Transcatheter Occlusion Of Patent Ductus Arteriosus Research Articles

The investigation of thrombocytopenia after transcatheter occlusion of patent ductus arteriosus

ObjectiveTo investigate the risk factors for thrombocytopenia after transcatheter occlusion operation of patent ductus arteriosus (PDA).MethodRetrospective analyses were conducted using clinical data from 106 patients with PDA who underwent transcatheter closure operations at Henan Provincial Chest Hospital, Zhengzhou University, from January 2018 to June 2022. The study compared the changes in platelet counts before and after the operation, and investigated the risk factors for thrombocytopenia following PDA closure in different groups and layers.ResultsThe platelet count of patients with PDA significantly decreased after undergoing transcatheter PDA occlusion. Logistic regression analysis revealed that factors such as PDA diameter, occluder diameter, pressure difference on the two sides of the occluder, and residual shunt were associated with an increased risk of thrombocytopenia following PDA occlusion. Specifically, the size of the occluder and the pressure difference between the two sides of the occluder were found to have a negative correlation with the postoperative platelet count. Further subgroup analysis demonstrated that the incidence of total thrombocytopenia was significantly higher in the large PDA group compared to the small-medium PDA groups.ConclusionOur findings suggest that occluder diameter, the pressure difference between the two sides of the occluder, and the residual shunt are major risk factors correlated with the incidence of postoperative thrombocytopenia. However, a multicenter and long-term prospective study is required to further evaluate the prognosis of PDA patients with thrombocytopenia after transcatheter occlusion.

Transcatheter closure of persistent ductus arteriosus in 2 to 6 kg infants: Preliminary results from an international, retrospective study

Transcatheter patent ductus arteriosus (PDA) closure has proved to be safe in < 2 kg preterm infants, but major safety concerns remain when applied to the 2 to 6 kg body weight range. The aim of the present work is to assess efficacy and safety of transcatheter PDA occlusion in low-body-weight infants. Patients weighing 2 to 6 kg who underwent attempted transcatheter closure of an isolated PDA in 10 tertiary pediatric cardiology units (5 countries, 2000 to 2022) were retrospectively analyzed to review the outcome. A total of 339 infants (m/f sex ratio: 0.53; 56% ex-preterm, median age: 5.3 months [9 days–41 months], median weight: 4.7 kg [2 kg–6 kg]) were analyzed. Patients were all symptomatic (respiratory support: 33.2%, hospitalization for heart failure: 49.6%, nutrition care: 45.7%) with a hemodynamically significant PDA. Ductus was large (minimal ductal diameter: 4.2 ± 1.6 mm) and mainly conical (Krichenko type A: 57%) or tubular (Krichenko type C: 23%). Procedure was performed under both fluoroscopy (fluoro time: 10.7 ± 7.3 min) and transthoracic echocardiography guidance in all patients, with both arterial and venous femoral access (90%). Successful device implantation and complete PDA occlusion was achieved in 320 (94.4%) patients using devices in 91% (mainly ADO-I: 43.1%, ADO-IIAS: 20.0%, AVP-II: 8.0%, ODO: 5.3%, ADO-II: 3.5%, MFO: 2.1%, AVP-IV: 0.9%) vs. coils in 9%. Moderate to major complications occurred in 27 (8.0%) patients, including one death (0.3%) after delayed device embolization to descending aorta, device embolization (5.3%) and device-related obstruction of the left pulmonary artery (1.5%) or of the aorta (0.3%). These are preliminary data from a wider international study. We plan to collect both surgical and transcatheter cases in a wider series (40 tertiary centers, 20 countries), i.e. the largest cohort to date. This will allow better delineation of risk stratification, to keep refining indications for device closure in low-body-weight infants and achieve ever-safer results.

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.&#x0D; METHODS This was a retrospective study in Sanglah Hospital, Denpasar, Bali, Indonesia, in patients aged &lt;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.&#x0D; RESULTS A total of 175 subjects were grouped into two categories: low weight, ?6 kg (n = 50) and high weight, &gt;6 kg (n = 125). The success rates (complete closure) in the ?6 and &gt;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 &gt;6 kg were transient dysrhythmia (n = 14), massive bleeding (n = 1), embolization (n = 1), and death (n = 1).&#x0D; CONCLUSIONS Transcatheter PDA occlusion had similar success rate and safety in both low and high weight pediatric patients.

Early experience with the Micro Plug Set for preterm patent ductus arteriosus closure.

We intend to describe early experience using a new, commercially available Micro Plug Set for preterm neonate and infant transcatheter patent ductus arteriosus (PDA) occlusion. Transcatheter PDA occlusion in premature neonates and small infants is safe and effective. The procedure is early in its evolution. Procedural and short-term outcomes of preterm neonates and infants undergoing transcatheter PDA occlusion with a new, commercially available device were reviewed. Eight preterm neonates and infants born at median 27 weeks gestation (23-36 weeks) underwent transcatheter PDA device closure with the Micro Plug Set. The device is short (2.5 mm) with a range of diameters (3, 4, 5, 6 mm) and delivered through a microcatheter. Procedures were performed at median 41 days of age (12-88 days) and at 1690 g (760-3,310 g). Transvenous PDA device occlusion was performed with fluoroscopic and echocardiography guidance. All procedures were successful with complete PDA occlusion. There were no procedural or short-term adverse events. Preterm neonate and infant transcatheter PDA device closure with a new, commercially available short and microcatheter delivered device (Micro Plug Set) was safe and effective in a small, early series of patients.

Late Complication After Transcatheter Closure of Patent Ductus Arteriosus

We describe the case of a 32-year-old man with history of patent ductus arteriosus (PDA) closed with an Amplatzer device 12 years earlier. Imaging investigations revealed a persistent large PDA and the device migrated in the right pulmonary artery. A new transcatheter PDA occlusion was attempted with optimal post-procedural results. (Level of Difficulty: Advanced.)

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

Transcatheter closure of patent ductus arteriosus, evaluating the outcome: Single center experience in Mansoura, Egypt

Device closure is considered the treatment of choice for patent ductus arteriosus (PDA). The study presents our experience in transcatheter occlusion of PDA using three different devices between January 2008 and December 2016. The immediate and short-term outcome of 213 pediatric patients with PDA underwent PDA occlusion were analyzed. Aortic angiography was done to evaluate the size, position, and shape of the duct for proper device selection. A second aortic angiography was performed 10 min after device deployment. Echocardiography was repeated at intervals of 24 h, then at one, three, six and 12 months after the procedure to assess the presence of any complications. The mean age of patients was 9.2 ± 5.2 months and their mean weight was 7.6 ± 1.8 kg. Mean PDA diameter at its narrowest point measured by angiography was 2.81 ± 0.51 mm. Nit-Occlud pfm Coil occlusion was performed in 107 (50.2%) patients, Amplatzer ductal occluder was performed in 84 (39.4%) and Nit-Occlud PDA-R was performed in 22 (10.3%). Complete closure was observed in 95.7% of patients prior to discharge and this rate has reached 98.5% after three months of follow up and increased to 100% at 6 and 12-months visits. There was no significant difference regarding the outcome for each of the three devices prior to discharge and at 3 months follow up (p = 0.9974 and 0.9729, respectively). Limited complications were reported (e.g. aortic protrusion, mild LPA obstruction, significant blood loss) which were related mainly to the use of large devices (e.g. ADO-1) deployed over large diameter sheaths in young children with small body weight. In conclusion, percutaneous transcatheter closure of PDA technique using Nit-Occlud pfm coils, Amplatzer ductal occluder and Nit-Occlud PDA-R is proved to be safe and effective, with limited complications and non-significant hemodynamic consequences.

Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune?

The aims of this study were to describe radiation level at our institution during transcatheter patent ductus arteriosus occlusion and to evaluate the components contributing to radiation exposure. Transcatheter occlusion relying on X-ray imaging has become the treatment of choice for patients with patent ductus arteriosus. Interventionists now work hard to minimise radiation exposure in order to reduce risk of induced cancers. We retrospectively reviewed all consecutive children who underwent transcatheter closure of patent ductus arteriosus from January 2012 to January 2016. Clinical data, anatomical characteristics, and catheterisation procedure parameters were reported. Radiation doses were analysed for the following variables: total air kerma, mGy; dose area product, Gy.cm2; dose area product per body weight, Gy.cm2/kg; and total fluoroscopic time. A total of 324 patients were included (median age=1.51 [Q1-Q3: 0.62-4.23] years; weight=10.3 [6.7-17.0] kg). In all, 322/324 (99.4%) procedures were successful. The median radiation doses were as follows: total air kerma: 26 (14.5-49.3) mGy; dose area product: 1.01 (0.56-2.24) Gy.cm2; dose area product/kg: 0.106 (0.061-0.185) Gy.cm2/kg; and fluoroscopic time: 2.8 (2-4) min. In multivariate analysis, a weight >10 kg, a ductus arteriosus width <2 mm, complications during the procedure, and a high frame rate (15 frames/second) were risk factors for an increased exposure. Lower doses of radiation can be achieved with subsequent recommendations: technical improvement, frame rate reduction, avoidance of biplane cineangiograms, use of stored fluoroscopy as much as possible, and limitation of fluoroscopic time. A greater use of echocardiography might even lessen the exposure.

Transcatheter Occlusion of the Patent Ductus Arteriosus in 747 Infants

ObjectivesThe authors sought to identify risk factors associated with major adverse events (MAEs) in infants <6 kg undergoing transcatheter patent ductus arteriosus (PDA) occlusion. BackgroundTranscatheter PDA occlusion is among the safest of interventional cardiac procedures in adults and older children, but use among infants <6 kg has not been characterized adequately. MethodsUsing the IMPACT (IMproving Pediatric and Adult Congenital Treatments) registry, we identified infants <6 kg undergoing transcatheter PDA occlusion (January 1, 2011, to March 1, 2015). Using mixed-effects multivariate regression, the authors assessed characteristics predictive of MAE or composite failure (procedural failure or MAE). Individual safety metrics (e.g., embolization, malposition) were also examined for differences across weight thresholds: extremely low weight (LW) (<2 kg), very LW (2 to <4 kg), and LW (4 to <6 kg). ResultsTranscatheter PDA occlusion was attempted in 747 infants <6 kg at 73 hospitals. Rate of procedural success was 94.3%. MAEs were observed in 12.6% of cases; the most common events were acute arterial injury and device embolization in 3.5% and 2.4% of cases, respectively. Younger age (<30 days) was associated with greater risk of a MAE (risk ratio: 3.3; 95% confidence interval: 1.5 to 7.6) and composite failure (risk ratio: 3.0; 95% confidence interval: 1.4 to 6.7). Risk of embolization was higher among extremely LW (10.5%) than very LW or LW infants (1.6% and 2.5%, respectively; p = 0.050). ConclusionsAmong infants <6 kg, transcatheter PDA occlusion is technically feasible, but risks of MAE are noteworthy. These findings may help inform patient selection and procedural approach for transcatheter PDA occlusion and direct targeted research efforts to support the practice of evidence-based medicine.

Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland.

This study aimed to report our national experience with transcatheter patent ductus arteriosus (PDA) occlusion in infants weighing <6 kg. The technique of transcatheter PDA closure has evolved in the past two decades and is increasingly used in smaller patients but data on safety and efficacy are limited. Patients weighing < 6 kg in whom transcatheter PDA occlusion was attempted in 13 tertiary paediatric cardiology units in the United Kingdom and Ireland were retrospectively analyzed to review the outcome and complications. A total of 408 patients underwent attempted transcatheter PDA closure between January 2004 and December 2014. The mean weight at catheterization was 4.9 ± 1.0 kg and mean age was 5.7 ± 3.0 months. Successful device implantation was achieved in 374 (92%) patients without major complication and of these, complete occlusion was achieved in 356 (95%) patients at last available follow-up. Device embolization occurred in 20 cases (5%). The incidence of device related obstruction to the left pulmonary artery or aorta and access related peripheral vascular injury were low. There were no deaths related to the procedure. Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.

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.

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

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.

Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants.

To describe the early multicenter, clinical experience with the Medtronic Micro Vascular Plug™ (MVP) for the occlusion of patent ductus arteriosus (PDA) in premature infants. The MVP is a large diameter plug that can be delivered through a microcatheter for occlusion of abnormal blood vessels. A Retrospective review of PDA embolization procedures performed in two centers using the MVP was performed. Fifteen premature infants underwent attempted PDA occlusion using the MVP. The gestational age and birth weight were 25.6 ± 2.5 weeks and 735 ± 251 g, respectively. The median weight and age at the time of the procedure were 1,210 g (700-3,500 g) and 4.5 weeks (2-12 weeks), respectively. Median procedure and fluoroscopy times were 45 and 6.5 min, respectively. The median radiation and contrast doses were 19.7 mGy and 2.4 mL/kg, respectively. Antegrade occlusion was successfully achieved in 13 patients <2 kg with only femoral venous access aided by echo guidance. The two patients >2 kg had arterial access and attempted retrograde occlusion; one of which was unsuccessful due to the PDA being short and wide. Complete closure was observed in 13 of 14 successful procedures (93%), with one patient having a small residual shunt that was not seen on follow-up. There were no complications related to the procedure or noted during follow-up (Median 11 months). The MVP is a new, large-diameter vascular embolization device that may be useful for the occlusion of PDA in extremely small, premature infants. © 2016 Wiley Periodicals, Inc.

Therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion

Objective: To investigate the therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion. Methods: Clinical data of 80 pure patent ductus arteriosus patients who underwent interventional occlusion between February 2011 and November 2014 in General Hospital of Shenyang Military Region were retrospective analyzed.A bolus of heparin calcium (80 U/kg) was administered by intravenous injection during the procedure.Blood test was conducted in all patients before and after the procedure.The patients with both platelet reduction rate ≥ 5% and platelet count <100×109/L(severe thrombocytopenia) were treated by following strategies: bed rest, avoidance of activities, intensive control of blood pressure through sodium nitroprusside administration, and inhibition of presumed immunological reaction by glucocorticoids and human immunoglobulin administration.Follow-up ended in May 2015. Results: (1) A total of 54 cases (67.5%) were diagnosed as thrombocytopenia in second days after the procedure.The reduction rate of platelet in 41 out of 54 patients was equal or more than 5% on the second day, and the diameter of occludes were equal or more than 14 mm in 35 out of these 54 patients.Severe thrombocytopenia occurred in 14 patients and the occluder diameter was ≥ 14 mm in these 14 patients.Severe thrombocytopenia did not occur in patients with occlude diameter <14 mm or with reduction rate of platelet <5%.(2) A total of 14 severe thrombocytopenia patients were treated.No bleeding events occurred in hospital and during the whole follow-up period.The the lowest value of platelet count of patients was seen on the 4.5 (3.8, 6.0) days post the procedure.The lowest numbers were 16.5 (7.5, 37.3)×109/L.The platelet count of patients restored to more than 30×109/L on the 8.0 (4.8, 9.5) days and restore to more than 100×109/L on the 12.0 (9.8, 39.3) days post procedure.The average hospitalization day of the patients were 15.5 (11.8, 21.5) days.The platelet counts of severe thrombocytopenia patients were normal during the end of follow up (median 3.8 (1.0, 4.9) years). Conclusion: The patients with very severe thrombocytopenia after transcatheter occlusion of patent ductus arteriosus are associated with a benign outcome in case of timely and proper treatment.

Transcatheter Patent Ductus Arteriosus Occlusion in Small Infants.

Transcatheter patent ductus arteriosus (PDA) occlusion is feasible in small infants and may improve lung function in symptomatic patients. We aimed to describe transcatheter PDA closure in small infants including predictors of technical success and rate of complication and to identify factors associated with improved respiratory status after closure. All patients in the NICU at our center who were referred for transcatheter PDA occlusion between 1/2010 and 11/2014 were retrospectively identified. Relevant details were extracted. Additionally, a modification of the respiratory severity score (RSS) (FiO2 × mean airway pressure) was used to characterize degree of pulmonary support before and at intervals after catheterization. Twenty patients were identified with median age of 96 days (13-247) and weight of 3.1 kg (1.7-4.7). The PDA was type F morphology in 14 (70%) patients. The PDA was successfully occluded in 16 (80%) patients. Ratio of minimum PDA diameter/length was >0.5 in all unsuccessful attempts and <0.4 in all successful cases (P = .01). Of the 16 cases of occlusion, Amplatzer Vascular Plug II was used in 15 (94%). No deaths or pulse loss occurred. Five (25%) patients required blood transfusion and transfusion was associated with lower hemoglobin (P = .049), lower weight (P = .008), and lower aortic pressure (P = .04). Excluding 1 patient with significant congenital heart disease, the RSS improved at 3 days in 9 (60%) patients and at 7 days in 12 (80%) compared with preintervention value. Patient factors were not associated with improved RSS at 3 or 7 days. In our cohort of symptomatic infants, transcatheter PDA occlusion was successful in most and a ratio of minimum PDA diameter/length of <0.4 was predictive of technical success. Using a surrogate for pulmonary support, the majority of patients were on less support 7 days after closure.

P16 Safety and efficacy of transcatheter PDA occlusion in infants less than 6kgs

<h3>Background</h3> The technique of transcatheter patent ductus arteriosus (PDA) closure has evolved in the past two decades and is increasingly used in smaller patients. We sought to report a multicentre experience of transcatheter PDA occlusion in infants weighing &lt;6kg. <h3>Methods</h3> A multicentre, retrospective analysis of children weighing &lt;6 kg in whom transcatheter PDA occlusion was attempted between January 2004 and December 2014 from 10 tertiary paediatric cardiology units in the UK and Ireland. <h3>Results</h3> A total of 361 patients underwent attempted transcatheter PDA closure. The mean weight at catheterization was 4.8 ± 1.0 kg and mean age was 5.7 ± 2.7 months. Successful device closure was achieved in 321(89%) patients without major complication. Device placement was attempted but failed in in 13 cases. Device malposition or embolization post release occurred in the remaining 27 cases. Of these, 11 patients had surgical retrieval of the embolized device and PDA ligation; 6 patients were referred for surgery at a later date after transcatheter retrieval of device and 10 patients had ductal closure with a different device after transcatheter retrieval of the initial device. In the 331 patients who had transcatheter PDA occlusion, 34 had coils and 297 had occluders, including Amplatzer Duct Occluder (ADO) (n = 197); ADO II (n = 51); ADO II Additional Sizes (n = 42); Amplatzer Vascular Plug (n = 6); Occlutech Duct Occluder (n = 1). Complete occlusion was achieved in a 312(94%) patients at either catheterization or last available follow-up. Three of 19 patients had mild residual flow which persisted at less than a year post procedure; but follow up data was not complete in the rest. There were 17 cases of mild left pulmonary artery (LPA) stenosis related to device impingement with velocity &gt;2m/s; 11 of which resolved with time, 5 had persistent mild LPA stenosis at last review with Doppler velocity of 2.5m/s or less; and 1 underwent LPA stenting. Mild aortic obstruction was recognised in 10 patients during catheterisation or on post procedure echocardiogram, 7 of which resolved; one had persistent increased velocity at the arch with no diastolic tail at last review and 2 had incomplete follow up data. Other complications include loss of pulse requiring TPA (n = 5) temporary reduction in pulse requiring heparin infusion (n = 16); bleeding requiring transfusion (n = 2); anaesthesia or airway related (n = 1); small pericardial effusion (n = 1); haemopericardium requiring percutaneous drainage (n = 1); tricuspid valve injury (n = 1); and cerebrovascular event (n = 1). There were 13 deaths in the cohort which were unrelated to the procedure. The causes of death were mainly related to underlying chronic lung disease and pulmonary hypertension. <h3>Conclusions</h3> Transcatheteter closure of PDA can be safely accomplished in selected infants who are less than 6 kg despite the manufacturer’s recommended weight limit of 6 kg for most ductal occluders. The embolization rate (7%) in this group appeared to be higher than published series in infants &gt;6kg, therefore thorough delineation of ductal anatomy and attention to device selection are vital to the success of the procedure.

A novel approach to ductal spasm during percutaneous device occlusion of patent ductus arteriosus.

Ductal spasm is a rare yet important complication of device occlusions of patent ductus arteriosus. Spasm may result in failure of the procedure, under-sizing of the device, or embolisation of the implanted device as the spasm resolves after the procedure. We describe a novel protocol that rapidly and completely reversed the spasm in eight prematurely born infants who experienced ductal spasm during cardiac catheterisations for patent ductus arteriosus occlusion. In total, eight infants born between 25 and 34 weeks of gestation presented for transcatheter patent ductus arteriosus occlusion between 13 and 87 months of age. All eight patients experienced ductal spasm either immediately before, during, or soon after induction of anaesthesia or only after entering the ductus arteriosus with a catheter. After detection of the spasm, the anaesthetist, in each case, changed the mode of anaesthesia from inhaled sevoflurane to total intravenous anaesthesia with propofol, reduced the inhaled oxygen fraction to 21%, and initiated a continuous intravenous infusion of prostaglandin E1. The first two steps (total intravenous anaesthesia and FiO2 0.21) resulted in only partial relaxation of the spasm. Complete relaxation was attained after intravenous prostaglandin E1 infusions of only 10-15 minutes' duration. While maintaining this protocol, six ducti were successfully occluded and two were considered to be unsuitable for device occlusion and were referred for surgery. Ductal spasm during transcatheter occlusion may be reliably resolved and the procedure safely completed by a simple anaesthetic protocol, including the continuous infusion of intravenous prostaglandin E1.

Comparing study of echocardiography and X-ray angiography on measurement of patent ductus arteriosus

Objective To measure the sizes of patent ductus arteriosus (PDA) by echocardiography, compare the results with those by X-ray angiography(XA), to analysis the correlation of measurements between echocardiography and XA, to explore the value of echocardiography on screening the size of PDA suitable for transcatheter occlusion. Methods One hundred and forty-one participants was included. The parameters of PDA including the length of PDA(PDAL), the aortic side diameter (PDADao) and the pulmonary side diameter of PDA(PDADpa) were measured from the parasternal great artery short-axis view (PSSA) and the suprasternal descending aorta long-axis view(SSLA) of echocardiography and left lateral projection of XA, and the other parameters such as the left ventriclular end-diastolic diameter index (LVEDDI), the main pulmonary artery diameter index(MPADI), the pressure drop of PDA shunt (ΔP) and the pulmonary artery systolic pressure index(PASPI) were measured by echocardiography. The sizes of PDA from PSSA, SSLA and XA were compared, and the correlations of the sizes of PDA between echocardiography and XA, the correlations between the other parameters by echocardiography and the PDADpa index(PDADIpa) by XA(PDADIpa-XA) and PSSA(PDADIpa-PSSA) were analyzed. Results ①The difference of the sizes of PDA: Between PSSA and SSLA had difference on mersurement of PDA(all P 0.05), others echocardiography parameters all had difference on measurement of PDA with XA(all P<0.05). ②Correlation: Both PSSA and SSLA had positive correlations with XA (all P<0.01). And among these parameters, PDAL by SSLA, PDADao by SSLA and PDADpa by PSSA had better correlations with XA (r=0.92, 0.87 and 0.91, respectively, all P<0.01). LVEDDI, MPADI and PASPI had positive correlations with PDADIpa (all P<0.01), the LVEDDI and MPADI had better correlations with PDADIpa-PSSA(r=0.76, 0.72, all P<0.01), but the PASPI had a better correlation with PDADIpa-XA(r=0.70, P<0.01). PASP had a negative correlation with ΔP (r=-0.79, P<0.01). Conclusions There was difference between the sizes of PDA at different echocardiographic views, PDADpa by PSSA and the PDAL and the PDADao by the SSLA were more close to those parameters by XA. Multiplane views of echocardiography can evaluate all the more accurately the size of PDA and play an important role in guiding transcatheter occlusion of PDA. Key words: Echocardiography; Angiography; Ductus arteriosus, patent; Occlude device

Delayed embolization of an Amplatz® canine duct occluder in a dog

A 5-year old, 5.8 kg, castrated male Pomeranian was diagnosed with a type IIa patent ductus arteriosus (PDA) with a minimal ductal diameter of 3.5 mm and ampulla width of 7.1 mm based on angiographic assessment. A 6 mm Amplatz® Canine Duct Occluder (ACDO) was deployed within the PDA. Once deployed, the device assumed it's native shape and back-and-forth maneuvering was performed with the delivery cable to assess device stability. Device position and complete occlusion were confirmed with both angiography and transesophageal echocardiography prior to and after release of the device. The device location was confirmed within the ductus arteriosus by echocardiography prior to discharge. The dog was discharged with instructions for strict activity restriction. Two days after discharge, the dog was left unsupervised in the backyard and shortly afterwards was found coughing with severe respiratory distress. The dog was evaluated at an emergency hospital and thoracic radiographs documented embolization of the ACDO to the main pulmonary artery along with a severe alveolar pattern throughout the right lung fields. Shortly after obtaining thoracic radiographs, the dog experienced cardiopulmonary arrest with unsuccessful resuscitation. This case describes a possible complication of transcatheter PDA occlusion with an ACDO, which has not been previously reported. An incident report, or catalog of adverse events with these devices, may prove useful in identifying additional fatal complications that others may have encountered, but are not reported in the literature. The report of this complication emphasizes the importance of strict activity restriction after device placement in dogs.

Percutaneous transcatheter closure of patent ductus arteriosus: Initial experience of Sohag University

Abstract Objectives Initial experience with transcatheter closure of patent ductus arteriosus (PDA) using different types of devices is reported in Sohag University Hospital. We evaluated the outcome, complications, and also assessed the need of surgical backup for such interventional procedures. Methods From March 2011 to September 2012, 51 patients who underwent transcatheter closure of PDA, were retrospectively identified and studied. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 min after device deployment. Echocardiography was repeated at intervals of 24 h, then at 1, 3, and 6 months after the procedure to assess complications. The PDA was closed by Amplatzer Duct Occluder (ADO) in 40 patients, Nit occlude PFM coil in five patients, Amplatzer muscular VSD in two patients and Detachable Cook coil in four patients . Results Of 51 cases, one patient had left pulmonary artery embolization of ADO that required surgical intervention. The PDA was successfully closed in 98.04% of the study population without any residual PDA shunting. All the patients were alive. Infants made up 29% of the total patients. 45 patients were children and six patients were adults. Conclusion Our initial results show that transcatheter occlusion of PDA using different types of devices is safe and effective with good midterm outcome alternative to surgery. Complications occurred in those with unfavorable duct anatomy and presence of pulmonary hypertension. Surgical backup was not important for such interventional procedures.