Treatment Options for Pediatric Patent Ductus Arteriosus

Lam, Jennifer; Lopushinsky, Steven R.; W.Y., Irene; Dicke, Frank; Brindle, Mary

doi:10.1378/chest.14-2997

Cited by 23 publications

(20 citation statements)

References 34 publications

(73 reference statements)

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“…The mortality rate for transcatheter PDA occlusion is nearly zero (0-0.9%). Procedure-related major and minor complications are rare, ranging 0-9.1% and 0-16.2%, respectively [17][18][19][20][21][22][23][24][25][26][27]. Similarly, our results showed zero mortality rate and the equal occurrence of major and minor complications (4.2%).…”

Section: Discussionsupporting

confidence: 77%

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

et al. 2017

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Introduction/Objective Transcatheter closure is a well-established procedure for treatment of patent ductus arteriosus (PDA). We aimed to make a comparison between transcatheter PDA occlusion with Flipper coil and Amplatzer Duct Occluder (ADO) and to determine the incidence and significance of procedural complications. Methods Between November 2004 and October 2014, 148 patients were eligible for transcatheter PDA closure at the University Children's Hospital in Belgrade, Serbia. The median age was 5.9 years (the range of 0.9 years to 17.3 years) and the median weight was 21 kg (the range of 8.8 kg to 94 kg). Follow-up evaluations with Doppler echocardiogram were performed at one day, three months, and one and two years after the PDA occlusion. Results Median narrowest PDA diameter was 1.5 mm (the range of 0.5 mm to 5.6 mm). Flipper coil was used for PDA closure in 84 (59.2%) and ADO in 58 patients (40.8%). There was no significant difference in the rate of immediate complete closure between the coil and the ADO group (86.9% vs. 75.9%, p = 0.089), but a significantly higher rate of complete closure was achieved with ADO at one day (83.3% vs. 98.3%, p = 0.004), three months (85.7% vs. 100%, p = 0.002), and both one and two years after the implantation (91.7% vs. 100%, p = 0.041). In total, 12 complications occurred during the procedure, seven of which with coil and five with ADO occlusion of PDA. Conclusion Transcatheter closure of PDA using both coils and ADOs is a very safe and effective procedure. ADO proved superior to coil in terms of complete closure rate as early as one day after the procedure.

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Section: Discussionsupporting

confidence: 77%

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

et al. 2017

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“…Our review of the available evidence suggests that the quantity of data addressing the superiority of percutaneous PDA closure over surgical ligation during infancy is insufficient. This is unfortunate, in view of the increasing numbers of percutaneous closures being performed during infancy . Based on the paucity of available data, health care providers must be careful not to trade the known risks of surgical PDA ligation for the lesser known risks of percutaneous PDA closure without obtaining and examining the necessary evidence base.…”

Section: Percutaneous Closure Vs Surgical Pda Ligationmentioning

confidence: 99%

“…Among older, more mature patients, percutaneous closure offers several potential benefits over surgical PDA ligation, including fewer complications, shorter recovery times, and lower health care expenditures. 15 However, procedures performed during infancy are more complex than are those performed during childhood or adulthood; thus, separate considerations of the potential risks and benefits in this at-risk subgroup are needed. 16 To examine the available evidence base comparing percutaneous closure vs surgical ligation during infancy, we conducted a literature search using PubMed/Medline database.…”

Section: Percutaneous Closure Vs Surg I C Al Pda Li G Ati Onmentioning

confidence: 99%

“…This is unfortunate, in view of the increasing numbers of percutaneous closures being performed during infancy. 13,[15][16][17][18] Based on the paucity of available data, health care providers must be careful not to trade the known risks of surgical PDA ligation for the lesser known risks of percutaneous PDA closure without obtaining and examining the necessary evidence base.…”

Section: Percutaneous Closure Vs Surg I C Al Pda Li G Ati Onmentioning

confidence: 99%

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Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

Mitchell

Rivera

Cooper

et al. 2019

Congenital Heart Disease

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The optimal treatment method for infants with a patent ductus arteriosus (PDA) necessitating closure remains a subject of controversy and debate. While the risks associated with surgical PDA ligation are well described, the available evidence base for alternative management strategies during infancy, including percutaneous closure or conservative (nonintervention) management, are not well explored. Among infants, the goals of this review are to: (a) use rigorous systematic review methodology to assess the quality and quantity of published reports on percutaneous closure vs surgical ligation; (b) compare outcomes of percutaneous closure vs conservative management; and (c) based on recommendations from the International PDA symposium, to elucidate needs and opportunities for future research and interdisciplinary collaboration. The available evidence base, as well as on broad consensus reached at the International PDA Symposium, suggests that a contemporary, pragmatic clinical trial comparing PDA treatment strategies is warranted. Additionally, quality assurance safeguards are necessary in the implementation of newer PDA closure devices. Finally, to determine best approaches to treatment for infants with PDA, tools for consistent data collection and reporting across centers and disciplines are needed to minimize heterogeneity and permit pooled analysis.

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“…Indications for patent ductus arteriosus closure were similar to those recommended in the guidelines. 11,[16][17][18][19] Detailed physical examination, basic blood analysis tests, an electrocardiogram, and echocardiographic examination were performed in all patients prior to the procedure. A pre-procedural echocardiogram was concentrated on the size of the defect, colour, and spectral Doppler characteristics of the shunt through the duct, cardiac chambers, associated lesions, and the haemodynamic importance of the patent ductus arteriosus.…”

mentioning

confidence: 99%

Preliminary results of the Ceraflex^TM PDA occluder and device behaviour during releasing

et al. 2019

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Introduction:The CeraFlexTM PDA occluder is a new flexible device with a unique delivery system that may be beneficial with regard to not changing the device position after releasing. We prospectively evaluate the efficacy of the device and also the device behaviour patterns during release.Methods:The study included 21 patients. Their median age was 1.2 years (from 6 months to 28 years) and weight was 9.6 kg (from 5.4 to 82 kg). All of the ducts were conical except one atypical ductus. Median ductal diameter at the pulmonary end was 3.8 mm (from 2.2 to 8.2 mm). The ductus was closed using an antegrade approach, but special attention was paid to the patterns of device behaviour during and just after releasing.Results:Three different modes of device behaviour were observed during and just after releasing: (1) Neither difficulty nor change of position in 13 patients (62%), (2) a little difficulty in releasing but no change of position in 6 (29%), and (3) change of the device position in 2 (9%). There was no residual shunt on the next day except in one patient, in whom late device embolisation occurred. The device was retrieved and another, bigger device implanted.Conclusion:The CeraFlexTM PDA occlude device seems to be safe and efficacious for patent ductus arteriosus closure. Its unique delivery system generally fixes the device in a stable position that does not change after release (91%). Minor difficulty in releasing is not uncommon; however, the major disadvantage is the need for larger sheaths for delivery.

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Treatment Options for Pediatric Patent Ductus Arteriosus

Cited by 23 publications

References 34 publications

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

Preliminary results of the Ceraflex^TM PDA occluder and device behaviour during releasing

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Treatment Options for Pediatric Patent Ductus Arteriosus

Cited by 23 publications

References 34 publications

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

Preliminary results of the CeraflexTM PDA occluder and device behaviour during releasing

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Preliminary results of the Ceraflex^TM PDA occluder and device behaviour during releasing