Amplatzer Angled Duct Occluder for Closure of Patent Ductus Arteriosus Larger than the Aorta in an Infant

Background and Objectives:Initial experience with transcatheter closure of patent ductus arteriosus (PDA) using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures.Methods:From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure.Results:Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period.Conclusion:Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

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“…A specially designed device is recently used to reduce the incidence of device protrusion into the aorta. [24]…”

Section: Discussionmentioning

confidence: 99%

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

2009

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“…2,5,18 Sheath kink at acute turns of the right ventricular outflow tract may hinder device deployment. 7 So most institutions prefer surgery in infants weighing less than 5-6 kg. 3,4 Two reports had shown feasibility of transcatheter closure of ducts in patients weighing less than 5-6 kg.…”

Section: Discussionmentioning

confidence: 99%

“…2 An experimental model of angled duct occluder to avoid aortic encroachment of the device was reported in two reports on two infants weighing 4.9 kg and 5 kg. 7,25 However, these devices were not approved and available for routine use.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Concerns in catheter approach in these small infants include fear of pulmonary and aortic encroachment by a large device, need for large delivery sheaths, and kinking of sheath in the acute turn of the right ventricular outflow tract. [5][6][7] SAFETY AND FEASIBILITY OF TRANSCATHETER CLOSURE OF LARGE PATENT DUCTUS ARTERIOSUS views using high-frequency transducer. The ductal and aortic isthmic dimensions were accurately measured on B-mode echocardiogram (Fig.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Feasibility of Transcatheter Closure of Large Patent Ductus Arteriosus Measuring ≥4 mm in Patients Weighing ≤6 kg

Sivakumar¹,

Francis²,

Krishnan³

2008

J Interven Cardiology

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“…Although the encroachment of the device on the origin of the left pulmonary artery is of little concern with regard to the redistribution of blood flow, and is expected to lose its significance with subsequent somatic growth, careful follow-up with echocardiogram is necessary, especially in infants. In order to avoid complications such as aortic narrowing in infants with large PDA, the subsequent development of a modified ADO retention disk will also be necessary (22, 23). …”

Section: Discussionmentioning

confidence: 99%

Complications after Transcatheter Closure of Patent Ductus Arteriosus

et al. 2007

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To evaluate the short- and mid-term results and complications ensuing the transcatheter closure of patent ductus arteriosus (PDA). Between October 1999 and December 2005, 117 patients (34 males and 83 females) underwent attempted percutaneous closure of PDA with a minimum diameter of more than 3 mm. Follow-up evaluations were conducted at 1 day and 1, 3, 6, 12 months after the performance of the transcatheter closure. The median age of patients at catheterization was 11 yr (range, 0.6 to 68 yr), median weight was 30 kg (range, 6 to 74 kg), and the median diameter of PDA was 4 mm (range, 3 to 8 mm). This procedure was conducted successfully in 114 patients (97.4%), using different devices. Major complications were detected in 4 patients (3.4%); significant hemolysis (2), infective endocarditis (1), failed procedure due to embolization (1). Minor complications occurred in 6 patients (5.1%); mild narrowing of the descending aorta (2) and mild encroachment on the origin of the left pulmonary artery (4). Although the transcatheter closure of PDA may be considered to be effective, several complications, including hemolysis, embolization, infective endocarditis, and the narrowing of adjacent vessels may occur in certain cases.

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Amplatzer Angled Duct Occluder for Closure of Patent Ductus Arteriosus Larger than the Aorta in an Infant

Cited by 9 publications

References 2 publications

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

Safety and Feasibility of Transcatheter Closure of Large Patent Ductus Arteriosus Measuring ≥4 mm in Patients Weighing ≤6 kg

Complications after Transcatheter Closure of Patent Ductus Arteriosus

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