Transcatheter Closure Of Patent Ductus Arteriosus Research Articles

Time period after transcatheter PDA closure with changes in left ventricular function and nutritional status

Background Few studies perform follow ups on patent ductus arteriosus (PDA) patients who undergo transcatheter closure. In addition to side effects from the procedure, it is important to evaluate changes in left ventricular function (LVF) parameters and nutritional status.
 Objective To compare LVF and nutritional status before and during the one-year period post-transcatheter PDA closure, and evaluate potential associated factors in post-closure PDA transcatheter patients.
 Methods This retrospective cohort study was done in a single center in patients diagnosed with PDA who had undergone transcatheter closure. Data were obtained from subjects’ medical records. The relationship between the post-closure PDA time span and LVF parameters [ejection fraction (EF) and fractional shortening (FS)] was analyzed by Friedman and repeated ANOVA tests; the post-closure PDA time period and nutritional status was analyzed by Friedman test. The time periods analyzed were 1, 3, 6, and 12 months post-closure. Factors potentially associated with LVF 12 months post-closure were analyzed by linear regression.
 Results A total of 30 patients who had undergone transcatheter PDA closure were included. The body weight mean of at the time of transcatheter PDA closure was 13.1 kg. We found a significant relationship between time period after PDA closure and nutritional status, before and 1, 3, 6, and at 12 months post-closure. In a comparison of pre-closure to 12 months post-closure, subjects’ mean EF (66.6 vs. 70.9%, respectively; P<0.001) and FS (34.4 vs. 37.8%, respectively; P<0.001) were significantly higher. In addition, significantly more patients had normal nutritional status 12 months post-closure than before closure. Age was not related to LVF parameters (EF: r=0.212; P=0.260; FS: r=0.137; P=0.471).
 Conclusion Both LVF and nutritional status significantly improve gradually over the 12 months post-closure compared to pre-closure. PDA size is not significantly associated with improved LVF parameters and nutritional status.

Transcatheter patent ductus arteriosus closure: what have we learned after over 25 years? A single--center experience with 1036 patients.

Transcatheter patent ductus arteriosus (PDA) closure has become the first‑choice method of treatment in the majority of patients. However, device selection poses a challenge. This study aimed to analyze periprocedural and 1‑year outcomes of PDA transcatheter closure performed with different devices throughout a 25‑year time period in a single center. All 1036 patients who underwent transcatheter PDA closure between 1993 and 2020 were included in retrospective analysis. Various devices were used: the Rashkind device (RD; n = 25), coils (n = 469), nitinol duct occluders type I (DO I; n = 300), type II (n = 32), type II additional sizes (ADO II AS; n = 209), as well as off‑label devices: vascular plugs and atrial septal and muscular ventricular septal defect occluders (n = 17). Data on 24‑hour and 1‑year follow‑up were available for 100% and 78.9% of the study patients, respectively. The procedure was successful in 98.6% of the study patients, with a major complication rate of 0.2%. Complete PDA closure after a year was observed in 81.8% of the patients treated with RD, 93.7% of those with coils, and 100% of those with duct occluders. There were no differences between Amplatzer DO I (n = 159) and its DO I copies manufactured in China (n = 141) with regard to success, efficacy, and complication rates. Recently, ADO II AS has replaced coils and become the preferred device to close small‑to‑moderate PDA. Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at 1‑year follow‑up. Due to higher efficacy, ADO II AS has replaced coils in the treatment of smaller PDA.

Management of Patent Ductus Arteriosus in Premature Infants in 2020.

The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the topic, the decision to treat the PDA is still strongly debated among cardiologists, surgeons, and neonatologists. This is in part due to the shortage of long-term benefits with the interventions studied. Practice variations still exist within sub-specialties and centers. This article briefly summarizes the history, embryology and histology of the PDA. It also succinctly discusses the hemodynamic significance of a PDA which builds the framework to review all the available literature on PDA closure in premature infants, though not a paradigm shift just yet; it introduces transcatheter PDA closure (TCPC) as a possible armament to the clinician for this age-old problem.

Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants With Very Low Birth Weight.

Background: The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature infants.Methods: We performed a retrospective study of infants born with a birth body weight of < 2,000 g and admitted to National Cheng Kung University Hospital from September 2014 to December 2019. Basic demographic and clinical information as well as echocardiographic and angiographic data were recorded.Results: Twenty-five premature infants (11 boys and 14 girls) born at gestational ages ranging between 22 and 35 weeks (mean, 25 weeks) were identified. The mean age at procedure was 34.5 ± 5.5 days, and the mean weight was 1,209 ± 94 g (range, 478–1,980 g). The mean diameter of the PDA was 3.4 ± 0.2 mm (range, 2.0–5.4 mm). The following devices were used in this study: Amplatzer Ductal Occluder II additional size (n = 20), Amplatzer Vascular Plug I (n = 1), and Amplatzer Vascular Plug II (n = 4). Complete closure was achieved in all patients. The mean follow-up period was 30.1 ± 17.3 months (range, 6–68 months). In total, 3 patients had left pulmonary artery (LPA) stenosis and 1 patient had coarctation of the aorta during the follow-up period. Younger procedure age and smaller procedure body weight were significantly associated with these obstructions.Conclusions: Performing transcatheter PDA closure in symptomatic premature infants weighing more than 478 g is feasible using currently available devices; moreover, the procedure serves as an alternative to surgery.

Fate of the Left Pulmonary Artery and Thoracic Aorta After Transcatheter Patent Ductus Arteriosus Closure in Low Birth Weight Premature Infants

Transcatheter patent ductus arteriosus closure (TCPC) is an emerging treatment for low birth weight extremely premature neonates (EPNs). Left pulmonary artery (LPA) and descending aorta (DAO) obstruction are described device-related complications, however, data on mid- and long-term vascular outcomes are lacking. A retrospective analysis of EPNs who underwent successful TCPC at our institution from 03/2013 to 12/2018 was performed. Two-dimensional echocardiography and spectral Doppler velocities from various time points before and after TCPC were used to identify LPA and DAO flow disturbances. A total of 44 EPNs underwent successful TCPC at a median (range) procedural weight of 1150 g (755–2500 g). Thirty-two (73%) patients were closed with the AVP II and 12 (27%) with the Amplatzer Piccolo device. LPA and DAO velocities on average remained within normal limits and improved spontaneously in long-term follow up (26.1 months, range 1–75 months). One patient, who had concerning LPA flow characteristics immediately after device implant (peak velocity 2.6 m/s) developed progressive LPA stenosis requiring stent placement 3 months post-procedure. In the remaining infants, including 7 (16%) who developed LPA and 3 (7%) who developed DAO flow disturbances (range 2–2.4 m/s), all had progressive normalization of flow velocities over time. TCPC can be performed safely in EPNs with a low incidence of LPA and DAO obstruction. In the absence of significant progressive vascular obstruction in the early post-procedure period, mild increases in LPA and DAO flow velocities tend to improve spontaneously and normalize in long-term follow-up.

Anterior mini-thoracotomy versus transcatheter closure of the patent ductus arteriosus in the extremely low birth weight preterm infant: A comparative bi-centric study

Patent ductus arteriosus (PDA) is common in preterm infants and contributes to prolonged mechanical ventilation, renal failure, necrotizing enterocolitis and periventricular leukomalacia. Several studies have shown the feasibility and safety of percutaneous PDA closure. Minimally invasive surgical ligation by anterior thoracotomy is an alternative, bedside technique for PDA closure in extremely low birth weight preterm infants. Our study aimed to compare short-term morbi-mortality between surgical PDA ligation by anterior mini-thoracotomy and transcatheter PDA closure. From 2010 to 2020, 92 preterm babies weighing < 1.6 kgs underwent PDA closure in 2 centres: 44 surgical anterior mini-thoracotomies (group 1, centre 1) and 48 transcatheter closures (group 2, centre 2). Using a 1:1 propensity score match analysis, 44 patients were included ( n = 22 in each group). The primary outcome was the time to extubation. Preoperative characteristics were similar between the 2 groups after propensity matching (mean weight at procedure, 1171 ± 183 gr; P = 0.8). PDA closure was successful in all cases, except 1 in the transcatheter group. Mean time to extubation was similar: 10 ± 15 days in group 1 versus 9 ± 13 d. in group 2 ( P = 0.9). Mean non-invasive ventilation duration was similar ( P = 0.96). Mean age at hospital discharge was 114 ± 29 days in group 1 versus 105 ± 19 d. in group 2 ( P = 0.2). 2 deaths occurred in group 1 (9%) and 1 in group 2 (4.5%) (logRank = 0.61). 5 complications (pneumothorax n = 2, chylothorax n = 2, phrenic nerve injury n = 1) occurred in 3 patients in group 1 (13%). 3 complications (chylothorax n = 1, endocarditis n = 1, renal vein thrombosis n = 1) occurred in 2 patients of group 2 (9%) ( P = 0.63). Equivalent efficiency and safety of surgical mini-invasive versus transcatheter PDA closure in extremely low birth weight preterm infants are in favour of applying these alternative techniques according to center's facilities and competences.

Novel Approach to Transcatheter Patent Ductus Arteriosus Closure via the Internal Jugular Vein in a Patient with an Interrupted Inferior Vena Cava

Novel Approach to Transcatheter Patent Ductus Arteriosus Closure via the Internal Jugular Vein in a Patient with an Interrupted Inferior Vena Cava

Acute aortic dissection as a late and fatal complication of transcatheter persistent ductus arteriosus occlusion: a case report.

Background Persistent ductus arteriosus (PDA) is a common congenital heart defect, of which, the preferred treatment in children and adults is transcatheter occlusion. This report describes the first reported case of acute aortic dissection as a late complication of transcatheter PDA occlusion.Case summary A 66-year-old healthy woman, with a history of transcatheter PDA closure 12 years previously, died suddenly at home. Post-mortem revealed pericardial tamponade complicating an acute aortic dissection, with a large intimal tear identified adjacent to the PDA occluder.Discussion Transcatheter occlusion is accepted as a safe and effective treatment in older children and adults, important in preventing haemodynamic sequelae such as heart failure and pulmonary hypertension. Complications are uncommon and mostly acute, including device embolization and haemolysis. Aortic dissection has been reported as an acute complication but only in the setting of incorrect device deployment. This is the first description of aortic dissection as a late complication of transcatheter PDA occlusion and although rare has important ramifications given it is a potentially fatal outcome of a common procedure.

Abstract 13501: Patent Ductus Arteriosus Catheterization Closure in Preterm Infants: A Descriptive Study of an Institutional Experience

Introduction: A patent ductus arteriosus (PDA) in a preterm infant can lead to respiratory insufficiency and chronic lung disease as well as necrotizing enterocolitis due to systemic hypoperfusion. Recently, catheter-based PDA closure has emerged as an appealing alternative to invasive surgical ligation in preterm infants; however, evidence to support this procedure in infancy, particularly in the premature population, is still evolving. Methods: A retrospective chart review was conducted to collect information regarding demographics, neonatal and maternal clinical characteristics, and procedural and post-catheterization data. Inclusion criteria included infants born at &lt;32 weeks gestational age whose PDAs were closed via catheterization at our institution between January 2017 and August 2019. Infants with critical congenital heart disease and/or lethal congenital anomalies were excluded from this study. Results: Twenty-seven patients were included in our study. Indications for PDA closure in our patient population included hemodynamically significant PDA on echocardiogram, difficulty weaning respiratory support, poor feeding and weight gain, and development of NEC. Median gestational age and weight were 26 weeks and 820 g (ranging from 23 to 30 weeks and 400 to 1540 g, respectively). Most infants tolerated the procedure well and without serious adverse outcomes. One infant developed an intimal flap post-catheterization that resolved without invasive intervention, and 1 infant developed a PAH crisis after PDA closure with resolution of PAH prior to discharge. Statistically significant associations were found between PDA plug closures and decreased oxygen requirements, decreased pulmonary artery hypertension, decreased diuretic requirements, and decreased vasodilator requirements by time of discharge. Conclusions: Successful device closures of PDAs are feasible and safe, and preliminary findings show promising outcomes without mortality or long-term morbidity following transcatheter PDA closure.

Abstract 16551: Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants - How Young is Too Young?

Background: Transcatheter patent ductus arteriosus (PDA) closure (TCPC), has been shown to be feasible and safe for infants as small as 700 grams or even smaller. Hypothesis: The corrected gestational age of the infant may be a better representation of tissue maturity than the weight of the infant. This study was aimed to explore the outcomes of TCPC based not just on weight, but also on the age of the infant. Methods: This was a retrospective study including infants born at gestational age &lt; 28 weeks who underwent TCPC between Jan-2012 and May-2020 and weighed &lt; 3 kg at the time of the procedure. The study period was divided into four-time blocks. Success and complication rates were compared for those who underwent the procedure at &lt; 28 days to those infants that underwent TCPC &gt;28 days of age. Results: In study period, TCPC was attempted on 241 infants that satisfied the inclusion criteria, with a 99.1% success rate. There was no difference in success rates based on the age at TCPC (99.3% vs. 99% for procedural age &lt; 28 days vs. &gt;28 days respectively; P=0.82). Overall, 140 infants underwent TCPC at &lt; 28 days of age, 29 of whom were &lt; 14 days, and 54 infants underwent TCPC between 15 and 21 days of age. The median age at TCPC progressively decreased from 60 days of life (14-211 days) between January 2012 and December 2014 to 18 days (8-38 days) between August 2019 and May 2020 (P &lt; 0.00001). Similarly, the weight at TCPC decreased over the same time periods (median 1985 grams vs. 900 grams; P &lt; 0.00001). Procedure-related complication rates were similar for those &lt; 28 days vs. &gt;28 days of age at the time of TCPC (2.8% vs. 4.9% respectively; P=0.42). Conclusions: It is feasible and safe to perform TCPC after the first week of life for infants born &lt; 28 weeks’ gestation. As experience grows, more infants are referred to earlier after birth which translates to performing TCPC on smaller infants. The benefits of early TCPC have to be determined in order for this therapy to be advocated routinely for all premature infants.

Safety and Procedural Success of Transcatheter Closure of Patent Ductus Arteriosus in Adults at Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Background and Aims: Transcatheter closure of patent ductus arteriosus (PDA) using either coils or device is a well-established procedure. PDA is one of the common congenital heart diseases and it is not uncommon for it to be diagnosed in adulthood. However, only few studies are conducted in our part of the world regarding the safety and procedural success of device closure of PDA in adults. We aim to assess safety and procedural success of transcatheter closure of PDA in adults at Shahid Gangalal National Heart Centre, Kathmandu, Nepal.&#x0D; Methods: It was a single center, retrospective study. Cardiac catheterization laboratory records of all consecutive adult patients (age ≥ 18 years) who underwent PDA device closure between March 2007 to March 2020 were reviewed. Patients age, gender, device size and device type along with procedural success of the procedure were reviewed. Any complication recorded was reviewed.&#x0D; Results: During the study period 118 adult patients were attempted for transcatheter closure of PDA. In three cases transcatheter closure was not attempted. In one patients attempt was made to close the duct with cook coil which embolized to pulmonary artery. PDA was successfully closed in 114 patients. Among the 114 patients, 87 were females and 27 were male. Age ranged from 18 to 69 years with mean age was 29.5 years. PDA size ranged from 3mm to 18mm with the mean of 6.9mm. In two patients, residual PDA after surgical closure were closed. Amplatzer duct occluder was the most commonly used device used in 89 (78%) patients followed by Memopart PDA device in 11 (9.6%) patients, Amplatzer Muscular VSD occluder in four patients. Device size of “8x10” in 32 patients and “10x12” device in 29 patients, were the most commonly used device size.&#x0D; Conclusion: Transcatheter closure of PDA in adults can safely be done with high success rate.

CATHETER BASED CLOSURE OF HYPERTENSIVE PDA(S) WITH UNCONVENTIONAL DEVICES –IMMEDIATE AND SHORT TERM FOLLOW UP

Patent ductus arteriosus (PDA) is a common form of CHD, accounts for approximately 8% of congenital heart disease with the incidence of one in 2500 to 5000 live births. More common in female. It may be asymptomatic and is sometimes not diagnosed early resulting into prolonged abnormal aorto-pulmonary shunt which may result in silently progressing hypertension and left ventricular dysfunction. This study aims to evaluate the immediate &amp;short-term follow up results after TCC of large PDAs with severe pulmonary arterial hypertension (PHT) in children.This is a observational study of 38 patients with Large PDA and severe PHT who were referred to this centre for treatment during the period from July 2015 to Feb 2018 . After evaluating clinical and hemodynamic parameters reversibility of severe PAH was established and transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months to assess the efficacy, safety of the procedure &amp; its impact on PHT. Thirty eight patients, (26 females, 12males) patients between 6 months to 16 years of age had underwent successful device closure. 18 patients had PDA sizes between 6-8 mm,12 had between 8- 10 mm , 6 had between 10-15mm and only 2 patients had largest PDA more than 15 mm at PA end . 5 patients were selected for closure with muscular VSD device . We have successfully closed 3 of our largest PDA (12 mm , 16mm and 18mm) with Post Infarct Muscular VSD Occluder measuring 20 mm,22 mm and 24 mm respectively. TCC of hypertensive but reversible PDA is feasible. The immediate and short-term outcomes have proven this method to be safe and valid.

Pulmonary Hypertension with Prolonged Patency of the Ductus Arteriosus in Preterm Infants.

There continues to be a reluctance to close the patent ductus arteriosus (PDA) in premature infants. The debate on whether the short-term outcomes translate to a difference in long-term benefits remains. This article intends to review the pulmonary vasculature changes that can occur with a chronic hemodynamically significant PDA in a preterm infant. It also explains the rationale and decision-making involved in a diagnostic cardiac catheterization and transcatheter PDA closure in these preterm infants.

Echocardiographic Short-Term Follow up of Children after Transcatheter Closure of Patent Ductus Arteriosus

Background: Patent ductus arteriosus constitutes 5-10% of all the congenital heart diseases. Volume overloading of the left side of the heart, risks of endocarditis, aneurysm of patent ductus arteriosus (PDA), and pulmonary vascular disease are indications for closure of the defect. Purpose: Evaluation of the efficacy and safety of PDA device closure in the paediatric age group patients. Methods: This prospective observational study included 26 children with a mean age of 30.2 ± 27.6 months and a mean weight of 12.8 ± 6.6 kg. Echocardiographic follow up was done at 24 hour, 1 week and 3 months post-intervention. Evaluation included assessment of residual shunt, left ventricle dimensions, left atrium/aorta ratio and velocity along descending aorta and left pulmonary artery. Results: Three different devices were used; the Amplatzer duct occluder (ADO-I) and its delivery system, PFM Nit-Occlud and Nit-Occlud PDA-R. All the patients were discharged safely from hospital after 24 hours of admission. Complete ductus closure was achieved in 77% of cases by 24 hours post-intervention, and in 96.15 % after three months. The left ventricular end diastolic diameter (LVEDd) Z score decreased from 2.13±2.37 pre-intervention, to 0.65±1.8 after 3 months (p <0.001). Although the LV showed decrease in systolic function (FS), all the patients showed improvement in symptoms. No significant obstruction along the descending aorta or left pulmonary artery was reported. No complications like thrombus formation, blood loss or infective endocarditis, in any case, were reported. Conclusion: Trans-catheter closure of PDA is effective and safe with rapid reversal of the left sided overload. Similar studies with long term follow up are needed for further evaluation of the LV systolic function pattern.

Hemodynamic and clinical consequences of early versus delayed closure of patent ductus arteriosus in extremely low birth weight infants.

To describe changes in hemodynamics, respiratory support, and growth associated with transcatheter PDA closure (TCPC) in ELBW infants, stratified by postnatal age at treatment. This is an observational study of ELBW infants who underwent TCPC at ≤4 weeks (Group-1; n = 34), 4-8 weeks (Group-2; n = 33), and >8 weeks of age (Group-3; n = 33). Hemodynamic assessment was performed during TCPC. Multivariate Cox-proportionate-hazard modeling was used to identify factors associated with respiratory severity score (RSS) > 2 for >30 days following TCPC. In comparison with Group-1, Group-3 infants had higher pulmonary vascular resistance (PVRi = 3.3 vs. 1.6 WU*m2; P = 0.01), less weight gain between 4 and 8 weeks of age (16 vs. 25 g/day) and took longer to achieve RSS < 2 (median 81 vs. 20 days; P = 0.001). RSS > 2 for >30 days was associated with TCPC > 8 weeks (OR = 3.2, 95% CI: 1.75-5.8; p = 0.03) and PVRi ≥ 3 (OR = 4.5, 95% CI: 2.7-8.9; p < 0.01). ELBW infants may benefit from PDA closure within the first 4 weeks of life in order to prevent early onset pulmonary vascular disease, promote faster growth, and for quicker weaning of ventilator and oxygen support.

Intracardiac Echocardiography as a Guide for Transcatheter Closure of Patent Ductus Arteriosus.

Background Transcatheter closure of patent ductus arteriosus (TC-PDA), conventionally guided by aortography, has become the standard treatment of this disease. The purposes of this study were to evaluate whether intracardiac echocardiography (ICE) may be used for measuring PDA size and be used as a guide for TC-PDA. Methods This study had 2 phases. In phase 1, we compared the measurements of PDA size: pulmonary artery side diameter (PA-D), length, and aortic side diameter (Ao-D) of PDA, as measured by ICE with those measured by aortography or cardiac computed tomography (AoG/CCT) in 23 patients who underwent TC-PDA. In phase 2, we compared the demographics, fluoroscopic time, contrast volume, and complications of the TC-PDAs between 10 adult patients with ICE guidance and 16 without it. Results In phase 1, we found great correlation and agreement between ICE and AoG/CCT in PA-D (r = 0.985, bias −0.077 to 0.224), but moderate to poor correlation and agreement in length (r = 0.653, bias −0.491 to 3.065) and Ao-D (r = 0.704, bias 0.738 to 4.732), respectively. Nevertheless, all patients underwent successful TC-PDA with ICE guidance that allowed us to continuously monitor the whole process. In phase 2, TC-PDA required a significantly lower contrast volume with ICE guidance than without it, and there was no significant difference in the remaining variables between the 2 groups. Conclusion ICE is comparable to AoG/CCT in providing accurate PA-D of the PDA and may be a safe alternative to guide TC-PDA as compared to conventional aortography.

Device closure of patent ductus arteriosus: analysis of cases in a Bangladeshi centre

Background: Transcatheter closure of Patent ductus arteriosus (PDA) has become the first-choice therapy for closure in patients of any age group. Authors reviewed the outcome of device closure in all age groups starting from neonate to adult.Methods: From December 2014 to December 2019, 440 cases underwent transcatheter closure in a catheterization laboratory of a tertiary level cardiac hospital. Selection criteria were isolated PDA or PDA with associated conditions which can be managed in the same setting by an intervention. Exclusion criteria were proven Eisenmenger syndrome. A retrospective review of outcome and complications were recorded from computerized data records.Results: Age of the patient varied from 10 days to 65 years. The median age was 3 years. Most of the patients were female (63%), weight varied from 1.8 kg to 75 kg. the median weight was 7.5 kg. Isolated PDA cases were 74.77 %. Among syndromes, congenital rubella syndrome was common (7.5%), followed by Down Syndrome (6.36%). The narrowest PDA diameter varied for 1.8 mm - 14 mm with a median of 5 mm. Among duct occluders, 8x6 mm CeraTM was the commonest one used in the study population. Complete occlusion was observed in 99.55% of cases.Conclusions: Transcatheter closure of PDA is considered safe and efficacious in all age groups. It is the gold standard now and replaced surgical option in most of the places.

A randomized trial of intravenous acetaminophen versus indomethacin for treatment of hemodynamically significant PDAs in VLBW infants.

Objective was to compare the rate of successful treatment of hsPDA based on echocardiogram criteria after use of IV acetaminophen or IV indomethacin in very low-birthweight infants. The study was a multi-center, randomized controlled trial. Infants born prior to 32 weeks with birthweight ≤ 1500 g were included if PDA treatment was indicated within the 21 days after birth. hsPDA was defined by strict echocardiogram criteria. Eligible infants were randomized to treatment with either IV acetaminophen or IV indomethacin. Of 86 eligible infants, 17 infants were randomized to acetaminophen and 20 to indomethacin. One (5.9%) hsPDA in the acetaminophen group had successful treatment compared to 11 (55%) in the indomethacin group (p = 0.002). Eight (47%) in the acetaminophen group and 3 (15%) in the indomethacin group received transcatheter PDA closure (p = 0.07). IV indomethacin was more effective than IV acetaminophen for treatment of hsPDAs. More infants in the acetaminophen group received transcatheter closure.

Transcatheter Closure of Patent Ductus Arteriosus in Elderly Patients: Initial and One-Year Follow-Up Results-Do We Have the Proper Device?

Objectives Patent ductus arteriosus (PDA) in elderly patients is an uncommon anomaly, and the duct itself is often calcified and fragile; therefore, transcatheter closure is more difficult. The aim is to analyse periprocedural and one-year follow-up results of transcatheter closure of PDA in such patients. Methods and results. Retrospective analysis of 33 elective patients aged ≥55 years (median 63; 56–85; 29 women), in whom PDA was closed percutaneously between 2002 and 2018 in two tertiary centres. All but three patients were symptomatic, with most in NYHA II (n = 14) and III (n = 11) class; pulmonary hypertension (n = 22), arterial hypertension (n = 22), duct calcifications (n = 17), atrial fibrillation (n = 15), significant mitral regurgitation (n = 5), and decompensated renal failure (n = 2) were observed. Different devices were applied depending on PDA morphology; nitinol wire mesh occluders with symmetrical articulating discs have been the most used in recent years (n = 11). Follow-up was conducted at an outpatient clinic (28/33 patients). The procedure was successful in all patients. There was one embolisation, followed by implantation of a larger device. No major complications were noted. A small residual shunt was present in echocardiography in one patient after one year. NYHA class improved in all but two patients (with multiple comorbidities). Conclusions Transcatheter PDA closure in elderly patients is safe and efficient with a high complete closure rate and few complications. Amplatzer duct occluder type II is an attractive device in such patients.

Incidence and fate of device-related left pulmonary artery stenosis and aortic coarctation in small infants undergoing transcatheter patent ductus arteriosus closure.

To evaluate short- and middle-term outcomes after transcatheter patent ductus arteriosus (TC-PDA) closure in small infants, specifically device-related left pulmonary artery (LPA) stenosis and aortic coarctation, risk factors, and changes over time. Recent studies have demonstrated successful transcatheter PDA (TC-PDA) closure in small infants. LPA stenosis and aortic coarctation have been seen after TC-PDA, but it is not clear whether device-related LPA/aortic obstruction persists. A single-center retrospective study of infants ≤4 kg who underwent TC-PDA closure from February 1, 2007 to September 1, 2018 was performed, evaluating the incidence and risk factors for LPA stenosis and coarctation. Forty-four patients underwent successful TC-PDA with Amplatzer Vascular Plug II (AVPII; n = 30), Amplatzer Duct Occluder II-Additional Sizes (n = 10), Amplatzer Duct Occluder I (n = 3), and coil-filled AVPI (n = 1) devices, all via an antegrade approach. Median birthweight and procedural weight were 890 g (range: 490-3,250) and 2.8 kg (range: 1.2-4.0), respectively. Median follow-up was 0.7 years (range: 2 days-7 years). Thirty-eight patients had post-procedure echocardiograms assessing LPA/aortic obstruction. Of those, 17 had LPA flow acceleration/stenosis (≥1.5 m/s), which improved or resolved in all patients with available follow-up; 3 developed mild coarctation (>2 m/s), which improved in the two with more than short-term follow-up; 4 developed mild flow acceleration (1.5-2 m/s) in the descending aorta, which resolved in three and increased in one (2.4 m/s). Flow acceleration in the LPA was associated with younger procedural age, larger PDA minimal diameter, and placement of a device other than the AVPII. There was no device-related mortality or need for reintervention. TC-PDA in small infants is effective, without significant complications. Device-related LPA/aortic obstruction can improve with time/growth.