325 Percutaneous closure of the patent ductus arteriosus with the Amplatzer duct occluder in infants weighing ≤ 6 kg

Abstract

Percutaneous closure of patent ductus arteriosus (PDA) using the Amplatzer duct occluder (ADO) is an effective and a true alternative to surgical closure. However, closure of PDA in infants with a low weight remains challenging for the interventionist. From April 1999 to February 2009, 203 patients underwent percutaneous PDA closure. We focus here on the 17 infants weighing ≤ 6 kg and in whom duct was closed using the ADO. All patients were symptomatic: failure to thrive, dyspnoea, and frequent respiratory infections. There were 15 females and 2 males. At implantation, the mean age was 5.1 ± 4 months, and the mean weight was 4.6 ± 0.9 (range 2.8 to 6 kg). The procedure was realized under local anaesthesia (n = 14) and general anaesthesia (n = 3). In 5 of the 17 pts, implantation was performed from a sole venous femoral access without arterial puncture and device release was controlled by transthoracic echocardiography. Size of the duct was 3.6 ± 1.3 mm (range 1.7 to 6 mm) and systolic pulmonary artery pressure was 54 ± 19 mm Hg (range 26 to 96 mm Hg). Implantation succeeded in all but one without any adverse event. Closure was performed by six 5/4 mm ADO, five 6/4 mm ADO, five 8/6 mm ADO, and one 10/8 mm ADO. One patient with failed procedure underwent subsequently surgical closure of the duct. During follow-up (0 to 58 months), Doppler echocardiography showed decrease in ductal shunting: complete occlusion was noticed in 5 pts at day one, 10 pts at one month, 14 pts at 3 months, and 16 pts at one year after implantation. No patient but one had persistent pulmonary hypertension and only one had a moderate stenosis on the left pulmonary artery due to device protrusion. One patient died 15 months after implantation from a non related device cause. In skilled hands, percutaneous closure of large PDA in symptomatic infants weighing ≤ 6 kg is safe and effective. Such procedure can solve clinical problems and offer a real alternative to the classic surgical correction.