Non-surgical closure of large ductus arteriosus using Amplatzer Duct Occluder feasibility and early follow-up results.

The aim of the study was the assess feasibility of closing large patent arterial ducts (PDA) in infants and children using the new Amplatzer Duct Occluder. All patients diagnosed to be having PDA were considered as potential candidates to undergo the device closure. 19 patients were diagnosed to be having PDA larger than 4 mm. There were 10 males and 9 females, their age ranged from 6 months to 120 months with a mean of 45 months. Mean body weight was 14.5 kg with a range from 7 kg to 23 kg. The procedure was carried out under Ketamine sedation and local anesthesia. The device was implanted by the transvenous route in all. Mean PDA diameter was 5 mm (range 4 mm-6.7 mm). Complete closure was achieved in 16/18 (88%) within 24 hours of the procedure. All patient have been followed for 3 months, and have documented complete closure, there is no evidence of aortic or left pulmonary stenosis in any of our patients. The unsuccessful attempt was in a malnourished patient (weighing 4.7 kg) with an arterial duct measuring 6.7 mm on angiography. This duct was considered too big for device closure and the procedure was abandoned. This patient subsequently has undergone successful surgical ligation. Catheter closure of large PDA in small children is feasible, safe and efficacious. However, it may still not be possible to close large PDA in very small or underweight children, for the fear of causing obstruction to the descending aorta. Further long-term is follow-up required to show sustained benefits without any side effects.

Transcatheter closure of patent ductus arteriosus.

OBJECTIVE: To present short and intermediate results of catheter closure of patent ductus artereiosus using spring coils and Amplatzer duct occluder. SETTING: Tertiary care referral hospital in New Delhi. METHOD: 121 patients were diagnosed to be having patency of the arterial duct between October 1996 and December 1999. Their ages ranged between 4 mo and 480 mo (mean 80.5 mo). Before August 1998 only spring coils were used as an alternative to surgical closure of the duct, whereas between August 1998 and December 1999 both coils and device were used. RESULTS: Spring coils were attempted in 48, Amplatzer duct occluder in 44 and 29 patients were referred for surgery. Coils were successfully deployed in 42/48 (87.5%) and device in 42/44 (95.5%) patients. Complete closure of the arterial duct was seen in 96% patients in the coil closure group at the end of one year and 100% closure was achieved in the device closure group at the end of 3 months in all the patients followed. Coil embolised in 11 patients, significant stenosis of left pulmonary occurred in one patient and severe hemolysis requiring blood transfusion occurred in one patient after coil closure. Six patients required a second procedure to close the residual shunt within 6 months of the initial coil deployment. One patient had loss of femoral artery pulses in right leg after device closure and required heparin infusion for 48 hours. There were 8 failed attempts. All these patients have been operated successfully. CONCLUSION: Percutaneous closure of the patent ductus arteriosus using Coils or the Amplatzer device is an acceptable method. Small residual shunts are common after the initial procedure especially after coil deployment but most close spontaneously.

Non surgical closure of atrial septal defect using the Amplatzer septal occluder in children--feasibility and early results.

OBJECTIVE: To assess the feasibility and early results of Amplatzer septal occluder in children withy secundim atrial septal defect. SETTING: Tertiary care referral hospital in New Delhi. METHODS: Forty nine children under 12 years of age were diagnosed to be having fossa ovalis atrial septal defect. Forty nine patients underwent detailed 2D-Echocardiography and color Doppler interrogation for the possibility of non-surgical closure of ASD. Sixteen children between age 2.5-12 years (mean 6.5 years) were enrolled into the study. Their weight ranged from 10 kg to 42 kg and there were 9 males and 7 females. The remaining 33 were not considered suitable for device closure in echocardiography and were referred for surgery. RESULTS: All patients had more than 1.8 : 1 shunt. The device was successfully deployed in 13/16 patients. ASD stretched diameter ranged between 13 mm-30 mm (mean 15 mm) and the device size ranged between 14 mm-22 mm. One patient had fenestrated ASD, in this patient the largest of the defect was crossed and closed with 24 mm device resulting in closure of all three defects. We failed in three of our attempts, on one there were deficient inferior margins while in the other two cases the ASD stretched size was such that the device would have encroached upon adjacent structures, hence the procedure was abandoned. All these patients have been operated successfully. Complete abolition of shunt was seen in 38% patients in the immediate post deployment period. At 24 hours complete closure was seen in 12/13 (92%) patients while one patient had trivial residual shunting across the device. This patient also achieved complete closure of atrial shunting when evaluated at three months follow-up. CONCLUSION: Device closure of ASD is emerging as an alternative to surgical closure. However, with the currently available device only a limited number of atrial septal defects can be closed. Long-term studies are required to show sustained benefits and absence of side effects of this device.