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Shah J, Bhalodiya D, Pravinchandra A, Saraiya S. Safety and efficacy of transcatheter device closure of patent ductus arteriosus in pediatric patients: Long-term outcomes. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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2
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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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P S, Jose J, George OK. Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults. Indian Heart J 2017; 70:308-315. [PMID: 29716712 PMCID: PMC5993916 DOI: 10.1016/j.ihj.2017.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/18/2017] [Accepted: 08/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. Methods This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Results Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. Conclusions In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.
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Affiliation(s)
- Sudhakar P
- Department of Cardiology, Christian Medical College Hospital, Vellore, India.
| | - John Jose
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
| | - Oommen K George
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
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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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5
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Hassine M, Hamdi S, Mlayeh D, Jomaa W, Ben Hamda K, Gamra H, Maatouk F. [Percutaneous closure of persistent ductus arteriosus in low-weight infants]. Arch Pediatr 2016; 24:112-117. [PMID: 27993443 DOI: 10.1016/j.arcped.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg. AIM OF THE STUDY The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children. PATIENTS AND METHODS The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed. RESULTS Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. CONCLUSION This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.
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Affiliation(s)
- M Hassine
- Cardiology A department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie.
| | - S Hamdi
- Cardiology B department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie
| | - D Mlayeh
- Cardiology A department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie
| | - W Jomaa
- Cardiology B department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie
| | - K Ben Hamda
- Cardiology B department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie
| | - H Gamra
- Cardiology A department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie
| | - F Maatouk
- Cardiology B department, university of Monastir, Fattouma Bourguiba university hospital, 5000 Monastir, Tunisie
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Ali S, El Sisi A. Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital. J Saudi Heart Assoc 2016; 28:95-100. [PMID: 27053899 PMCID: PMC4803776 DOI: 10.1016/j.jsha.2015.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/15/2015] [Accepted: 06/17/2015] [Indexed: 11/05/2022] Open
Abstract
Aim To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Methods Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Results Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8–3.5 mm), median weight 8 kg (IQR, 7–10 kg), and median age 10 months (IQR, 8–17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. Conclusion With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.
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Affiliation(s)
- Safaa Ali
- Pediatric Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Amel El Sisi
- Pediatric Department, Faculty of Medicine, Sohag University, Sohag, Egypt
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Parra-Bravo JR, Apolonio-Martínez A, Estrada-Loza MDJ, Beirana-Palencia LG, Ramírez-Portillo CI. [Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:188-94. [PMID: 25700578 DOI: 10.1016/j.acmx.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/06/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. METHODS Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion<40% was considered abnormal. RESULTS The device implantation was successful in all patients. Average perfusion of left lung was 44.7±4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. CONCLUSION The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.
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Affiliation(s)
- José Rafael Parra-Bravo
- Servicio de Cardiología y Hemodinamia, Hospital de Pediatría Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México, Distrito Federal, México.
| | - Adriana Apolonio-Martínez
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México, Distrito Federal, México
| | - María de Jesús Estrada-Loza
- Servicio de Cardiología y Hemodinamia, Hospital de Pediatría Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México, Distrito Federal, México
| | - Luisa Gracia Beirana-Palencia
- Servicio de Cardiología y Hemodinamia, Hospital de Pediatría Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México, Distrito Federal, México
| | - César Iván Ramírez-Portillo
- Servicio de Cardiología y Hemodinamia, Hospital de Pediatría Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México, Distrito Federal, México
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Chen W, Yan X, Huang Y, Sun X, Zhong L, Li J, Chen H, Zhong H, Chen L. Transthoracic echocardiography as an alternative major guidance to angiography during transcatheter closure of patent ductus arteriosus: technical feasibility and clinical relevance. Pediatr Cardiol 2015; 36:14-9. [PMID: 25070385 DOI: 10.1007/s00246-014-0956-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/17/2014] [Indexed: 12/26/2022]
Abstract
The conventional transcatheter closure of patent ductus arteriosus (PDA) requires femoral artery puncture and angiography for duct anatomic and shunting estimation. If such estimation can be replaced by transthoracic echocardiography (TTE), the procedure will be further simplified, with fewer invasions. This study aimed to examine whether TTE can serve as an alternative to aorta angiography and as a major guidance for transcatheter duct closure. The study enrolled 298 consecutive patients (71 males and 227 females) with PDA. In the study, TTE with combined two-dimensional echocardiography (2DE) imaging and color-coded flow imaging (CDFI) was performed to measure the minimal shunting width (MSW) as the estimated minimal duct size for selection of an Amplatzer duct occluder (ADO) and to monitor the transcatheter duct closure intraprocedurally. The MSW was validated against the duct-stretched diameter (SDD), against the minimal waist diameter of the conical part of a released occluder measured by X-ray spot picture after successful duct closure (SDC), and against the size of the finally used ADO (SADO). Good correlation was found between MSW and SDD [SDD (mm) = 1.31 MSW; r = 0.89; p < 0.01] and between MSW and SADO [SADO (mm) = 1.71 MSW; r = 0.88; p < 0.01]. Of 296 patients who received occlusion using MSW as the reference for selection of the occluder, SDC was attained in 288 (97.3%), 5 (1.7%), and 2 (0.7%) patients, respectively, at the first, second (1 ADO replacement), and third (2 ADO replacements) occluding attempt. Acute occluder dislodgement occurred in one patient (0.3%). At the 12-month follow-up assessment, no major complications were found, and the total immediate or 12-month SDC was 99.7%. Echocardiography as an alternative major guidance to angiography for transcatheter duct closure is technically feasible, and TTE guidance can further simplify the procedure, with fewer invasions and potential complications.
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Affiliation(s)
- Wanhua Chen
- Department of Cardiology, The Affiliated Union Hospital, Fujian Medical University, 29 XinQuan Road, Fuzhou, 350001, People's Republic of China
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VIJAYALAKSHMI ISHWARAPPABALEKUNDRI, SETTY NATRAJ, NARASIMHAN CHITRA, SINGLA VIVEK, MANJUNATH CHOLENAHALLINANJAPPA. Percutaneous Device Closure of Patent Ductus Arteriosus with Pulmonary Artery Hypertension: Long-Term Results. J Interv Cardiol 2014; 27:563-9. [PMID: 25490863 DOI: 10.1111/joic.12156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - NATRAJ SETTY
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru; Bangalore Karnataka India
| | - CHITRA NARASIMHAN
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru; Bangalore Karnataka India
| | - VIVEK SINGLA
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru; Bangalore Karnataka India
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Subramanian V, Kavassery Mahadevan K, Sivasubramonian S. Self-repositioning of an embolized patent ductus arteriosus device--a nightmare turned into sweet dreams. Catheter Cardiovasc Interv 2014; 85:1013-6. [PMID: 25381681 DOI: 10.1002/ccd.25725] [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] [Received: 05/18/2014] [Accepted: 11/03/2014] [Indexed: 11/12/2022]
Abstract
A 7-month-old boy was admitted for the device closure of symptomatic patent ductus arteriosus (PDA) with moderate pulmonary hypertension. The PDA measured 4.2 mm with adequate ampulla. It was closed with an 8-6 mm Heart R device from pulmonary artery (PA) end. Post extubation, the device embolized to proximal descending thoracic aorta just distal to PDA ampulla. While attempting to snare from the venous side, the device self-repositioned to PDA. It was stable thereafter and patient was discharged after 2 days. We report a complication, which got self-corrected.
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Affiliation(s)
- Venkateshwaran Subramanian
- Department of cardiology, Sreechitra Tirunal institute for medical sciences and technology, Thiruvananthapuram, Kerala, India
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Parra-Bravo JR, Osuna-Izaguirre MA, Beirana-Palencia L, Gálvez-Cancino F, Martínez-Monterrosas C, Lazo-Cárdenas C, Reyes-Vargas C. [Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:171-6. [PMID: 24998666 DOI: 10.1016/j.acmx.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/29/2013] [Accepted: 09/19/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. OBJECTIVE We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. METHODS We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7kg (range 6-16.3kg). The minimal ductus arteriosus diameter was 2.7mm (1-5mm). RESULTS Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4mm (3 patients), in 2 patients were used 3-4mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. CONCLUSIONS The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I.
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Affiliation(s)
- José Rafael Parra-Bravo
- Servicio de Cardiología, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
| | - Manuel Alfredo Osuna-Izaguirre
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Luisa Beirana-Palencia
- Servicio de Cardiología, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Franco Gálvez-Cancino
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Christian Martínez-Monterrosas
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - César Lazo-Cárdenas
- Servicio de Cardiología, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - César Reyes-Vargas
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
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Abstract
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Although surgery is still required in symptomatic neonates, the majority of older infants and children can undergo safe and effective transcatheter device closure on an out-patient basis. First described in 1967, over the past four decades, numerous devices have been specifically developed for this purpose. This article will review the current status of transcatheter therapy. The experience with each device is detailed and issues and controversies are reviewed.
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Affiliation(s)
- Jennifer M Rutledge
- Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
More than three decades have passed since the introduction of transcatheter devices for closure of patent ductus arteriosus, and many occluders have been made available since then. The ideal requirements of any procedure are a user-friendly technique, optimum success rate, no residual anomaly, minimal morbidity/mortality, and comparability or superiority to the existing conventional modality of treatment. With various advancements in device design, delivery and assisted systems, the tremendous procedural safety and effectiveness, along with low cost and widespread availability of these devices makes transcatheter closure of patent ductus arteriosus a preferred therapeutic modality in all age groups, with decreasing demographic trends of surgical management.
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Affiliation(s)
- R Arora
- Metro Hospital and Heart Institute, G.B. Pant Hospital, New Delhi 110002, India.
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14
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Dean PN, Slack MC. Stent angioplasty to relieve left pulmonary artery obstruction caused by patent ductus arteriosus device occlusion: bipartisan teamwork by two interventional devices. Catheter Cardiovasc Interv 2013; 82:480-4. [PMID: 23359589 DOI: 10.1002/ccd.24840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/21/2013] [Indexed: 11/11/2022]
Abstract
A 7-month-old patient in congestive heart failure due to a moderate sized patent ductus arteriosus (PDA) underwent uncomplicated implantation of an Amplatzer Ductal Occluder (ADO1). Two months after percutaneous device PDA closure, left pulmonary artery (LPA) stenosis was discovered. Rather than spontaneous improvement as reported in previous cases, our patient's LPA stenosis progressed in severity 7 months after ADO1 placement. A catheterization demonstrated a 32 mm Hg peak gradient from her main pulmonary artery to her LPA. She underwent successful stent angioplasty of her LPA with an excellent result and preserved PDA closure. This case demonstrates that stent angioplasty is a feasible an effective method of relieving LPA obstruction caused by a PDA occluder device. Additionally, despite slight deflection by the stent, the ADO1 device continued to provide complete ductal closure. Stent angioplasty should be considered in patients who have LPA stenosis caused by ADO1 occluder device that does not improve over time.
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Affiliation(s)
- Peter N Dean
- Division of Cardiology, Children's National Heart Institute, Children's National Medical Center, Washington, District of Columbia
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Bishnoi RN, Coulson JD, Ringel RE. Recent advances in interventional pediatric cardiology. Adv Pediatr 2013; 60:187-200. [PMID: 24007845 DOI: 10.1016/j.yapd.2013.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ram N Bishnoi
- Department of Pediatric Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children's Center M2309, Baltimore, MD 21287, USA.
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16
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Al-Hamash SM, Wahab HA, Khalid ZH, Nasser IV. Transcatheter closure of patent ductus arteriosus using ado device: retrospective study of 149 patients. Heart Views 2012; 13:1-6. [PMID: 22754633 PMCID: PMC3385190 DOI: 10.4103/1995-705x.96658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Patent ductus arteriosus (PDA) is a common form of congenital heart disease and forms about 5-10% of congenital heart diseases. Surgical closure is safe and effective; however, certain patients may experience some morbidity. Recently, transcatheter closure of PDA using the Amplatzer duct occluder has been shown to be safe and efficacious. Objectives: To evaluate whether transcatheter closure with this device offers an alternative to surgical closure of PDA. Patients and Methods: Between July 2006 to July 2008, 149 patients (98 females and 51 males) with PDA underwent cardiac catheterization in an attempt to close their PDA by transcatheter approach using Amplatzer duct occluder device. Results: The patient's age ranged from 4 months to 45 years (median 5 years). Successful PDA closure was achieved in 136 patients (91.2%) with 100% complete closure rate within 24 hours after the procedure. Thirteen patients (8.7%) had unsuccessful attempts, 11 (7.3%) of them had failure of deployment of the device, while embolization of the device occurred in two of the patients (1.3%). Conclusions: Amplatzer duct occluder device is safe and effective for closure of different types and sizes of PDA with low rate of complication.
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Affiliation(s)
- Sadiq M Al-Hamash
- Department of Pediatric Cardiology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
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17
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VIJAYALAKSHMI IB, CHITRA NARASIMHAN, PRAVEEN JAYAN, PRASANNA SIMHARAO. Challenges in Device Closure of a Large Patent Ductus Arteriosus in Infants Weighing Less Than 6 Kg. J Interv Cardiol 2012; 26:69-76. [DOI: 10.1111/j.1540-8183.2012.00762.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- I. B. VIJAYALAKSHMI
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
| | - NARASIMHAN CHITRA
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
| | - JAYAN PRAVEEN
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
| | - SIMHA RAO PRASANNA
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 492] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kharouf R, Heitschmidt M, Hijazi ZM. Pulmonary perfusion scans following transcatheter patent ductus arteriosus closure using the Amplatzer devices. Catheter Cardiovasc Interv 2011; 77:664-70. [PMID: 21433271 DOI: 10.1002/ccd.22917] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/22/2010] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Obstruction to flow in the left pulmonary artery (LPA) is a well-known complication after transcatheter device closure of patent ductus arteriosus (PDA). This complication has been studied for different devices using lung perfusion radionuclide scintigraphy (LPRS), but not for Amplatzer devices. This study was performed to evaluate the effect of such devices on lung perfusion using LPRS. METHODS This is a retrospective study that looked at all patients who had PDA closure using different Amplatzer devices at our center between July 1999 and January 2007. All patients underwent LPRS within 24 hr of the procedure. We compared LPRS with other hemodynamic data obtained by cardiac catheterization and echocardiography. Results are presented as mean ± SD or median and ranges. RESULTS A total of 70 patients had PDA closure using an Amplatzer device; median age was 1.8 years (4 months to 75 years) and median weight was 12 kg (5-112 Kg). Nine patients had associated cardiac anomalies. Sixty eight patients had available LPRS. The mean percent of left lung perfusion (LLP) was 42.7% (± 6.7%). Excluding patients with pre-existing LPA stenosis, 17% had abnormally decreased LLP. On hemodynamic measurements, 62 patients had available direct pressure measurements following PDA closure. None had significant increase. No correlation was found with echocardiographic data. CONCLUSION PDA closure with Amplatzer family of devices is associated with a relatively significant risk of decreased perfusion to the left lung, mostly mild abnormalities. Comparison with catheterization and echocardiographic measurements showed lack of correlation with LPRS findings.
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Affiliation(s)
- Rami Kharouf
- Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois, USA
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20
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Park YA, Kim NK, Park SJ, Yun BS, Choi JY, Sul JH. Clinical outcome of transcatheter closure of patent ductus arteriosus in small children weighing 10 kg or less. KOREAN JOURNAL OF PEDIATRICS 2010; 53:1012-7. [PMID: 21253316 PMCID: PMC3021727 DOI: 10.3345/kjp.2010.53.12.1012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 10/08/2010] [Accepted: 10/26/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Transcatheter closure has become an effective therapy in most patients with patent ductus arteriosus (PDA). However, there are difficulties in transcatheter closure of PDA in small children. We reviewed clinical outcomes of transcatheter closure of PDA in children weighing less than 10 kg in a single center. METHODS Between January 2003 and December 2009, 314 patients with PDA underwent transcatheter closure in our institute. Among them, 115 weighed less than 10 kg. All of these patients underwent transcatheter closure of PDA using either COOK Detachable Coil®, PFM Nit-Occlud®, or Amplatzer duct occluder®. A retrospective review of the treatment results and complications was performed. RESULTS The mean age of patients was 9.1±5.9 months (median, 8 months), and mean weight was 7.6±1.8 kg (median, 7.8 kg). The mean diameter of PDA was 3.2±1.4 mm (median, 3 mm). Complete occlusion occurred in 113 patients (98%). One patient was sent to surgery because of a failed attempt at device closure, and another patient had a small residual shunt after device placement. The average mean length of hospital stay was 3.0±3.3 days, and mean follow-up duration was 21.0±19.6 months. There were no major complications in any of the patients. CONCLUSION Transcatheter closure of PDA is considered safe and efficacious in infants weighing less than 10 kg. With sufficient experience and further effort, transcatheter closure of PDA can be accepted as the gold standard of treatment for this group of patients.
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Affiliation(s)
- Young A Park
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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21
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Abstract
We report a development of severe haemolysis after complete transcatheter closure of patent arterial duct. Aortography and echocardiography revealed no signs of residual shunt. Haemolysis occurred a day after the implantation. Aortography was performed and the extrusion of coil in aorta was evident. The extruded part of the coil was surgically removed. No signs of haemolysis remained.
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22
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Wang JK, Wu MH, Lin MT, Chiu SN, Chen CA, Chiu HH. Transcatheter Closure of Moderate-to-Large Patent Ductus Arteriosus in Infants Using Amplatzer Duct Occluder. Circ J 2010; 74:361-4. [DOI: 10.1253/circj.cj-09-0473] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Hsin-Hui Chiu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
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23
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Chen Z, Chen L, Wu L. Transcatheter amplatzer occlusion and surgical closure of patent ductus arteriosus: comparison of effectiveness and costs in a low-income country. Pediatr Cardiol 2009; 30:781-5. [PMID: 19365653 DOI: 10.1007/s00246-009-9440-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 03/03/2009] [Accepted: 03/18/2009] [Indexed: 11/26/2022]
Abstract
The goal of this study was to compare the effectiveness and cost of transcatheter Amplatzer occlusion with those of surgical closure for patent ductus arteriosus (PDA) in a low-income country, China. Although transcatheter Amplatzer occlusion for PDA has been increasingly performed, surgical PDA closure is still a routine procedure at many hospitals in China. Therefore, the selection of treatment modality for patients with PDA who could undergo either treatment option is controversial. The treatment of patients with PDA from February 2005 to February 2007 was analyzed retrospectively. A total of 130 patients underwent surgical closure for PDA, whereas 51 patients underwent Amplatzer occlusion. There were no deaths and no residual left-to-right shunting in either group at last follow-up. In total, 2% of patients with complications requiring management underwent Amplatzer device closure and 6.2% surgical closure. The mean hospital stay was 3.6 +/- 1.5 days for the device group and 8.8 +/- 2.3 days for the surgical group (p < 0.001). The cost with surgical closure was 26% less than that with Amplatzer device closure (13,841.2 +/- 3630.3 vs. 18,708.7 +/- 1816.5 Renminbi [Chinese currency]; p < 0.001). In conclusion, although transcatheter Amplatzer device occlusion is as effective as and less invasive than surgical closure for PDA, surgical closure is less costly. In low-income countries such as China, where health-care resources are limited, PDA closure with the Amplatzer duct occluder device is not cost-effective.
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Affiliation(s)
- Zhaoyang Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, 88 Jiaotong Road, Fuzhou, Fujian 350004, China
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24
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Parra-Bravo R, Cruz-Ramírez A, Rebolledo-Pineda V, Robles-Cervantes J, Chávez-Fernández A, Beirana-Palencia L, Jiménez-Montufar L, de Jesús Estrada-Loza M, Estrada-Flores J, Báez-Zamudio N, Escobar-Ponce M. Cierre transcatéter del conducto arterioso persistente con dispositivo de Amplatzer en niños menores de un año. Rev Esp Cardiol 2009; 62:867-74. [DOI: 10.1016/s0300-8932(09)72069-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Accepted: 05/05/2009] [Indexed: 10/18/2022]
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Abadir S, Sarquella-Brugada G, Mivelaz Y, Dahdah N, Miró J. Advances in paediatric interventional cardiology since 2000. Arch Cardiovasc Dis 2009; 102:569-82. [PMID: 19664577 DOI: 10.1016/j.acvd.2009.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 04/09/2009] [Accepted: 04/10/2009] [Indexed: 11/17/2022]
Abstract
Interventional paediatric and congenital cardiology is expanding at a rapid pace. Validated techniques (such as aortic or pulmonary valve dilatations and occlusion of persistent ductus arteriosus and atrial septal defects) are improving thanks to the use of smaller introducers and sheaths, low-profile balloons and novel devices. Moreover, catheter-based interventions have emerged as an attractive alternative to surgery in other fields: pulmonary valve replacement, balloon and stent implantation for native and recurrent coarctation, and percutaneous closure of ventricular septal defects. On the other hand, percutaneous interventions in the paediatric population may be limited by patient size or the anatomy of the defect. Hybrid approaches involving both cardiac interventionists and surgeons are being developed to overcome these limitations. Based on a better understanding of cardiac development, fetal cardiac interventions are being attempted in order to alter the history of severe obstructive lesions. Finally, some interventional procedures still carry a low success rate-for example, pulmonary vein stenosis, even with the use of conventional stents. Biodegradable stents and devices are being developed and may find an application in this setting as well as in others. The purpose of this review is to highlight the advances in paediatric interventional cardiology since the beginning of the third millennium.
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Affiliation(s)
- Sylvia Abadir
- Service de cardiologie pédiatrique, hôpital Sainte-Justine, 3175, chemin de Côte-Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
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Abadir S, Boudjemline Y, Rey C, Petit J, Sassolas F, Acar P, Fraisse A, Dauphin C, Piechaud JF, Chantepie A, Lusson JR. Significant persistent ductus arteriosus in infants less or equal to 6kg: Percutaneous closure or surgery? Arch Cardiovasc Dis 2009; 102:533-40. [DOI: 10.1016/j.acvd.2009.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/03/2009] [Accepted: 04/07/2009] [Indexed: 11/30/2022]
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27
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Lin CC, Hsieh KS, Huang TC, Weng KP. Closure of large patent ductus arteriosus in infants. Am J Cardiol 2009; 103:857-61. [PMID: 19268745 DOI: 10.1016/j.amjcard.2008.11.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 11/20/2008] [Accepted: 11/20/2008] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to evaluate the feasibility, clinical outcome, and resource utilization of transcatheter closure of large, symptomatic patent ductus arteriosus (PDA) in young infants, and compare the results with those of surgery. From January 2003 to December 2006, successful transcatheter implantation of the Amplatzer duct occluder was performed in 20 young infants (< or = 3 months of age) with large PDA who suffered from severe congestive heart failure despite medical treatment. The data was compared with a historical control of 18 young infants who underwent surgical ligation of PDA. Patient ages ranged from 18 to 89 days (mean 51.8) in the study group and 13 to 82 days (mean 39.9) in the control group. Patient weight ranged from 2.7 to 7.1 kg (mean 4.24) in study group and 2.5 to 5.7 kg (mean 3.79) in the control group. Between the 2 groups, there was no significant difference in the rate of complications. Patients who underwent transcatheter closure utilized significantly fewer resources (length of hospital stay and total cost) than those who underwent surgery. In conclusion, percutaneous device occlusion with Amplatzer duct occluder in small, symptomatic infants is feasible and more cost-effective compared with surgery. In experienced hands with careful preprocedural evaluation and delicate manipulation, the safety of transcatheter closure with Amplatzer ductus occluder in this age group can be assured and major complication avoided. Revision of the delivery sheath, making it kink-resistant, and PDA shape-tailored devices should further optimize the procedure.
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Affiliation(s)
- Chu-Chuan Lin
- Department of Pediatrics, Veterans General Hospital, Kaohsiung, Taiwan
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Saliba Z, El-rassi I, Helou D, Abou-Jaoudeh P, Chehab G, Daou L, Khater D, Gerbaka B, Jebara V. Development of catheter-based treatment of patent ductus arteriosus: A medium-sized centre experience. Arch Cardiovasc Dis 2009; 102:111-8. [DOI: 10.1016/j.acvd.2008.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/19/2008] [Accepted: 11/07/2008] [Indexed: 11/15/2022]
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Al-Hamash S, Nasir IV. Novel procedure for treatment of aortic obstruction caused by amplatzer occluder of patent ductus arteriosus. Pediatr Cardiol 2008; 29:782-5. [PMID: 18521655 DOI: 10.1007/s00246-008-9241-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 04/14/2008] [Indexed: 10/22/2022]
Abstract
An 18-month-old boy with patent ductus arteriosus and pulmonary hypertension is reported, in whom deployment of the Amplatzer ductal occluder caused significant aortic obstruction, requiring the inflation of an intraortic balloon against the aortic retention disk of the device as a new procedure to treat such an obstruction. This case emphasizes the need for careful hemodynamic and angiographic assessment of the position of the Amplatzer ductal occluder before and after detaching the device from its delivery system, with particular emphasis on the aortic retention ring and the possibility of interventional management of this complication.
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Affiliation(s)
- Sadiq Al-Hamash
- Department of Pediatric, College of Medicine, University of Baghdad, Baghdad, Iraq.
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30
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SIVAKUMAR KOTHANDAM, FRANCIS EDWIN, KRISHNAN PRASAD. Safety and Feasibility of Transcatheter Closure of Large Patent Ductus Arteriosus Measuring ≥4 mm in Patients Weighing ≤6 kg. J Interv Cardiol 2008; 21:196-203. [DOI: 10.1111/j.1540-8183.2008.00348.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Glatz AC, Petit CJ, Gillespie MJ. Novel use of a modified Amplatzer Vascular Plug® to occlude a patent ductus arteriosus in two patients. Catheter Cardiovasc Interv 2008; 72:82-6. [PMID: 18383167 DOI: 10.1002/ccd.21546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
MESH Headings
- Cardiac Catheterization/instrumentation
- Child, Preschool
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/therapy
- Embolization, Therapeutic/instrumentation
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/therapy
- Male
- Radiography
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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32
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Jeong YH, Yun TJ, Song JM, Park JJ, Seo DM, Koh JK, Lee SW, Kim MJ, Kang DH, Song JK. Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure. Am Heart J 2007; 154:436-40. [PMID: 17719286 DOI: 10.1016/j.ahj.2007.04.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 04/25/2007] [Indexed: 05/16/2023]
Abstract
BACKGROUND Left ventricular (LV) remodeling and predictors of LV systolic function late after closure of patent ductus arteriosus (PDA) in adults remain to be clearly demonstrated. METHODS In 45 patients with PDA, including 28 patients who received successful occlusion using the Amplatzer device (AD group) (AGA, Golden Valley, MN) and 17 patients who received surgical closure (OP group), echocardiography studies were performed before closure and 1 day (AD group) or within 7 days (OP group) after closure, and then were repeated at > or = 6 months (17 +/- 13 months). RESULTS In both groups, LV ejection fraction (EF) and end-diastolic volume index were significantly decreased immediately after closure, whereas end-systolic volume index did not change. During the long-term follow-up period, end-systolic as well as end-diastolic volume indices decreased significantly in both groups and LV EF recovered compared to the immediate postclosure state. However, LV EF remained low compared to the preclosure state. Five patients (11.1%) including 3 patients in the AD group and 2 patients in the OP group showed persistent late LV systolic dysfunction (EF <50%). In stepwise, multiple logistic regression analysis, preclosure EF was the only independent predictor of late normal postclosure EF (odds ratio, 1.230; 95% CI, 1.054-1.434; P = .008). Receiver operating characteristic curve analysis showed that preclosure EF > or = 62% had a sensitivity of 72% and a specificity of 83% for predicting late normal LV EF after closure. CONCLUSIONS Left ventricular EF remains low late after PDA closure compared with preclosure state in adults. Preclosure LV EF is the best index to predict late postclosure LV EF.
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Affiliation(s)
- Young-Hoon Jeong
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Wang JK, Wu MH, Hwang JJ, Chiang FT, Lin MT, Lue HC. Transcatheter closure of moderate to large patent ductus arteriosus with the Amplatzer duct occluder. Catheter Cardiovasc Interv 2007; 69:572-8. [PMID: 17323360 DOI: 10.1002/ccd.20701] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate the acute and follow-up results of transcatheter closure of moderate to large patent ductus arteriosus (PDA) with the Amplatzer duct occluder. METHODS Between April 2000 and June 2005, 237 patients underwent attempted transcatheter closure of PDA, of whom Amplatzer duct occluder was used in 68 patients with moderate-to-large-sized PDA (45 females, with ages ranging from 56 days to 75 years, median 3.3 years). Moderate to large PDA is defined as ductus diameter > or =2.5 mm (> or =3 mm in early phase of this study) in infants and young children, or > or =4 mm in adolescents and adults. The size of device selected was generally at least 1-2 mm larger than ductus diameter. RESULTS The ductus diameter ranged from 2.5 to 8.5 mm (4.1 +/- 1.3 mm). Amplatzer duct occluder was successfully deployed in 66 out of 68 patients. The size of device deployed ranged from 4 to 12 mm (6.3 +/- 1.6 mm). The causes of failure in the 2 patients included calcification of ductus resulting, in failure in advancing a sheath to descending aorta in 1 and kinking of a Cook sheath in the other. Distal embolization of the device occurred several hours later in one. After the device was retrieved percutaneously, the patient was sent to surgery. No other significant complications occurred. In the 3-month follow-up, complete occlusion was achieved in all patients. No patient had left pulmonary artery stenosis. CONCLUSIONS Transcatheter closure of moderate-to-large-sized ductus with Amplatzer ductus occluder is effective and safe.
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Affiliation(s)
- Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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34
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Al-Hamash S. Transcatheter closure of patent ductus arteriosus and interruption of inferior vena cava with azygous continuation using an Amplatzer duct occluder. Pediatr Cardiol 2006; 27:618-20. [PMID: 16933065 DOI: 10.1007/s00246-006-1213-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 03/13/2006] [Indexed: 10/24/2022]
Abstract
Two cases with interrupted inferior vena cava and azygous continuation requiring patent ductus arteriosus (PDA) occlusion per cardiac catheterization are presented. A technique is described enabelmy occlusion of PDA using an Amplatzer ductal occluder despite interruption of inferior vena cava and azygous continuation.
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Affiliation(s)
- Sadiq Al-Hamash
- Department of Paediatrics, College of Medicine, Baghdad University, Ibn Al-Bitar Cardiac Center, Baghdad, Iraq.
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35
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Vijayalakshmi IB, Chitra N, Rajasri R, Vasudevan K. Initial clinical experience in transcatheter closure of large patent arterial ducts in infants using the modified and angled Amplatzler duct occluder. Cardiol Young 2006; 16:378-84. [PMID: 16839430 DOI: 10.1017/s1047951106000394] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2005] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish the feasibility and efficacy of closing large patent arterial duct in infants, using the modified and angled variants of the Amplatzer duct occluder. BACKGROUND Closure of large patent arterial ducts by inserting devices in sick and underweight infants, particularly those weighing around 5 kilograms, remains a challenge. Bigger devices require larger delivery sheaths and may cause obstruction either to the aorta or left pulmonary artery. Negotiating a large device is difficult or impossible, as the sheath gets kinked. Because of these problems, such underweight infants with large ducts who are failing to thrive, and in left ventricular failure with associated lesions, are typically referred for surgery, often leading to higher morbidity and mortality. METHODS We attempted to close such large patent arterial ducts using the new Amplatzer occluder, modified with single layer of polyester, and the angled occluder, with no polyester material, inserted through a specially braided kink-resistant sheath. RESULTS Closure was achieved in 10 infants, with mean age of 8.2 months, mean weight of 5.5 kilograms, the lowest weighing 3.9 kilograms. The mean size of the patent ducts was 6.3 millimetres, with the largest measuring 8.6 millimetres. We implanted 6 modified and 4 angled occluders. In one patient, suffering from hydronephrosis, a 14/12 angled device embolized and was retrieved, but the patient died. In the remaining patients, all ducts were closed completely, with no obstruction to either the aorta or left pulmonary artery. On follow up, all showed excellent clinical improvement. CONCLUSION Complete closure of very large patent arterial ducts is now possible, even in very sick and underweight infants, using the large but low profile custom-made angled or modified versions of the Amplatzer occluder.
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Affiliation(s)
- Ishwarappa B Vijayalakshmi
- Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India.
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Gillor A, Perrey SE, Schnegg C. Soll ein silenter persistierender Ductus arteriosus Botalli verschlossen werden? Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1330-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eerola A, Jokinen E, Boldt T, Pihkala J. The Influence of Percutaneous Closure of Patent Ductus Arteriosus on Left Ventricular Size and Function. J Am Coll Cardiol 2006; 47:1060-6. [PMID: 16516094 DOI: 10.1016/j.jacc.2005.09.067] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 08/23/2005] [Accepted: 10/03/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) hemodynamics. BACKGROUND Today, most PDAs are closed percutaneously. Little is known, however, about hemodynamic changes after the procedure. METHODS Of 37 children (ages 0.6 to 10.6 years) taken to the catheterization laboratory for percutaneous PDA closure, the PDA was closed in 33. Left ventricular diastolic and systolic dimensions, volumes, and function were examined by two-dimensional (2D) and three-dimensional (3D) echocardiography and serum concentrations of natriuretic peptides measured before PDA closure, on the following day, and 6 months thereafter. Control subjects comprised 36 healthy children of comparable ages. RESULTS At baseline, LV diastolic diameter measured >+2 SD in 5 of 33 patients. In 3D echocardiography, a median LV diastolic volume measured 54.0 ml/m2 in the control subjects and 58.4 ml/m2 (p < 0.05) in the PDA group before closure and 57.2 ml/m2 (p = NS) 6 months after closure. A median N-terminal brain natriuretic peptide (pro-BNP) concentration measured 72 ng/l in the control group and 141 ng/l in the PDA group before closure (p = 0.001) and 78.5 ng/l (p = NS) 6 months after closure. Patients differed from control subjects in indices of LV systolic and diastolic function at baseline. By the end of follow-up, all these differences had disappeared. Even in the subgroup of patients with normal-sized LV at baseline, the LV diastolic volume decreased significantly during follow-up. CONCLUSIONS Changes in LV volume and function caused by PDA disappear by 6 months after percutaneous closure. Even the children with normal-sized LV benefit from the procedure.
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Affiliation(s)
- Anneli Eerola
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
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Masura J, Tittel P, Gavora P, Podnar T. Long-term outcome of transcatheter patent ductus arteriosus closure using Amplatzer duct occluders. Am Heart J 2006; 151:755.e7-755.e10. [PMID: 16504649 DOI: 10.1016/j.ahj.2005.12.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Accepted: 12/06/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immediate-, short-, and intermediate-term results of percutaneous patent ductus arteriosus (PDA) closure using Amplatzer duct occluders are excellent. However, long-term results have not yet been reported to date. METHODS Between September 1996 and April 2002, 64 consecutive patients having isolated PDA with minimal diameter of > or =2 mm underwent percutaneous closure using Amplatzer duct occluders. All patients were included in this study and have been followed up until September 2005. RESULTS Patients have been followed up from 40 to 108 months (median 58 months). The mean PDA diameter was 3.5 +/- 1.6 mm. There were no deaths or significant complications during the study period. At a 1-month follow-up, all PDA were completely closed and remained closed thereafter. CONCLUSIONS Since the initial clinical experience in September 1996, the Amplatzer duct occluder has been proven as a safe and effective device for transcatheter PDA closure. Based on our experience, we believe that in patients having completely closed PDA with laminar blood flow pattern in the descending thoracic aorta and left pulmonary artery at a 1-year follow-up, there is no need for further evaluations. In contrast, few remaining patients need a careful follow-up until a complete normalization of all findings.
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Affiliation(s)
- Jozef Masura
- Children's Cardiac Center, University Children's Hospital, Limbova 1, Kramare, 83 340 Bratislava, Slovakia
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Wang JK, Hwang JJ, Chiang FT, Wu MH, Lin MT, Lee WL, Lue HC. A strategic approach to transcatheter closure of patent ductus: Gianturco coils for small-to-moderate ductus and Amplatzer duct occluder for large ductus. Int J Cardiol 2006; 106:10-5. [PMID: 16146660 DOI: 10.1016/j.ijcard.2004.09.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2004] [Revised: 05/28/2004] [Accepted: 09/04/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the effectiveness of the strategy of transcatheter occlusion with the Gianturco coil for small-to-moderate sized ductus and with Amplatzer duct occluder (ADO) for large ductus. PATIENT AND METHODS For ductus closure, the following strategy was applied: ADO was used in large ductus: infants and young children weighing < 15 kg with a ductus diameter > or = 3 mm and in older children or adults with a ductus diameter > or = 4 mm and coils were employed in patients with small-to-moderate sized ductus. During a 3-year period, this strategy was applied in 136 patients. The results were compared between 214 patients (group I) undergoing ductus closure using only coil before application of this strategy and strategic closure in 136 patients (group II). Each group was divided into 2 subgroups: subgroup A with large ductus and subgroup B with small-to-moderate ductus. There were 54 patients in subgroup IA, 160 in subgroup IB, 33 in subgroup IIA and 103 in subgroup IIB, respectively. RESULTS In group I, PDA occlusion was successful in 207 (96.7%) and failed in 7 (6 of group IA and 1 of group IB). In group II, ductus closure was successful in 134 patients (98.5%) (32/33 with ADO and 102/103 with coils). There was no significant difference in success rate between group I and II. Distal embolization occurred in 19 patients of group I and in 2 of group II, respectively (19/214 vs. 2/136, P < 0.01). There was no significant difference in success rate between group IA and IIA but the distal embolization rate was higher in group IA than IIA (13/54 vs. 1/33, P=0.014). Left pulmonary artery stenosis was found exclusively in 9 patients of group I at the 6-month follow-up (P < 0.05). Nine patients in group I required second intervention to achieve complete occlusion. CONCLUSIONS The strategy of ductus closure worked well by reducing embolization rate, incidence of left pulmonary artery stenosis and the need of second intervention.
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Affiliation(s)
- Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan.
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Abstract
Transcatheter closure of patent ductus arteriosus (PDA) was one of the first interventions established in invasive cardiology and is now more than 30 years old. The challenges for successful closure with the first devices in children consisted of handling the rather large introducer sheaths and stiff application systems. Today, interventional closure can be performed with different types of plugs, occluders, and coils. Thus, beyond infancy, transcatheter closure can be successfully performed in almost all cases. Challenging from the technical standpoint can be the closure of window-type ducts, in which excessive protrusion of the device into the descending aorta should be avoided, as well as the closure of tubular ducts, in which secure anchoring of one or more devices in the vessel can be very difficult. For the combination of a coarctation and an open duct, different strategies can be considered. In selected cases, use of a covered stent can be helpful. From the physiological standpoint, open ducts in patients with pulmonary hypertension with or without concomitant congenital heart diseases can be challenging because testing of vasoreactivity with temporarily blocked duct and the option of subsequent treatment with vasodilators may be necessary prior to making the decision whether the patient may benefit from definitive duct occlusion or not. Large ducts in infants less than 8 kg can be difficult to treat due to a relative mismatch of introducers, plugs, or occluders to the small anatomic dimensions. The implantation of multiple coils can be associated with a higher risk of device embolization. Unfortunately, for the large group of preterm infants with very low body weights and large ducts of tubular shape there is currently no standardized interventional therapy available.
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Affiliation(s)
- P Ewert
- Department of Congenital Heart Diseases, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Dugal JS, Jetley V, Sharma JK, Singh C, Mehta M, Sabharwa JS, Sofat S, Bharadwaj P. Techniques in Cardiology : PDA Closure in Children. Med J Armed Forces India 2005; 61:63-5. [PMID: 27407706 DOI: 10.1016/s0377-1237(05)80123-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Accepted: 05/06/2004] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Transcatheter closure of patent ductus arteriosus (PDA) with various devices has been evaluated worldwide and in selected cases can be performed successfully, thus avoiding the morbidity associated with surgical closure. METHODS AND RESULTS A 2 year old female child presented with PDA and aortic angiography showed large PDA (tubular). This defect can be closed nonsurgically by coils and devices. The coil used are normally 0.038" having delivery system called Flipper, but this child had a large PDA and so was closed by thicker coil 0.052" using a coil-Bioptome-sheath system, which is the first reported case from the Armed Forces. CONCLUSIONS We report the initial experience at our center of closure of PDA with a new coil-Bioptome-sheath system.
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Affiliation(s)
- J S Dugal
- Ex-Classified Specialist (Medicine & Cardiology), Military Hospital, Cardio Thoracic Centre, Pune-40
| | - V Jetley
- Classified Specialist (Medicine & Cardiology), Base Hospital Delhi Cantt
| | - J K Sharma
- Ex-Classified Specialist (Medicine & Cardiology), Military Hospital, Cardio Thoracic Centre, Pune-40
| | - Charanjit Singh
- Consultant (Medicine & Cardiology), Military Hospital, Cardio Thoracic Centre, Pune-40
| | - M Mehta
- Classified Specialist (Medicine & Cardiology), Military Hospital, Jalandhar Cantt
| | - J S Sabharwa
- Classified Specialist (Medicine & Cardiology), Command Hospital (Central Command), Lucknow
| | - Sunil Sofat
- Classified Specialist (Medicine), Command Hospital (Northern Command), C/o 56 APO
| | - P Bharadwaj
- Classified Specialist (Medicine), Military Hospital, Cardio Thoracic Centre, Pune-40
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Arora R, Sengupta PP, Thakur AK, Mehta V, Trehan V. Device Closure of Patent Ductus Arteriosus. J Interv Cardiol 2003; 16:385-91. [PMID: 14603796 DOI: 10.1046/j.1540-8183.2003.01005.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ramesh Arora
- Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
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Pfammatter JP, Meier B. Successful repositioning of an Amplatzer duct occluder immediately after inadvertent embolization in the descending aorta. Catheter Cardiovasc Interv 2003; 59:83-5. [PMID: 12720247 DOI: 10.1002/ccd.10504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A case is described of the inadvertent embolization of an Amplatzer duct occluder in the descending aorta in a 10-year-old girl. It was possible to snare the device and bring it in its normal position in the aortic ductus ampulla. With a second snare, the recessed screw of the device could be caught and the device was successfully pulled back into the ductus.
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Affiliation(s)
- Jean-Pierre Pfammatter
- Department of Pediatric Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.
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Masura J, Gavora P, Podnar T. Transcatheter occlusion of patent ductus arteriosus using a new angled Amplatzer duct occluder: initial clinical experience. Catheter Cardiovasc Interv 2003; 58:261-7. [PMID: 12552553 DOI: 10.1002/ccd.10413] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the present study, we report the initial clinical experience with the new angled Amplatzer duct occluder (ADO) for the percutaneous closure of patent ductus arteriosus (PDA). Percutaneous closure of PDA using standard ADO in infants and in patients with small PDA ampulla is difficult, or even impossible, due to protrusion of the aortic disk into the descending thoracic aorta. The aortic disk of an angled ADO is angled at 32 degrees to the body of the device and concave toward the aorta to prevent protrusion of the disk into the aorta. Percutaneous closure of PDA was attempted in nine patients with a median age of 5.2 years (range, 0.5-12.7) and median weight of 20 kg (range, 4.9-55). Selection of the occluder and the implantation technique were similar to the standard ADO. The minimal PDA diameter ranged from 2.1 to 3.7 mm (median, 2.5 mm). Occluders were successfully implanted in all patients. Immediate complete PDA closure was achieved in all patients. There were no complications. The new angled ADO is a safe and effective device for PDA closure, particularly suitable for infants and patients with small PDA ampulla. Further studies and long-term follow-up are necessary to confirm our initial experience.
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Affiliation(s)
- Jozef Masura
- Children's Cardiac Center, University Children's Hospital, Bratislava, Slovakia
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Forbes TJ, Harahsheh A, Rodriguez-Cruz E, Morrow WR, Thomas R, Turner D, Vincent JA. Angiographic and hemodynamic predictors for successful outcome of transcatheter occlusion of patent ductus arteriosus in infants less than 8 kilograms. Catheter Cardiovasc Interv 2003; 61:117-22. [PMID: 14696170 DOI: 10.1002/ccd.10751] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transcatheter occlusion of patent ductus arteriosus (PDA) using Gianturco coils (GCs) has been performed for the past decade. However, little has been written regarding anatomical and hemodynamic predictors for successful occlusion of the PDA in infants. This report is to evaluate the outcome of transcatheter occlusion of PDA in symptomatic infants less than 8 kg and to assess predictors of successful occlusion. Retrospective review of catheterization charts and cineangiograms of 42 symptomatic infants who underwent cardiac catheterization for attempted transcatheter occlusion of their PDA was conducted. The hemodynamic and angiographic data evaluated included the length/diameter (L/D) ratio, defined as the length divided by the narrowest diameter of the ductus arteriosus, and preocclusion pulmonary artery pressures. Thirty-one out of 42 patients (74%) had successful occlusion. Twenty-nine out of 42 infants had an L/D ratio > 3. Of these, 26 (90%) had successful occlusion of their PDA. Thirteen out of 42 patients had an L/D ratio < or = 3. Of these, 8 (62%) had unsuccessful occlusion. Complications encountered were transient loss of femoral arterial pulse (n = 6), coil embolization (n = 5), hemolysis (n = 2), and mild left pulmonary artery obstruction (n = 2). No permanent loss of femoral arterial pulse was noted. These complications resulted in no mortality and minimal morbidity. The L/D ratio was the strongest predictor of successful outcome, with an L/D ratio greater than 3.0 being more amenable to transcatheter occlusion (odds ratio of 4.6). Other predictors for success included lower preocclusion systolic, diastolic, and mean pulmonary artery pressure and smaller ductal diameter. Our conclusion was that infants less than 8 kg with an L/D ratio > 3.0 can safely and successfully undergo transcatheter occlusion of their PDA using transcatheter coils.
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Affiliation(s)
- Thomas J Forbes
- Department of Cardiology at Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
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Fernández Ruiz A, del Cerro Marín MJ, Rubio Vidal D, Castro Gussoni MC, Moreno Granados F. [Transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder: initial results and mid-term follow-up]. Rev Esp Cardiol 2002; 55:1057-62. [PMID: 12383391 DOI: 10.1016/s0300-8932(02)76756-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter closure of patent ductus arteriosus is a well-established procedure. The aim of this study was to assess the initial and mid-term results of the treatment of PDA with the Amplatzer duct occluder. PATIENTS AND METHODS From October 1999 to December 2001, 30 children underwent transcatheter closure of persistent ductus arteriosus at a mean SD age of 5 4.02 years (range: 3 months to 14 years) and weight of 20.3 10.3 kg (range: 4.5-45 kg). Infants under 10 kg weight made up 46% of total patients. A lateral view aortogram was made to determine the morphology of the ductus and select the size of the device. Occlusion was achieved using the anterograde venous approach. Follow-up evaluations were made with chest X-ray and echocardiogram at 24 hours and 1, 4 and 12 months after implantation. RESULTS Twenty-eight patients (93.3%) immediately achieved complete occlusion, and on color Doppler examination the closure rate was 100% within 24 hours of implantation. There was no device embolization. In the follow-up, a 19-month-old patient developed a 20 mmHg gradient across the aortic arch. CONCLUSIONS Patent ductus arteriosus can be easily occluded with the Amplatz Duct Occluder, which is effective and particularly useful in infants and children with relatively large PDA. Further experience and long-term follow-up are still needed to assess the safety of this device in smaller children.
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Ewert P, Kretschmar O, Nuernberg JH, Nagdyman N, Lange PE. First closure of a large patent ductus arteriosus in an infant with an angulated nitinol plug. Catheter Cardiovasc Interv 2002; 57:88-91. [PMID: 12203937 DOI: 10.1002/ccd.10270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the first human implantation of an angulated plug in a 5 mm PDA in a child of 11 kg. Implanted through a 5 Fr sheath, the plug showed excellent anatomical alignment. Complete occlusion was documented after 6 hr. This device will extend the limits for interventional closure of PDA.
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Affiliation(s)
- Peter Ewert
- Abteilung für angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
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