Types Of Patent Ductus Arteriosus Research Articles

Comparison and Results of Transcatheter Closure of Patent Ductus Arteriosus Using the Swivel-Disk Device Versus Plug Occluder in Children

The transcatheter closure of certain types of patent ductus arteriosus (PDA) remains a challenge. The investigators report initial clinical experience with 25 patients who underwent PDA occlusion with the use of a swivel-disk device (SDD) or a plug occluder (PO). The patients were divided into 2 groups: in the SDD group, 12 patients aged 1 to 2 years with type A PDA underwent attempted closure using the SDD, a modified Amplatzer duct occluder with a very low profile retention disk that can adapt itself at different PDA insertion angles. The mean PDA diameter was 4.8 +/- 1.5 mm (range 3.8 to 8). In the PO group, 13 patients aged 0.5 to 3 years with type C, D, or E PDA underwent attempted occlusion with the PO, a tubular occluder made of Nitinol wire mesh. The mean PDA diameter was 4.2 +/- 3.5 mm (range 1.2 to 9). The 2 occluders are filled with Dacron patches. The mean device diameters were 6.5 +/- 1.2 and 6.8 +/- 2.2 mm (range 4 to 11) in the SDD and PO groups, respectively. Complete angiographic closure was seen in 24 of 25 patients. The deployment of 4 5-PDA5 coils abolished a residual shunt associated with hemolysis in a 5-month-old patient with a large type C PDA after the implantation of an 11-mm PO. No other complications were observed. In conclusion, the SDD and the PO are promising additions to the armamentarium for PDA closure.

Unsuccessful Percutaneous Transcatheter Occlusion of A Patent Ductus Arteriosus and Surgical Treatment

The traditional percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus due to morphological abnormalities. The anatomic changes of the patent ductus arteriosus in adult patients, such as being short or sometimes friable, could complicate its transcatheter occlusion. In this study, we reported successful surgical closure of our case with patent ductus arteriosus of abnormal morphology under the light of literature who underwent an unsuccessful attempt of transcatheter occlusion.

PERCUTANEOUS TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH AN AMPLATZER DUCT OCCLUDER USING RETROGRADE GUIDEWIRE‐ESTABLISHED FEMORAL ARTERIOVENOUS LOOP

1. The traditional antegrade wire-guided percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus (PDA) with abnormal morphology. The aim of the present study was to evaluate the efficacy of a retrograde wire-guided transcatheter approach for closure of some types of PDA using the Amplatzer duct occluder (ADO). 2. Nineteen patients with abnormal PDA morphology, including a smaller ostium of the side of the pulmonary artery compared with the side of the descending aorta, severe calcification or tortuosity, were included in the present study. In these patients, after the antegrade approach failed to cross a wire from the pulmonary artery via the PDA to the descending aorta, a retrograde guidewire was passed through the PDA in the opposite direction, from the descending aorta to the pulmonary artery, to establish a femoral arteriovenous loop that assisted the deployment of the ADO in all 19 patients. The size of the PDA, as determined by angiography, was 3.1 +/- 1.1 mm and the diameter of the ADO selected was 6.5 +/- 1.5 mm. 3. In 16 cases, systolic murmur disappeared after the procedure. Systolic murmur (less than Grade II) and angiographic residual shunt remained in three cases immediately after the procedure, but disappeared 1 month later. Mean pulmonary arterial pressure decreased from 33 +/- 8 to 22 +/- 4 mmHg in all 19 patients (P < 0.01). There were no complications during or after the procedure. 4. The retrograde wire-guided technique offers an alternative approach to facilitate closure of a PDA that cannot be achieved by traditional antegrade wire-guided methods due to morphological abnormalities in the PDA.

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.

Transcatheter embolisation of patent ductus arteriosus using an Amplatzer vascular plug in six dogs

The objective of this study was to assess the feasibility of transcatheter embolisation of a patent ductus arteriosus using an Amplatzer vascular plug (Amplatzer Medical UK) in six dogs. The Amplatzer vascular plug is a self-expandable, cylindrical device attached to a delivery cable. In all the dogs, the device was delivered transvenously. Successful device implantation was defined as firm anchorage of the device squarely within the distal part of the ductus arteriosus with no intra- or postoperative dislodgement. Successful occlusion of the ductus arteriosus occurred if a disappearance of the continuous murmur was achieved 24 hours after placement of the Amplatzer vascular plug. The age of the dogs ranged from 16 weeks to 7.5 years. Their weights ranged from 2.9 to 27.6 kg (median 6 kg). Two dogs had congestive heart failure before embolisation. Successful device implantation was achieved in all dogs. Successful occlusion of the ductus arteriosus was achieved in four of the six dogs. Complications included mild lameness, residual shunting, and bruising and pruritus around the surgical wound site. At follow-up, two dogs had a continuous murmur and one required treatment for congestive heart failure. This technique may represent a clinically effective and less expensive alternative to the use of an Amplatzer duct occluder (Amplatzer Medical UK) in dogs with medium-sized patent ductus arteriosus. Further investigations are required to fully evaluate its efficacy and safety in various sizes and types of patent ductus arteriosus, and to determine the optimal device size in relation to the size of the ductus.

The Right-Sided Window Ductus: A Rare Anatomical Entity

A rare type of patent ductus arteriosus called window ductus was identified in association with a right aortic arch in a 1-year-old child who was referred for closure of a membranous ventricular septal defect.

New device for percutaneous closure of aortopulmonary collaterals

A 4.5-month-old infant with tetralogy of Fallot, pulmonary atresia, and multiple aortopulmonary collaterals underwent successful occlusion of the collaterals using a new device. This new plug (Amplatzer vascular plug) is a self-expandable cylindrical device made of nitinol wire mesh. The device is available in sizes from 4 to 16 mm in 2 mm increment. The device can be used in patients with aortopulmonary collaterals, pulmonary arteriovenous malformations, venovenous collaterals, shunts, coronary fistulas, and certain type of patent ductus arteriosus.

Comprehensive assessment of patent ductus arteriosus by echocardiography before transcatheter closure

Background: Anatomic type and angiographic measurements of patent ductus arteriosus (PDA) are used to determine the suitability of transcatheter closure (TCC). The purpose of this study is to evaluate whether these PDA features can be obtained by 2-dimensional echocardiography (2DE). Methods: We retrospectively compared PDA measurements and type from 36 patients submitted to TCC between November 1995 and October 2000. Results: The patient age ranged between 2 months to 10.5 years (median = 1.2 years). A significant correlation was found between measurements of PDA minimal diameter ( R 2 = 0.88) and diameter at aortic ostium ( R 2 = 0.72); whereas a poor correlation existed between measurements of the ampulla length. The 2DE and angiographic PDA classification were concordant in 31 of 36 (86%) patients. Conclusion: Our data support the use of 2DE measurements of PDA minimal diameter and PDA diameter at the aortic end to assess suitability for TCC. In the majority of cases, PDA type can be diagnosed by 2DE. (J Am Soc Echocardiogr 2002;15:1154-9.)

Early reopening and recanalization after successful coil occlusion of the patent ductus arteriosus

Background Controversy exists regarding early reopening and recanalization after successful (complete) coil occlusion of the patent ductus arteriosus (PDA). Methods Patients with successful PDA coil occlusion were reviewed with regard to PDA size and type, coil size, number of coils, and delivery technique. Follow-up echocardiograms at <24 hours, 6 months, and >12 months were reviewed for residual PDA shunt, left pulmonary artery (LPA) stenosis, and aortic obstruction. Results Successful coil occlusion was achieved in 94 patients. On the initial (<24 hours) echocardiogram, 76 of 92 (83%) had complete PDA occlusion, 5 of 92 (5%) had mild LPA stenosis, and no patient had aortic obstruction. Follow-up at 6 months was available in 70 patients, 57 with complete occlusion on the initial echocardiogram. PDA reopening was found in 3 of 57 patients (5%). Larger PDA diameter was associated with residual shunt (2.40 ± 0.40 mm versus 1.87 ± 0.53 mm; P <.01). Disagreement between the initial and 6-month echocardiogram was found in 11 of 70 patients (16%). Intermediate follow-up (median, 30 months; range, 12 months to 5.3 years) was available in 46 patients, 38 with complete occlusion on the 6-month echocardiogram. No patient (0 of 38) with a normal echocardiogram at 6 months developed recanalization, LPA stenosis, or aortic obstruction. Conclusion These data suggest that: (1) routine echocardiography immediately after PDA coil occlusion is unnecessary; (2) early PDA reopening is uncommon; and (3) PDA recanalization does not occur if complete echocardiographic closure is documented 6 months after coil occlusion. Additional follow-up examination in these patients may not be necessary. (Am Heart J 2002;143:889-93.)

The snare-assisted technique for transcatheter coil occlusion of moderate to large patent ductus arteriosus: immediate and intermediate results

OBJECTIVESThe purpose of this study was to evaluate the feasibility, safety and efficacy of using a snare-assisted technique to coil occlude the moderate to large size patent ductus arteriosus (PDA).BACKGROUNDTranscatheter occlusion of small PDAs using Gianturco coils is safe and effective. However, in larger size PDAs and/or those with short PDA length, the procedure still carries risks of coil embolization, incomplete occlusion and failure to implant the coil.METHODSFrom January 1994 to June 1997, the records of 104 consecutive snare-assisted coil occlusions of moderate to large PDAs (minimum diameter >2.0 mm) were reviewed. Immediate and intermediate outcomes including complete and partial occlusion, failure to implant and complications were analyzed with respect to ductal type and size.RESULTSPatient age ranged from 0.1 to 70.1 years (median 3.3 years). Minimum PDA diameter ranged from 2.1 to 6.8 mm (mean 3.0 ± 0.9 mm). Angiographic types were A-62, B-13, C-6, D-14 and E-9. Using the snare-assisted technique, coil placement was successful in 104/104 patients (100%), irrespective of size or angiographic type. Immediate complete closure was observed in 73/104 (70.2%) and was related to smaller PDA size, but not to angiographic type. Complete closure was documented in 102/104 (98.1%) at 2- to 16-month follow-up. Successful closure was unrelated to PDA size or type. Coil embolization to the pulmonary artery occurred in 3/104 (2.9%) patients and was not related to PDA size or type. The need for multiple coils was found in 28/104 patients (26.9%), and was related to larger PDA size, but not to angiographic type.CONCLUSIONSThe snare-assisted delivery technique allows successful occlusion of moderate to large PDAs up to 6.8 mm, irrespective of angiographic type. This technique permits improved control and accuracy of coil placement, and facilitates delivery of multiple coils.

Follow-up results of transvenous occlusion of patent ductus arteriosus with the buttoned device

OBJECTIVESThe purpose of this presentation is to document results of buttoned device (BD) occlusion of patent ductus arteriosus (PDA) in a large number of patients with particular emphasis on long-term follow-up in an attempt to provide evidence for feasibility, safety and effectiveness of this method of PDA closure.BACKGROUNDImmediate and short-term results of BD occlusion of PDA have been documented in a limited number of children.METHODSDuring a six-year period ending August 1996, transcatheter BD closure of PDA was attempted in 284 patients, ages 0.3 to 92 years (median 7) under a protocol approved by the local institutional review boards and FDA with an investigational device exemption in U.S. cases.RESULTSThe PDAs measured 1 to 15 mm (median 4) at the narrowest diameter; 20 were larger than 8 mm and 10 larger than 10 mm. They were occluded with devices measuring from 15 to 35 mm delivered via 7F (N = 140) or 8F (N = 144) sheaths. Successful implantation of the device was accomplished in 278 (98%) of 284 patients. The Qp:Qs decreased from 1.8 ± 0.6 (mean ± SD) to 1.09 ± 0.19 (p < 0.001). Effective occlusion defined as no (N = 167 [60%]) or trivial (N = 79 [28%]) residual shunt was achieved in 246 (88%) patients. All types of PDAs, irrespective of the shape (conical, tubular or short), size (small or large) or length (short or long) of the PDA and previously implanted Rashkind devices, could be occluded. Follow-up data, 1 to 60 months (median 24) after device implantation, were available in 234 (84%) patients. Seven (3%) patients required reintervention to treat residual shunt with (N = 2) or without (N = 5) hemolysis. Actuarial reintervention-free rates were 95% at 1 and 5 years. There was gradual reduction of actuarial residual shunts and were 40%, 28%, 21%, 14%, 11%, 10%, 6% and 0% respectively at 1 day, 1, 6, 12, 24, 36, 48 and 60 months after device implantation. Incorporation of folding plug over the button loop in 10 additional patients produced immediate and complete occlusion of PDA.CONCLUSIONSThis large multiinstitutional experience confirms the feasibility, safety and effectiveness of buttoned device closure of PDAs. All types of PDAs irrespective of the shape, length and diameter can be effectively occluded. Incorporation of folding plug over the button loop produces complete PDA occlusion at the time of device implantation.

The Large Window Ductus: A Surgical Trap

A rare window type of patent ductus arteriosus is reported that was large (15 mm in maximal transverse dimension) but had virtually no length and hence was externally invisible. The smaller aortic isthmus (4 mm in diameter), which was intrapericardial, was mistaken for the ductus and was inadvertently clip-occluded, leading to death. After a specific diagnosis is made, the large window ductus should be patched on cardiopulmonary bypass with a transpulmonary approach.

Reopening After Successful Coil Occlusion for Patent Ductus Arteriosus

Objectives. This study was performed to determine the frequency of patent ductus arteriosus (PDA) reopening and the factors that may predict reopening after successful coil occlusion.Background. Transcatheter coil occlusion is a widely used and accepted method to close a PDA. After documented successful coil occlusion, we found PDAs that reopened. We hypothesized that specific factors are involved in those that reopened.Methods. All patients who underwent percutaneous transarterial PDA coil occlusion were studied. Successful coil occlusion was documented. PDA reopening was determined when Doppler-echocardiography (DE) performed after the procedure was negative for PDA flow but at follow-up demonstrated PDA shunting. Patients with a reopened PDA were compared with all other patients in evaluating independent variables.Results. Coil occlusion for PDA was attempted in 22 patients. Clinical success was achieved in 20 patients (91%), and DE was negative for PDA shunting in 19 patients (90%). At follow-up, five patients demonstrated reopening. The PDA minimal diameter was 1.4 ± 0.5 mm (mean ± SD) for the reopened group and 1.2 ± 0.7 mm for the other patients. The PDA length was 2.9 ± 1.9 mm for the reopened group and 7.1 ± 3.2 mm for all other patients. All those with type B PDA were in the reopened group. When independent variables were compared between groups, only PDA length and type B PDA predicted reopening (p < 0.05).Conclusions. PDA reopening may occur after successful coil occlusion. Short PDA length and type B PDA are associated with reopening. The data suggest that in such anatomy, alternative strategies to the current coil occlusion technique should be considered.

783-4 Follow-up Results of Transvenous Occlusion of Patent Ductus Arteriosus with the Adjustable Buttoned Device

During a 4-year period ending July 1994, 81 patients underwenttranscatheter occlusion of patent ductus arteriosus (PDA) with the adjustable buttoned device at 22 institutions around the world under an IRB-approved custom-made device protocol. The device is a modified version of the Sideris’ buttoned device for atrial septal defect closure. The patients were 11 mo to 65 years (median. 7.0 years) with weight range of 7.2 to 90 kg (median. 19 kg) The PDAs measured 1 to 15 mm (median, 4 mm) at the narrowest diameter; fifteen were larger than 8 mm and three larger than 10 mm with a Qp:Qs range of 1.3 to 3.2. They were occluded with devices measuring 15 to 35 mm; all but 10 were delivered via #7-French sheaths. Ten devices ≥ 25 mm were delivered to the implantation site via #8-French sheaths. 78 of 81 (96%) were implanted at first attempt. In all three with device dislodgment, the device was retrieved via the sheath and two of these underwent PDA occlusion with larger devices and third patient had elective surgical closure of PDA. Small residual shunts detected by color Doppler were present in 31 (39%) patients. Forty-one patients were followed for 1 to 24 months (8 ± 7 mo) with clinical, chest x-ray and echo-Doppler evaluation. None required repeat intervention. The device was found intact on chest x-ray and echo. No evidence for thromboembolism, endocarditis or hemolysis was found nor was there evidence for descending aortic or left pulmonary artery obstruction. Percent incidence of residual shunt by color Doppler gradually decreased and was 39,21.15.13 and 0% respectively at 1 day. 1.6,12 and 24 months following device implantation. Based on these data it is concluded that 1) transvenous occlusion of PDA is feasible, effective and safe, 2) small-sized sheaths (7-French in most, 8French in some) are adequate for all ductus sizes, 3) all types of PDAs (conical, tubular and short) and both long and short PDAs can be occluded because of the adjustable button loop design of the device. 4) further improvementlminiaturization may eventually result in extending the procedure to neonates and premature infants.