Percutaneous Occlusion Of Patent Ductus Arteriosus Research Articles

Angle Formed Between Patent Ductus Arteriosus and Descending Thoracic Aorta in a Beating Heart: A Helpful Study to Design a Better Device for Occluding Patent Ductus Arteriosus

Background: The percutaneous transcatheter closure of patent ductus arteriosus (PDA) has been a widely used treatment method. However, PDA device closure in neonates or patients with specific PDA morphology has been difficult due to the protrusion of the device into the descending aorta. The right angle between the disc and plug causes some degree of protrusion of the disc into the descending aorta because normal PDA forms an acute angle with the descending aorta. Objectives: There have been limited data about the angles of PDA since Mancini’s study in 1951, and new studies are required in this regard. This study measured the angles between PDA and descending aorta through angiography in a beating heart. Methods: Within December 2008 to November 2016, 190 patients undergoing percutaneous PDA occlusion were included in this study. Retrospectively, the mean angle of PDA was measured by three cardiologists between the longitudinal axis of the descending aorta and the longitudinal axis of the PDA through an aortogram. The patients were divided into three groups according to age (group A: under 1, group B: 1 - 6, and group C: over 6 years of age) and PDA morphology based on Krichenko’s classification (type A: conical PDA, type B: window PDA, type C: tubular PDA, type D: complex PDA, and type E: elongated PDA). Results: Of 190 study patients, 135 patients were female, and the median age of the patients was 7 years (range: 75 days to 60 years). The mean angle of PDA was 48.2 ± 12.0°. There were no statistical differences regarding PDA angle among the groups classified by age and PDA morphology. Conclusions: The authors are hopeful that the obtained data will help develop a better device for the percutaneous transcatheter closure of PDA.

Short-term follow-up after percutaneous patent ductus arteriosus occlusion between low and high weight pediatric patients: a single center experience

BACKGROUND Device occlusion is a preferred treatment for patent ductus arteriosus (PDA) in adult and children patients; however, the exact limit of body weight requirement has not been established. This study aimed to describe the outcome and safety of transcatheter PDA occlusion in low and high weight pediatric patients.
 METHODS This was a retrospective study in Sanglah Hospital, Denpasar, Bali, Indonesia, in patients aged <12 years who had undergone transcatheter PDA occlusions from 2010 to 2017. Data were obtained from the registry including baseline characteristics (age, sex, body weight, and height), procedural-specific data (PDA characteristics, pulmonary and systemic pressures, and flow ratio intra-procedure), and procedural complications. Success rate and adverse events at 24 hours, 1 month, and 3 months after the procedure were assessed.
 RESULTS A total of 175 subjects were grouped into two categories: low weight, ?6 kg (n = 50) and high weight, >6 kg (n = 125). The success rates (complete closure) in the ?6 and >6 kg groups were, 90.0% and 75.9% at 24 hours follow-up, 92.9% and 85.5% at 1 month, and 95.8% and 91.1% at 3 months, respectively. Major complications related to the procedure in patients ?6 kg included transient dysrhythmia (n = 6) and massive bleeding (n = 2), and complications in patients >6 kg were transient dysrhythmia (n = 14), massive bleeding (n = 1), embolization (n = 1), and death (n = 1).
 CONCLUSIONS Transcatheter PDA occlusion had similar success rate and safety in both low and high weight pediatric patients.

Transcatheter Closure of Patent Ductus Arteriosus under Echocardiography Guidance: A Randomized Controlled Noninferiority Trial.

Background Percutaneous occlusion under fluoroscopy guidance has become the preferred method for the treatment of patent ductus arteriosus (PDA). To avoid radiation exposure and contrast agent use, PDA occlusion under transthoracic echocardiography (TTE) guidance was conducted. Objectives We assessed the hypothesis that the success rate of percutaneous PDA occlusion under TTE was noninferior to that under fluoroscopy guidance. Methods In this single-center trial, 100 patients were randomly assigned in a 1 : 1 ratio to the TTE group (n = 50) or to the fluoroscopy group (n = 50). The primary endpoint was the success rate of occlusion, with the noninferiority margin set at 8% for the between-group difference in intention-to-treat analysis. Secondary endpoints were hospitalization duration, cost, procedure time, and rate of adverse events including occluder migration, hemolysis, peripheral vascular complications, and residual shunt at 1-month and 12-month follow-up. Results Patient, defect, and device characteristics were similarly distributed between groups. The success rate of occlusion was 98% for the TTE group and 100% for the fluoroscopy group (absolute difference: −2%; 95% confidence interval: −5.9% to 1.9%). Cost and procedure duration were significantly lower in the TTE group, without adverse events in either group at a median of 12.0 months (range, 10.0–15.5 months) of follow-up. Conclusion Percutaneous PDA occlusion can be performed via TTE guidance safely and effectively, and the success rate of the TTE-guided procedure was noninferior to that under fluoroscopy guidance, with reduced cost and procedure time. The trial is registered with http://www.chictr.org.cn (ChiCTR-ICR-15006334).

Follow-up after Percutaneous Patent Ductus Arteriosus Occlusion in Lower Weight Infants

To describe longer term outcomes for infants <6kg undergoing percutaneous occlusion of the patent ductus arteriosus (PDA). This was a retrospective cohort study of infants <6kg who underwent isolated percutaneous closure of the PDA at a single, tertiary center (2003-2017). Cardiopulmonary outcomes and device-related complications (eg, left pulmonary artery obstruction) were examined for differences across weight thresholds (very low weight, <3kg; low weight, 3-<6kg). We assessed composite measures of respiratory status during and beyond the initial hospitalization using linear mixed effects models. In this cohort of lower weight infants, 92 of 106 percutaneous occlusion procedures were successful. Median age and weight at procedure were 3.0months (range, 0.5-11.1months) and 3.7kg (range, 1.4-5.9kg), respectively. Among infants with pulmonary artery obstruction on initial postprocedural echocardiograms (n=20 [22%]), obstruction persisted through hospital discharge in 3 infants. No measured variables were associated with device-related complications. Rates of oxygenation failure (28% vs 8%; P<.01) and decreased left ventricular systolic function (29% vs 5%; P<.01) were higher among very low weight than low weight infants. Pulmonary scores decreased (indicating improved respiratory status) following percutaneous PDA closure. Percutaneous PDA occlusion among lower weight infants is associated with potential longer term improvements in respiratory health. Risks of device-related complications and adverse cardiopulmonary outcomes, particularly among very low weight infants, underscore the need for continued device modification. Before widespread use, clinical trials comparing percutaneous occlusion vs alternative treatments are needed.

Percutaneous Closure of the Patent Ductus Arteriosus in Very Low Weight Infants: Considerations Following US Food and Drug Administration Approval of a Novel Device

Percutaneous Closure of the Patent Ductus Arteriosus in Very Low Weight Infants: Considerations Following US Food and Drug Administration Approval of a Novel Device

Late Amplatzer device displacement after percutaneous PDA embolization: case description.

A 6-month-old, 17 kg, male Labrador Retriever was presented for an evaluation of a suspected patent ductus arteriosus (PDA). Transthoracic echocardiography confirmed a left-to-right shunting PDA with a minimal ductal diameter of 3.5 mm. A transcatheter PDA occlusion was performed, and a 16 mm Amplatzer Vascular Plug II was selected for the procedure. Within 13 days of discharge, the dog developed sudden lethargy, tachypnea, and coughing after physical activity. Thoracic radiographs showed the Amplatzer device to be abnormally positioned in the lumen of the pulmonary artery with a distinct alveolar pattern. Given the progressive cardiopulmonary distress of the dog, the owners opted for euthanasia. In the present case study, the authors have not been able to satisfactorily explain why the device migrated several days after the procedure. In order to avoid device migration, greater emphasis should be placed on strict activity restriction in dogs after percutaneous PDA occlusion.

Abstract 10972: Transthoracic Echocardiography-guided Percutaneous Patent Ductus Arteriosus Occlusion: A New Strategy For Interventional Treatment

Objectives: This prospective single center study investigated the safety and efficacy of percutaneous patent ductus arteriosus (PDA) occlusion using the Amplatzer Duct Occluder II (ADO II) under only guidance of transthoracic echocardiography, which avoids the radiation and contrast agents of traditional PDA occlusion. Methods: From June 2013 to February 2015, 54 consecutive PDA patients (age, 4.6 ± 2.9 years; weight, 18.5 ± 7.5 kg; PDA narrowest diameter, 3.3 ± 1.1 mm) underwent transthoracic echocardiography guided PDA occlusion through the femoral artery. Outpatient follow-up was conducted at 1, 3, and 6 months, and yearly. Results: Echocardiography-guided percutaneous PDA occlusion was successfully performed in 53 patients. The procedure was converted to minimally invasive transthoracic occlusion in one patient due to failure of delivery catheter passage through tortuous PDA. Mean procedure duration was 25.5 ± 7.4 minutes; ADO II diameter averaged 4.7 ± 0.9 mm; 8 cases showed traces of residual shunt immediately after operation; and mean hospital stay was 3.4 ± 0.7 days. There was no occluder migration, hemolysis or pericardial effusion at mean 10.2±4.9 months follow-up. Conclusions: Percutaneous PDA occlusion under only guidance of transthoracic echocardiography appears safe and effective while avoiding radiation and contrast agent use. Legends: A) A suprasternal view showed the tip of pigtail catheter (arrow) faced the aortic end of the PDA. B) The left parasternal long axis view of the pulmonary artery showed that the guide wire (arrow) was located within the main pulmonary artery. C) The release of the occluder at the pulmonary side (arrow). D) The occluder was completely released (arrows point to each side of the occluder). PDA, patent ductus arteriosus; DAO, descending aorta; PA, pulmonary artery; AO, ascending aorta.

Oclusão Percutânea da Persistência do Ducto Arterioso

Introducao: A persistencia do ducto arterioso e uma condicao congenita de alta morbidade, especialmente em recem-nascidos prematuros de extremo baixo peso, representando 5 a 10% das cardiopatias congenitas. Nosso objetivo foi descrever as abordagens realizadas em hospital de referencia para o tratamento da persistencia do ducto arterioso com o metodo percutâneo de oclusao. Metodos: Foi realizado estudo retrospectivo do tratamento transcateter da persistencia do ducto arterioso no periodo de abril de 2008 a abril de 2010. Resultados: Foram revisados 47 casos, a maioria (78,8%) tratada com molas Flipper®; os demais tratados com a protese Amplatzer®. A configuracao morfologica ductal foi do tipo A de Krichenko em 89,4% (34 no grupo molas Flipper® e 8 no grupo Amplatzer®), tipo D em 6,4% (2 no grupo molas Flipper® e 1 no grupo Amplatzer®) e tipo E em 4,2% (1 em cada grupo) dos pacientes. Os diâmetros minimos pre-cateterismo foram de 2,6 ± 0,8 mm e 3,8 ± 1,6 mm para os grupos de molas Flipper® e Amplatzer®, respectivamente. Obteve-se oclusao imediata total do defeito na angiografia de controle em 72,3% dos pacientes tratados. Sete pacientes tratados com molas Flipper® receberam molas adicionais e os tratados com protese Amplatzer® mostraram apenas shunts residuais minimos em dois casos. Nao ocorreram complicacoes do procedimento. No acompanhamento apos a alta, um paciente permaneceu com minimo shunt residual a ecografia, 45 dias apos o cateterismo. Conclusoes: A oclusao da persistencia do ducto arterioso por metodo percutâneo tem-se mostrado segura e efetiva na maioria dos casos.

A Case of Patent Ductus Arteriosus with Congestive Heart Failure in a 80-Year-Old Man

Patent ductus arteriosus (PDA) is a rare clinical finding in adult patients. Considering the increase in cases of PDA discovered incidentally on echocardiograms at young ages, and the life-shortening effect of PDA, it is rare to diagnose PDA in old patients. We report a case of an 80-year-old patient who experienced symptoms of congestive heart failure showed findings suggestive of PDA in echocardiogram and confirmed the diagnosis through a cardiac catheterization and a coronary angiography. After percutaneous occlusion of PDA with an Amplatzer duct occlusion device, symptoms related to congestive heart failure improved.

The Results of Transcatheter Occlusion of Patent Ductus Arteriosus: Success Rate and Complications Over 12 Years in a Single Center

Background and ObjectivesPercutaneous occlusion of patent ductus arteriosus (PDA) has become increasingly attractive with the evolution of devices and techniques. We reviewed results for percutaneous occlusion of PDA using various devices in a single center.Subjects and MethodsA retrospective review was done for 118 consecutive procedures performed in 111 patients with PDA between January 1996 and December 2007.ResultsThe median age of the patients was 4.5 years (0.9 to 60.3 years); body weight was 16.9 kg (6.8 to 74.7 kg). The median PDA diameter at the pulmonic end was 3.8 mm (0.7 to 10 mm); mean pulmonary artery pressure was 21.0 mmHg (7 to 60 mmHg). Complete occlusion occurred in 76/111 (68.4%) immediately after implantation and in 100/111 (90.0%) at one year of follow-up. Second procedures for residual shunts were done in 7 patients. After the year 2001, the complete closure rate was 95.2% compared to 71.4% before 2001. Complications associated with the procedure were left pulmonary artery narrowing (all <20 mmHg) in 14, arrhythmia in 2, and death in 1.ConclusionEvolution of devices, cumulative experience, and health insurance covering the cost of devices have contributed to good outcomes in our center for percutaneous occlusion of PDA. Our results have improved over the years, particularly with the use of the Amplatzer duct occluder.

Differential Pulmonary Perfusion Scan After Percutaneous Occlusion of the Patent Ductus Arteriosus: One-Decade Consecutive Longitudinal Study from a Single Institution

Reduced left lung perfusion has been described following percutaneous occlusion of the patent ductus arteriosus (PDA). We aimed to identify the incidence of lung perfusion abnormalities and the associated risk factors in our consecutive series. Between November 1994 and December 2003, 150 procedures were performed on 145 patients, age 4.6 +/- 4 years. Gianturco coil was used in 88.2%, Amplatzer duct occluder in 6.7%, and Rashkind Umbrella in 5.5%. Lung perfusion scan was scheduled within 48 h (LPS-1), at 6-12 months (LPS-2) and later (LPS-3) in the case of persistent abnormalities. Left lung perfusion <40% was considered abnormal. LPS-1 was obtained in 95.8% and was abnormal in 31%. LPS-2, available in 48.2%, returned to normal in 65.7% (p < 0.001). LPS-3, required in 6.2%, was normal in 55.6% (p = 0.07). Identifiable risk factors were low age and height (p < 0.01), higher Q(p)/Q(s) ratio (p < 0.05), and larger PDA size indexed for height (p < 0.001) or body surface area (p < 0.01). The number of coils or loops deployed in the pulmonary end of the PDA did not influence lung perfusion. In conclusion, we describe a high incidence of left lung perfusion reduction following percutaneous PDA occlusion, more likely in the young with large PDA. However, spontaneous recovery usually occurs within a few months.

Oclusão percutânea dos canais arteriais com prótese amplatzer

INTRODUÇÃO: Vários dispositivos têm sido utilizados para o fechamento percutâneo dos canais arteriais, com graus variáveis de sucesso. Dentre eles, destaca-se o oclusor ductal Amplatzer (Amplatzer Duct Occluder® - ADO) que, pela sua facilidade de uso, segurança e eficiência, em praticamente todos os tipos de canais, tem sido largamente utilizado. Neste trabalho, apresentamos a experiência do nosso grupo com este dispositivo, discutindo suas características, aspectos técnicos do seu implante, bem como os resultados obtidos com o seu emprego. MÉTODO: De abril de 1999 até dezembro de 2006, 116 pacientes foram encaminhados para oclusão percutânea. Destes, 91 (64F:27M) foram selecionados para fechamento percutâneo utilizando a prótese Amplatzer. O implante foi realizado da maneira tradicional, já descrita em outros trabalhos, na maioria dos casos. Nos PCA de menor diâmetro, foi necessária a dilatação da extremidade pulmonar do canal com cateter-balão para angioplastia coronariana. Os casos foram todos selecionados por meio de ecocardiogramas transtorácicos (ETT) com mapeamento de fluxo a cores. O seguimento foi feito com ETT no dia seguinte ao procedimento e com 1, 3, 6 e 12 meses (m) após. RESULTADOS: As idades variaram de 2 a 600 meses (48,0 ± 116,4 meses) e os pesos de 4 a 88 kg (17,0 ± 19,1 kg). Os menores diâmetros dos canais variaram entre 0,5 e 11 mm (3,0 ± 1,8 mm), sendo 25 menores do que 2 mm. Os tipos morfológicos se distribuíram da seguinte maneira: tipo A= 58 (64%); tipo C= 6 (7%); tipo D= 2 (2%) e tipo E= 25 (27%), de acordo com a classificação de Krichenko. Não houve nenhum canal do tipo B na nossa casuística. Foram usadas ADO em 90 casos, distribuídas segundo os tamanhos, como se segue: 5-4 em 4 casos (4%); 6-4 em 34 casos (37%); 8-6 em 33 (37%); 10-8 em 16 (18%) e 12-10 em 3 (3%). Em uma paciente de 50 anos com canal amplo e hipertensão arterial pulmonar grave, foi utilizada, com sucesso, uma prótese de CIV muscular (Amplatzer Muscular VSD Occluder® -VSD MUSC) de 12 mm. O implante foi possível em 90 casos. No outro, a rosca defeituosa de uma prótese ADO 8-6 causou seu destacamento prematuro na aorta descendente. O paciente foi encaminhado para cirurgia eletiva, onde teve a prótese resgatada e seu canal ligado sem problemas. Em todos os que tiveram o implante, houve fechamento completo, sem fluxo residual dentro do primeiro mês do procedimento, e se mantêm fechados desde então. Não houve complicações significativas relacionadas ao uso da prótese. Não houve óbitos relacionados ao procedimento. CONCLUSÕES: O fechamento dos canais arteriais com a prótese Amplatzer é um procedimento extremamente simples, seguro e com alto índice de sucesso. É nossa opinião que deva ser adotada como primeira opção para a oclusão de todos os canais. O procedimento é possível mesmo nos canais de pequeno diâmetro (< 2 mm), que são indicados para fechamento percutâneo.

Percutaneous Occlusion of Patent Ductus Arteriosus with Controlled-Release Coil

We evaluated the efficacy of the controlled-release Cook coil for percutaneous patent ductus arteriosus occlusion. Between October 1994 and December 1997, 45 consecutive patients with patent ductus arteriosus underwent cardiac catheterization and coil occlusion was attempted in 41, of whom 37 had Cook coils. A single coil was deployed in 34 of these patients and 2 or more coils were deployed in 3, with successful occlusion in 36 (97%). Immediate complete angiographic closure was achieved in 15 (41%), 18 (49%) had a trivial residual shunt, and 3 had a mild residual shunt on post-occlusion aortograms. Color Doppler echocardiography 24 hours after the procedure, revealed no detectable shunt in 33/36 (92%) and only a trivial residual shunt in 3 (8%) patients. Thus, 86% of patients with residual shunts immediately after occlusion had no evidence of residual shunts by 24 hours. No evidence of residual shunt or obstruction of the left pulmonary artery or the descending aorta was present at a mean follow-up of 26 months We concluded that Cook coils are a safe and cost-effective modality for percutaneous occlusion of patent ductus arteriosus with a high success rate and favorable intermediate-term follow-up.

Percutaneous coil occlusion of patent ductus arteriosus

Objective: To determine the success rate and safety of percutaneous patent ductus arteriosus (PDA) coil occlusion. Design: Thirty consecutive pediatric patients with small to moderate-size PDAs (minimum diameter ≤4 mm) underwent percutaneous coil occlusion. The results were assessed by angiography and echocardiography. The mean age was 5.1 ± 4.2 years (range, 0.8 to 18.8 years); mean weight was 19.2 ± 10.3 kg (range, 8.1 to 40.0 kg). The mean minimum diameter of the PDA was 1.8 ± 0.8 mm (range, 1.0 to 4.0 mm). Results: PDA occlusion was achieved with one coil in 24 patients, 2 coils in 3 patients and 3 coils in 3 patients. The mean coil/PDA diameter ratio was 2.5 ± 0.5. Immediately after coil occlusion, 29 PDAs had no flow by angiography; one had a small residual shunt. There were no significant complications. In the first 24 hours after coil implantation, echocardiography showed complete occlusion in 28 patients, a small left-to-right shunt in the same patient that had a residual shunt by angiography, and a trace shunt in one additional patient. In the two patients with residual flow by echocardiography, follow-up ultrasonography revealed no residual shunt 1 and 3 months later. At a mean follow-up of 11.8 ± 9.3 months (range, 0 to 36.0 months), there was no PDA flow by color Doppler echocardiography in any of the 30 patients. Conclusion: Coil occlusion is a safe and effective method of percutaneous closure of small to moderate-size PDAs. The largest PDA that can be closed with this technique remains to be determined. (J Pediatr 1997;130:447-54)