Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

Trans-Catheter Closure of Patent Ductus Arteriosus, which device should we use?

Despite the operational experience in the percutaneous closure of Patent ductus arteriosus (PDA), complications can arise during the procedure. To overcome these complications the choice of the device must be adapted to each patient.

AIM

To report the experience of the cardiology department in the transcatheter device closure of PDA and to determine the influencing factors of choice of the device.

METHODS

Our study included patients with patent ductus arteriosus that are admitted for transcatheter closure, between September 2003 and June 2016.

RESULT

One hundred and fifty-three patients were included in our study. Transcatheter closure was not done in 9 cases. The transcatheter closure was successful in 140 patients. The complications were observed in 11 patients that includes device embolization in 3 cases, aortic protrusion in four cases pulmonary protrusion in three cases and inguinal hematoma in one another. Three predictive factors of complications were: age < 2 years, tubular PDA type C and ratio duct diameter/weight > 0.95. A mild residual shunt was observed at the end of the procedure in 22.85 % of the patients. The risk of residual shunt was significantly increased when the age < 2 years, the large PDA, the presence of pulmonary hypertension and the tubular C PDA.

CONCLUSION

The choice of the device depends essentially on age, the weight and the duct anatomy.

Acute ascending aortic dissection due to transcatheter patent ductus arteriosus closure in the elderly: An extremely rare complication of transcatheter patent ductus arteriosus closure

It is well known that patent ductus arteriosus (PDA) in adults, especially in the elderly, differs from that in pediatric patients. A 68-year-old woman with a PDA with focal calcification at the aortic orifice of the ampulla with a minimum diameter of 4.0 mm and length of 14.8 mm, was treated with a 10/8-mm Amplatzer duct occluder (ADO) (St. Jude Medical Corp, St. Paul, MN, USA). After device implantation, systolic blood pressure (BP) increased to approximately 220 mmHg from 130 mmHg. She experienced transient dyspnea from hypertensive heart failure, which improved through continuous infusion of anti-hypertensive agents. She suddenly felt pressure on her chest 12 h post-procedure and collapsed. Surgical thoracotomy revealed an ascending aortic dissection into the pericardial space. In retrospective review, the ADO may have been slightly deformed by fluoroscopy. The complication may have been triggered by the resilience caused by device deformation, damage to the aortic wall due to the aortic side of the device, uneven elasticity of the arterial wall, and uncontrolled excessively high blood pressure. <Learning objective: Although transcatheter patent ductus arteriosus (PDA) closure is an established, safe, and effective procedure when treating PDA of the elderly, wall damage due to the device may occur because of atherosclerotic changes different from that of younger patients and blood pressure will rise after closure. Therefore, it is necessary to carefully select the type and size of the device and to strictly control blood pressure in patients with a history of hypertension.>.

Transcatheter closure through single venous approach for young children with patent ductus arteriosus: A retrospective study of 686 cases

The objective is to explore the feasibility and safety of transcatheter closure of patent ductus arteriosus (PDA) through single venous approach in Chinese young children.A total of 1088 patients aged between 9 months old to 3 years old who underwent transcatheter closure of PDA from May 2004 to May 2015 were retrospectively reviewed. All the procedures were under ultrasound monitoring. The shape and size of PDA as well as immediate therapeutic results were recorded by angiography and ultrasonography. The size of occluder was individually selected according to the smallest diameter of the PDAs. Echocardiography was respectively performed 3 days, 1month, 6 months, and 12 months after the procedure to evaluate the outcomes.Among the total 1088 children, transcatheter closure of PDA was accomplished through single venous approach that was performed in 686 cases. The average weight and age of the children were 10.9 ± 3.6 kg (5.0-14.3 kg) and 1.8 ± 1.6 years (9 months-3 years), respectively. The fluoroscopic time was about 5.1 to 11.6 minutes. Successful device placement with the initially selected occluder was achieved in 662 cases. In other 14 cases, the procedure was eventually completed after being replaced with a larger occluder; while in the other 10 cases, smaller occluders were applied to replace the initial ones. Technically, all the procedures were successfully performed. All the patients were followed up for 15.6 ± 8.2 years. No serious complications and death were observed during the follow-up.Transcatheter closure of PDA with occluder by single venous approach is an effective and reliable method in vast majority of young children.

Outcomes Associated with the Off-label Use of Medical Devices in Congenital Heart Disease at a Single Institute

Background and Objectives

While the off-label use of implantable medical devices for treating congenital heart disease is not uncommon, the present conditions and outcomes of their off-label use have rarely been described. Therefore, this study evaluated the prevalence and results of using implantable devices off-label to treat congenital heart disease at a single institute.

Subjects and Methods

This was a retrospective study based on the medical records of catheter-based interventions for congenital heart disease performed from July 1, 1995 to June 1, 2015. The inclusion criterion was the off-label use of an implantable device. Patient demographic data, procedural success, and follow-up status regarding late complications were investigated, and the results of the off-label use of each device were compared.

Results

Off-label use occurred in 144 of 1730 interventions with device implantation, accounting for 8.3% of the interventions. The median patient age and mean body weight were 51.0 months and 16.3 kg, respectively. Immediate and late failures were found in 9 cases, and 3 cases of mortality were not directly related to the devices used. The overall success rate was 93.8%. There were no long-term complications of the off-label use of occlusion devices. No procedural failures resulted from stent implantation, but one case of stent malposition and two cases of stent fracture were identified after procedure completion.

Conclusion

In general, the off-label use of implantable devices for treating congenital heart disease is safe and effective.

Closure of Tubular Patent Ductus Arteriosus With the Amplatzer Vascular Plug IV

Background:

Closure of tubular patent ductus arteriosus remains a challenging procedure. Anecdotal use of Amplatzer Vascular Plug IV for tubular ductus closure has been reported but feasibility and safety in a consecutive patients’ series remain unknown.

Methods:

We performed a monocenter prospective study at the Marie Lannelongue Hospital in Paris, France. From 2009 to 2014, a total of 47 patients (39 infants, 3 children, and 5 adults) underwent ductus closure with the Plug IV.

Results:

Ductus morphology was a type E in 34 (72.3%) patients and a type C in 13 (27.7%) patients. Ductus closure occurred in 39 (83.0%) infants at a median age of seven months (range: 3-23 months) and a median weight of 6.9 kg (range: 4.1-17.0 kg). A past history of prematurity and very low birth weight was found in 33 (70.2%) of them. Twelve (25.5%) patients had pulmonary hypertension. Mean Plug IV diameter was 1.9 ± 0.1 mm larger than the mean maximal ductus diameter. Early complete closure of the ductus was obtained in all patients. Early migration of an undersized Plug IV occurred in one (2.1%) patient and was suitable for percutaneous device retrieval. After a mean follow-up of 3.4 ± 1.4 years, all patients are alive and asymptomatic, no late complication occurred.

Conclusion:

Transcatheter closure of tubular ductus with the Amplatzer Vascular Plug IV can be safe and effective, with a 100% early occlusion rate. This device, suitable for a 4F sheath, is a new alternative for tubular ductus closure in low-body-weight infants.