal closure, including efforts to reduce thrombotic complications and the emergence of a novel US Food and Drug Administration-approved device; 3) a systematic review and meta-analysis to better understand risk profiles of percutaneous PDA closure in this population; and 4) discussion of current gaps in our understanding of optimal PDA care, including the critical need for well-designed, randomized, controlled clinical trials.
Collapse
Affiliation(s)
- Danielle Scerbo
- The Ohio University Heritage College of Osteopathic Medicine, Athens, OH.,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Clifford L Cua
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Brian K Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Laura C Marzec
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, WA
| | - Jonathan L Slaughter
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH
| | - Darren P Berman
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Carl H Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
10
|
Pinto FF. Percutaneous closure of patent ductus arteriosus: A standard procedure with new perspectives. Rev Port Cardiol 2021. [PMID: 34303579 DOI: 10.1016/j.repc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Fátima F Pinto
- Universidade NOVA de Lisboa, Serviço de Cardiologia Pediátrica, Centro de Referência de Cardiopatias Congénitas, CHULC, EPE - Hospital de Santa Marta, Portugal.
| |
Collapse
|
11
|
Transcatheter patent ductus arteriosus closure in extremely premature infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
12
|
Diab KA, Boujemline Y, Hijazi ZM. Update on shunt closure in neonates and infants. Expert Rev Cardiovasc Ther 2021; 19:475-492. [PMID: 33899641 DOI: 10.1080/14779072.2021.1922079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.
Collapse
Affiliation(s)
- Karim A Diab
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Younes Boujemline
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
13
|
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: 18] [Impact Index Per Article: 6.0] [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.
Collapse
|
14
|
Sathanandam S, Gutfinger D, Morray B, Berman D, Gillespie M, Forbes T, Johnson JN, Garg R, Malekzadeh-Milani S, Fraisse A, Baspinar O, Zahn EM. Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants. Pediatr Cardiol 2021; 42:1258-1274. [PMID: 34195869 PMCID: PMC8292293 DOI: 10.1007/s00246-021-02665-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022]
Abstract
Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.
Collapse
Affiliation(s)
- Shyam Sathanandam
- LeBonheur Children's Hospital, University of Tennessee, 848 Adams Avenue, Memphis, TN, 38103, USA.
| | | | | | | | | | | | - Jason N. Johnson
- LeBonheur Children’s Hospital, University of Tennessee, 848 Adams Avenue, Memphis, TN 38103 USA
| | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, CA USA
| | | | | | - Osman Baspinar
- Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Evan M. Zahn
- Cedars-Sinai Medical Center, Los Angeles, CA USA
| |
Collapse
|
15
|
Markush D, Tsing JC, Gupta S, Berndsen NC, Radville G, Garg R, Zahn EM, Almeida-Jones M. Fate of the Left Pulmonary Artery and Thoracic Aorta After Transcatheter Patent Ductus Arteriosus Closure in Low Birth Weight Premature Infants. Pediatr Cardiol 2021; 42:628-636. [PMID: 33394112 PMCID: PMC7990822 DOI: 10.1007/s00246-020-02523-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/04/2020] [Indexed: 01/07/2023]
Abstract
Transcatheter patent ductus arteriosus closure (TCPC) is an emerging treatment for low birth weight extremely premature neonates (EPNs). Left pulmonary artery (LPA) and descending aorta (DAO) obstruction are described device-related complications, however, data on mid- and long-term vascular outcomes are lacking. A retrospective analysis of EPNs who underwent successful TCPC at our institution from 03/2013 to 12/2018 was performed. Two-dimensional echocardiography and spectral Doppler velocities from various time points before and after TCPC were used to identify LPA and DAO flow disturbances. A total of 44 EPNs underwent successful TCPC at a median (range) procedural weight of 1150 g (755-2500 g). Thirty-two (73%) patients were closed with the AVP II and 12 (27%) with the Amplatzer Piccolo device. LPA and DAO velocities on average remained within normal limits and improved spontaneously in long-term follow up (26.1 months, range 1-75 months). One patient, who had concerning LPA flow characteristics immediately after device implant (peak velocity 2.6 m/s) developed progressive LPA stenosis requiring stent placement 3 months post-procedure. In the remaining infants, including 7 (16%) who developed LPA and 3 (7%) who developed DAO flow disturbances (range 2-2.4 m/s), all had progressive normalization of flow velocities over time. TCPC can be performed safely in EPNs with a low incidence of LPA and DAO obstruction. In the absence of significant progressive vascular obstruction in the early post-procedure period, mild increases in LPA and DAO flow velocities tend to improve spontaneously and normalize in long-term follow-up.
Collapse
Affiliation(s)
- Dor Markush
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,Guerin Family Congenital Heart Program, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA.
| | - Jennifer C. Tsing
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Surbhi Gupta
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA USA
| | - Nicole C. Berndsen
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | | | - Ruchira Garg
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA ,Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Evan M. Zahn
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA ,Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Myriam Almeida-Jones
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA ,Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA USA
| |
Collapse
|
16
|
Faim DRO, Tiago JAM, Castelo RJS, Francisco ASS, Alves RR, Pires AMGS. PATENT DUCTUS ARTERIOSUS CLOSURE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER. REVISTA PAULISTA DE PEDIATRIA 2020; 39:e2020013. [PMID: 33263696 PMCID: PMC7695124 DOI: 10.1590/1984-0462/2021/39/2020013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/24/2020] [Indexed: 11/22/2022]
Abstract
Objective: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital. Methods: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored. Results: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001). Conclusions: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.
Collapse
|
17
|
Heyden CM, El-Said HG, Moore JW, Guyon PW, Katheria AC, Ratnayaka K. Early experience with the Micro Plug Set for preterm patent ductus arteriosus closure. Catheter Cardiovasc Interv 2020; 96:1439-1444. [PMID: 32979038 DOI: 10.1002/ccd.29298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We intend to describe early experience using a new, commercially available Micro Plug Set for preterm neonate and infant transcatheter patent ductus arteriosus (PDA) occlusion. BACKGROUND Transcatheter PDA occlusion in premature neonates and small infants is safe and effective. The procedure is early in its evolution. METHODS Procedural and short-term outcomes of preterm neonates and infants undergoing transcatheter PDA occlusion with a new, commercially available device were reviewed. RESULTS Eight preterm neonates and infants born at median 27 weeks gestation (23-36 weeks) underwent transcatheter PDA device closure with the Micro Plug Set. The device is short (2.5 mm) with a range of diameters (3, 4, 5, 6 mm) and delivered through a microcatheter. Procedures were performed at median 41 days of age (12-88 days) and at 1690 g (760-3,310 g). Transvenous PDA device occlusion was performed with fluoroscopic and echocardiography guidance. All procedures were successful with complete PDA occlusion. There were no procedural or short-term adverse events. CONCLUSIONS Preterm neonate and infant transcatheter PDA device closure with a new, commercially available short and microcatheter delivered device (Micro Plug Set) was safe and effective in a small, early series of patients.
Collapse
Affiliation(s)
- Caitlin M Heyden
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Howaida G El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - John W Moore
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Peter W Guyon
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Anup C Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| |
Collapse
|
18
|
Piccolo devices in premie ductus arteriosi. Int J Cardiol 2020; 311:37-38. [DOI: 10.1016/j.ijcard.2020.02.054] [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: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
|
19
|
Sathanandam SK, Gutfinger D, O'Brien L, Forbes TJ, Gillespie MJ, Berman DP, Armstrong AK, Shahanavaz S, Jones TK, Morray BH, Rockefeller TA, Justino H, Nykanen DG, Zahn EM. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv 2020; 96:1266-1276. [PMID: 32433821 PMCID: PMC7754477 DOI: 10.1002/ccd.28973] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 01/08/2023]
Abstract
Objectives Characterize the safety and effectiveness of the Amplatzer Piccolo Occluder for patent ductus arteriosus (PDA) closure. Background The presence of a hemodynamically significant PDA has been associated with an increased risk of morbidity and mortality in children born premature. Methods This was a single arm, prospective, multicenter, non‐randomized study to evaluate the Amplatzer Piccolo Occluder to treat PDA in patients ≥700 g. From June 2017 to February 2019, 200 patients were enrolled at nine centers, with 100 patients weighing ≤2 kg. Primary effectiveness endpoint was the rate of PDA closure at 6‐month follow‐up. Primary safety endpoint was the rate of major complications through 6 months. Secondary endpoint was rate of significant pulmonary or aortic obstruction through 6 months' follow‐up. Results The implant success rate was 95.5% (191/200) overall and 99% in patients ≤2 kg (99/100). The primary effectiveness endpoint was achieved in 99.4% of implanted patients. Four patients experienced a primary safety endpoint event (2 transfusions, 1 hemolysis, and 1 aortic obstruction). There were no branch pulmonary artery obstructions. Five patients, all ≤2 kg, were noted to have worsening of tricuspid regurgitation (TR) after the procedure. None of the TR incidences manifested clinically. The Amplatzer Piccolo Occluder received FDA approval in January 2019 and became the first device approved for PDA closure in patients ≥700 g. Conclusions This study supports the safety and effectiveness of the Amplatzer Piccolo Occluder, particularly in patients between 700 g and 2 kg where there is currently a significant unmet need in the United States. ClinicalTrials.gov identifier: NCT03055858.
Collapse
Affiliation(s)
- Shyam K Sathanandam
- LeBonheur Children's Hospital, University of Tennessee, Memphis, Tennessee, USA
| | - Dan Gutfinger
- Abbott Structural Heart, Santa Clara, California, USA
| | - Laura O'Brien
- Abbott Structural Heart, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | | | | | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW To review the most recent literature on pediatric transcatheter ductal intervention including ductus arteriosus occlusion and stenting. RECENT FINDINGS With the development and FDA approval of smaller ductal devices, including most recently the Amplatzer Piccolo Occluder (Abbott, Abbott Park, IL), transcatheter ductus arteriosus device closure is now being safely performed in premature infants and patients < 6 kg using a transvenous approach. In patients with ductus-dependent pulmonary blood flow, ductal stenting with pre-mounted coronary artery stents has been shown to be an acceptable alternative to the surgically placed Blalock-Taussig shunt. Centers with experience in ductal stenting have demonstrated success, even with the tortuous ductus. Innovation in transcatheter device technology and procedural practices have allowed for significant advances. Transcatheter ductal device closure is a reasonable alternative to surgical ligation even in premature, low-birthweight infants. Ductal stenting is also an accepted alternative to the modified Blalock-Taussig shunt. We anticipate continued advancement and procedural refinement over the next several years.
Collapse
|
21
|
Fraisse A, Bautista-Rodriguez C, Burmester M, Lane M, Singh Y. Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams. Front Pediatr 2020; 8:558256. [PMID: 33072674 PMCID: PMC7536298 DOI: 10.3389/fped.2020.558256] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA-when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early- and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.
Collapse
Affiliation(s)
- Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Margarita Burmester
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Pediatric Cardiac Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Mary Lane
- Pediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Yogen Singh
- Department of Pediatrics-Pediatric Cardiology and Neonatal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| |
Collapse
|
22
|
Patent ductus arteriosus in preterm infants: is early transcatheter closure a paradigm shift? J Perinatol 2019; 39:1449-1461. [PMID: 31562396 DOI: 10.1038/s41372-019-0506-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Abstract
The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain owing the lack of evidence for long-term benefits and the limited analyses of the complications of medical and surgical interventions to date. In recent years, devices suitable to plug the PDA of premature infants (including extremely low birthweight, <1000 g) have become available and several trials have demonstrated successful and safe transcatheter PDA closure (TCPC) in this population. Whether TCPC represents a paradigm shift in PDA management that will result in improved short- and long-term outcomes, less bronchopulmonary dysplasia, improved neurodevelopment, or better long term renal function remains to be seen. Careful rigorous study of the potential benefits of TCPC in this highly vulnerable population in the context of well-designed adequately powered trials is needed prior to widespread adoption of this approach.
Collapse
|
23
|
A beneficial technique for preventing the device protrusion to the aorta during percutaneous patent ductus arteriosus closure: "Balloon-assisted device releasing technique". Cardiol Young 2019; 29:1380-1386. [PMID: 31502534 DOI: 10.1017/s1047951119002269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion. METHODS One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation. RESULTS There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1. CONCLUSION The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.
Collapse
|
24
|
Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.
Collapse
|
25
|
Almeida-Jones M, Tang NY, Reddy A, Zahn E. Overview of transcatheter patent ductus arteriosus closure in preterm infants. CONGENIT HEART DIS 2019; 14:60-64. [DOI: 10.1111/chd.12712] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Myriam Almeida-Jones
- Guerin Family Congenital Heart Program, Smidt Heart Institute; Los Angeles California
- Department of Pediatrics; Cedars-Sinai Medical Center; Los Angeles California
| | - Nai Yu Tang
- Guerin Family Congenital Heart Program, Smidt Heart Institute; Los Angeles California
- Department of Pediatrics; Cedars-Sinai Medical Center; Los Angeles California
| | - Aneela Reddy
- Department of Pediatrics; University of California Los Angeles; Los Angeles California
| | - Evan Zahn
- Guerin Family Congenital Heart Program, Smidt Heart Institute; Los Angeles California
- Department of Pediatrics; Cedars-Sinai Medical Center; Los Angeles California
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Interventionelle Kinderkardiologie – Entwicklungen, Trends und Grenzen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
28
|
Abstract
The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.
Collapse
Affiliation(s)
- Sok-Leng Kang
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada.,Department of Pediatric Cardiology, Bristol Royal Hospital for Children, Bristol, BS2 OJJ, UK
| | - Lee Benson
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada
| |
Collapse
|
29
|
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.
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
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: 35] [Impact Index Per Article: 5.0] [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.
Collapse
|
32
|
Kang SL, Jivanji S, Mehta C, Tometzki AJ, Derrick G, Yates R, Khambadkone S, de Giovanni J, Stumper O, Dhillon R, Bhole V, Slavik Z, Rigby M, Noonan P, Smith B, Knight B, Richens T, Wilson N, Walsh K, James A, Thomson J, Bentham J, Hayes N, Nazir S, Adwani S, Shauq A, Ramaraj R, Duke C, Taliotis D, Kudumula V, Yong SF, Morgan G, Rosenthal E, Krasemann T, Qureshi S, Crossland D, Hermuzi T, Martin RP. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv 2017; 90:1135-1144. [PMID: 28799706 DOI: 10.1002/ccd.27212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 06/25/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to report our national experience with transcatheter patent ductus arteriosus (PDA) occlusion in infants weighing <6 kg. BACKGROUND The technique of transcatheter PDA closure has evolved in the past two decades and is increasingly used in smaller patients but data on safety and efficacy are limited. METHODS Patients weighing < 6 kg in whom transcatheter PDA occlusion was attempted in 13 tertiary paediatric cardiology units in the United Kingdom and Ireland were retrospectively analyzed to review the outcome and complications. RESULTS A total of 408 patients underwent attempted transcatheter PDA closure between January 2004 and December 2014. The mean weight at catheterization was 4.9 ± 1.0 kg and mean age was 5.7 ± 3.0 months. Successful device implantation was achieved in 374 (92%) patients without major complication and of these, complete occlusion was achieved in 356 (95%) patients at last available follow-up. Device embolization occurred in 20 cases (5%). The incidence of device related obstruction to the left pulmonary artery or aorta and access related peripheral vascular injury were low. There were no deaths related to the procedure. CONCLUSIONS Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.
Collapse
Affiliation(s)
- Sok-Leng Kang
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Salim Jivanji
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Chetan Mehta
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Andrew J Tometzki
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Graham Derrick
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Robert Yates
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Sachin Khambadkone
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Joseph de Giovanni
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Oliver Stumper
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Rami Dhillon
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Vinay Bhole
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Zdenek Slavik
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Michael Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Patrick Noonan
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Ben Smith
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Brodie Knight
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Trevor Richens
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Neil Wilson
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Kevin Walsh
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - Adam James
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - John Thomson
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Jamie Bentham
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Nicholas Hayes
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Sajid Nazir
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Satish Adwani
- Department of Paediatric Cardiology, Oxford University Hospitals, Oxford, England, United Kingdom
| | - Arjamand Shauq
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Ram Ramaraj
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Christopher Duke
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Demetris Taliotis
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Vikram Kudumula
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - San-Fui Yong
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Gareth Morgan
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Eric Rosenthal
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Shakeel Qureshi
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - David Crossland
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Tony Hermuzi
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Robin P Martin
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| |
Collapse
|
33
|
McElhinney DB. Small and preterm infants: The shrinking frontier of transcatheter patent ductus arteriosus closure. Catheter Cardiovasc Interv 2017; 89:1066-1068. [PMID: 28432825 DOI: 10.1002/ccd.27076] [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: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Abstract
Objective: Our hypothesis was that percutaneous PDA closure in babies less than 2 kg was a safe and effective method. The aim of this study is to share our experience in transcatheter PDA closure in infants whose body weight is less than 2 kg in order to support our hypothesis. Methods: Between July 1997 and October 2014, 382 percutaneous PDA closures were done in our center. Nineteen patients who weighed less than 2 kg were included in this retrospectively study. The other inclusion criteria were 1) being symptomatic and PDA was thought as a possible contributor of medical state and 2) persistence of PDA after medical closure treatment. Patients who had sepsis and bleeding diathesis were excluded. According to size and shape of PDA, different types of devices were used such as detachable coils and Amplatzer duct occluders. Data was expressed as mean (SD) or median (minimum–maximum). Comparisons of means and medians were performed with Student’s t-test and with Mann–Whitney U test, respectively. Results: The median patient age and weight were 32 days and 1603 g (range 910–2000 g) respectively. Mean PDA diameter was 3.2±1.3 mm. Morphology of PDA was type A in 7 patients, type C in 10, type E in 1, and type B in 1 patient. There were no reported major complications. Stenosis of left pulmonary artery was detected in four patients, all of which resolved in 6 months follow-up. Conclusion: Percutaneous PDA closure in babies less than 2 kg is a safe and effective method that can be an alternative to surgery. Main distinguishing feature of this study is that it includes the largest cohort of patients less than 2 kg whose PDA closed percutaneously.
Collapse
|
36
|
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).
Collapse
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
| |
Collapse
|