Influence of Ductal Size on the Results of Transcatheter Closure of Patent Ductus Arteriosus with Coils

Abstract

SUMMARYTo assess the influence of ductal size on the results of transcatheter closure of patent ductus arteriosus (PDA) with coils, 154 consecutive patients were studied prospectively. Ductal size was defined as the narrowest diameter of ductus measured on aortography. All patients were divided into 5 groups according to ductal size: < 1 mm, 1-1.9 mm, 2-2.9 mm, 3-3.9 mm, and ≥ 4 mm. The occlusion of PDA with coils was performed through a transarterial approach. The results were evaluated by angiography at 10 minutes and by color Doppler echocardiography at 1 day, 2 days, 1 week, 1 month, 3 months, 6 months, and 12 months after the procedure. The immediate occlusion rates for ductal sizes < 1 mm, 1-1.9 mm, 2-2.9 mm, 3-3.9 mm, and ≥ 4 mm were 89.7%, 75.4%, 51.4%, 30.8%, and 40%, respectively; whereas the occlusion rates at 12-months follow-up were 100%, 98.5%, 97.3%, 69.2%, and 80%, respectively. There were no significant differences in occlusion rate at 12-months follow-up among the groups with ductal sizes < 3 mm or among the groups with ductal sizes ≥3 mm. The occlusion rate for ductal size < 3 mm at each follow-up time was significantly higher than that for ductal size ≥ 3 mm (10 minutes: 71.8% vs 34.8%, P = 0.001; 12-months: 98.5% vs 73.9%, P < 0.001). The occlusion rate of residual shuntings at 12-months follow-up for ductal size < 3 mm was also significantly higher than that for ductal size ≥ 3 mm (94.6% vs 60%, P = 0.007). The results of the present study demonstrate that ductal size < 3 mm had a higher occlusion rate than that for a size ≥ 3 mm. PDA with a size ≥ 3 mm may need other treatment strategies or other devices to achieve better results. (Jpn Heart J 2003; 44: 395-401)

Treatment Options for Pediatric Patent Ductus Arteriosus

“…Th e success of PDA closure via catheter-based intervention is associated with PDA size and morphology. 27,28 Larger PDAs oft en require more coils or alternative devices; subsequently, it is more diffi cult to achieve complete closure. Many studies in this review did not include information on the size or morphology of the PDA, nor was consistent information provided in terms of the number of devices used or the decision-making around device selection.…”

Transcatheter Closure of Patent Ductus Arteriosus: Experience with a New Device

“…1,6,7 At present coils and standard ADO have proved safety and effectiveness in closing small, and moderate to large ducts respectively. 1,2,3,4,5 In small PDA closure (diameter <2.5 mm) coils have the advantage of small catheter size (5 Fr), short fluoroscopic time and low cost. However, for moderate to large ducts closure multiple coils are necessary, with a significant rate of residual shunt and occasionally coil embolization.…”

“…Detachable coils are widely used to close small ducts, while the Amplatzer duct occluder (ADO) is generally employed for moderate or large ducts. 1,2,3,4,5 A new device for ductal closure, the Amplatzer Duct Occluder II (ADO II, AGA Medical Corporation), has recently received the European Community mark approval. It is made of nitinol flexible mesh, fabric free with a symmetrical design, and three articulated mesh lobes.…”

Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

“…In our institution, the decision to close via catheterisation or surgical closure is based on ductal anatomyif short and broad, we elect to proceed via the latter, based on American Heart Association (AHA) recommendations and investigations which have demonstrated worse outcomes in large ductuses. 17,18 In our study, we observed that nine patients (six thoracoscopy and three thoracotomy) had previously failed attempts at transcatheter device closure, some due to large ductal size and others due to aortopulmonary window-like anatomy. A head-to-head comparison of thoracoscopy and catheter occlusion was outside the scope of this investigation, but in light of ongoing debate regarding outcomes such as efficacy, complication rates, and resource utilisation, future work should seek to undertake this direct comparison.…”