Percutaneous closure of persistent ductus arteriosus in small weight infants

Abstract

The persistent ductus arteriosus remains a common congenital pathology. If percutaneous closure of wide channels by Amplatzer duct occluder is an attractive alternative to the surgical treatment, this prosthesis is however not recommended for infants less than 6 kg. Our objective was to evaluate the efficacy and the safety of use of this prosthesis in low-weight children. The records of children less than 6 kg who underwent closure by the Amplatzer Duct Occluder prosthesis between January 2010 and December 2015 were retrospectively analyzed. Fourteen patients [mean weight 5.7 kg (4.8 to 6); mean age 6.5 months (3–12)] have been included. The average diameter angiographic persistent ductus arteriosus was 3.5 mm (3–6 mm) with a good correlation with that found on ultrasound ( r = 0.68). The prosthesis was implanted successfully in 92.8% of cases. The immediate angiographic occlusion rate was 71.4%. The average duration of the procedure was 46 ± 12 min. Three children had a type of channel C of the classification Krichenko. Two complications occurred in two of our patients. Persistent ductus arteriosus C-type (tubular) and a diameter ratio of the persistent ductus arteriosus/weight of higher child 0.95 were significantly associated with a failure of intervention and/or major complications throughout the percutaneous closure of register having included 67 patients, while a weight of less than 6 kg was not retained as a predictor of failure of the procedure. No late embolisation occurred after 11 months of median follow up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. Our study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants less or equal to 6 kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.