Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults

Background Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. Methods This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Results Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. Conclusions In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.

Prolonged reflex bradycardia after occlusion of patent ductus arteriosus with an Amplatz canine duct occluder in a dog

A 9-month-old intact male Maltese dog (1.52 kg) was diagnosed with a patent ductus arteriosus (PDA). Transcatheter occlusion of the PDA was performed by using the Amplatz canine duct occluder (ACDO). After occlusion, reflex bradycardia occurred and lasted for at least 15 h with normal systolic arterial pressure and slightly increased diastolic arterial pressure. The bradycardia slowly resolved, and the heart rate was normal in re-examinations after 7 and 30 days. This is the first case of reflex bradycardia after ACDO implantation, in which the bradycardia continued for a long time, even after recovery from anesthesia.

Interventional therapy for pediatric congenital heart disease with second generation amplatzer duct occluder / 中国介入心脏病学杂志

Objective To summarize the clinical experience and efficacy of interventional therapy for pediatric congenital heart disease(CHD) with the Amplatzer Duct Occluder Ⅱ (ADO-Ⅱ). Methods A total of 24 patients had received intervention of CHD with the ADO-Ⅱ,including 18 patients of patent ductus arteriosus(PDA),2 patients of ventricular septal defect(VSD) of muscular part,and 4 patients of coronary artery fistula.All patients were screened by transthoracic echocardiogram before the operations.preoperative. Transthoracic echocardiography was performed to determine the device position, residual shunt and procedural complications during and after ADO-Ⅱ implantation.Results 16 patients with PAD had suecessful transcatheter closure without residual shunt and other complications during the follow-up.Minimal residual shunt was found in 2 PDA patients immediately after the occlusion which became undetectable on control echocardiography the day after operation.3 coronary artery fistula patients had suecessful transcatheter closure without residual shunts,and minimal residual shunt was found in 1 patient with coronary artery fistula at 1 month follow up.All the 2 of VSD patients had suecessful transcatheter closure without residual shunts. No complication and no atrioventricular conduction block were found in these 2 patients. Conclusions Transcatheter closure using the ADO-Ⅱ is safe and effective for interventional therapy for pediatric congenital heart disease.

Interventional therapy for pediatric congenital heart disease with second generation amplatzer duct occluder / 中国介入心脏病学杂志

Objective To summarize the clinical experience and efficacy of interventional therapy for pediatric congenital heart disease(CHD) with the Amplatzer Duct Occluder Ⅱ (ADO-Ⅱ). Methods A total of 24 patients had received intervention of CHD with the ADO-Ⅱ,including 18 patients of patent ductus arteriosus(PDA),2 patients of ventricular septal defect(VSD) of muscular part,and 4 patients of coronary artery fistula.All patients were screened by transthoracic echocardiogram before the operations.preoperative. Transthoracic echocardiography was performed to determine the device position, residual shunt and procedural complications during and after ADO-Ⅱ implantation.Results 16 patients with PAD had suecessful transcatheter closure without residual shunt and other complications during the follow-up.Minimal residual shunt was found in 2 PDA patients immediately after the occlusion which became undetectable on control echocardiography the day after operation.3 coronary artery fistula patients had suecessful transcatheter closure without residual shunts,and minimal residual shunt was found in 1 patient with coronary artery fistula at 1 month follow up.All the 2 of VSD patients had suecessful transcatheter closure without residual shunts. No complication and no atrioventricular conduction block were found in these 2 patients. Conclusions Transcatheter closure using the ADO-Ⅱ is safe and effective for interventional therapy for pediatric congenital heart disease.

Clinical study application of Amplatzer duct occluder Ⅱ to occlude aortopulmonary collateral arteries / 中国介入心脏病学杂志

Objective To assess the feasibility and efficacy of Amplatzer duct occluder Ⅱ (ADOⅡ) in occlusion of aortopulmonary collateral arteries. Methods Seven patients,6 males and 1 female, with aortopulmonary collateral circulation diagnosed previously by cardiac Computed Tomograpy or cardioangiography from Mar 2014 to Apr 2015 were enrolled. All of them were treated with ADO Ⅱ. Results The age of the patients ranged between 5 - 71 months old and weight 4. 2 - 22. 0 kg. Successful hybrid approach was achieved in 6 of 7 patients. One patient failed the occlusion because of severe hypoxemia and mild-moderate residual shunt after catheter intervention. Total 15 aortopulmonary collateral vessels were embolized by 7 ADO-Ⅱ, 22 non-detachable coils ( Cook corp. ) and 2 detachable micro-coils ( Boston Scientific corp. ). Complete embolization was achieved in 2 patients,4 patients had mild residual shunt and 1 patient had mild-moderate residual shunt after the embolisation. No interventional complications recorded. Conclusions ADO Ⅱ has high controllability and suitable for application through small delivery catheter for minimally-invasive procedures to the vessels. It is a preferable alternative in treating pediatric patients with large and tortuous aortopulmonary collateral arteries.

Estudio de la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder en niños / Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children

Objetivo: La reducción en la perfusión pulmonar se ha descrito tras el cierre percutáneo del conducto arterioso permeable con varios dispositivos. Evaluamos la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso con el dispositivo Amplatzer Duct Occluder utilizando la gammagrafía pulmonar de perfusión. Métodos: Treinta pacientes con oclusión transcatéter exitosa del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder fueron incluidos en este estudio. La gammagrafía pulmonar de perfusión se realizó 6 meses después del procedimiento. Las velocidades de flujo máximo y la protrusión del dispositivo fueron analizadas por ecocardiografía Doppler. Una perfusión pulmonar izquierda < 40% se consideró anormal. Resultados: El implante del dispositivo fue exitoso en todos. La media de perfusión hacia el pulmón izquierdo fue de 44.7 ± 4.9% (37.8-61.4). Cinco pacientes (16.6%) mostraron disminución en la perfusión pulmonar izquierda. Tanto la edad y el peso bajo, así como la longitud del conducto arterioso y la relación diámetro mínimo y máximo con la longitud del conducto arterioso fueron estadísticamente significativos en los pacientes con anomalías de la perfusión pulmonar. Se observó protrusión del dispositivo en 6 pacientes con una velocidad de flujo máximo mayor en la arteria pulmonar izquierda. Conclusión: La perfusión pulmonar izquierda puede comprometerse tras el cierre percutáneo del conducto arterioso con el Amplatzer Duct Occluder. El aumento en la velocidad de flujo en el origen de la arteria pulmonar izquierda puede ser un pobre indicador de la reducción en la perfusión pulmonar y puede ocurrir en ausencia de protrusión del dispositivo.

Objective: The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. Methods: Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion < 40% was considered abnormal. Results: The device implantation was successful in all patients. Average perfusion of left lung was 44.7 ± 4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. Conclusion: The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.

Surgical Removal of Amplatzer Duct Occluder for a Patent Ductus Arteriosus / 日本心臓血管外科学会雑誌

A 1-year-old girl with patent ductus arteriosus (PDA) was admitted for cardiac catheter examination which identified a 7.8 mm Krichenko D type PDA. An Amplatzer duct occluder (ADO) was used but fluoroscopy showed the device at an oblique angle and residual shunt. The girl underwent surgical removal of the device 2 days after deployment because of progression of residual PDA shunt and left pulmonary artery encroachment, suggesting device dislodgement. Median sternotomy was performed, cardiopulmonary bypass was established and dissection was carried out around the PDA. Marked protrusion of the PDA wall made by the ADO retention disc was noted. The main pulmonary artery was incised under cardioplegic arrest. The device was incarcerated in PDA and attempts to remove the device failed. Therefore delivery cable through sheath was reconnected to the device by its microscrew, and the pulmonary end of the device was recaptured into sheath. The incarceration was dissolved and the device was removed. PDA was ligated.

Cierre percutáneo del conducto arterioso permeable en niños con el Amplatzer Duct Occluder II / Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II

Introducción: En las últimas décadas, varios dispositivos se han utilizado para el cierre percutáneo del conducto arterioso permeable con sus propias limitaciones y riesgos. El Amplatzer Duct Occluder II ha sido diseñado para mejorar dichas limitaciones y reducir complicaciones. Objetivo: Presentar una serie inicial de pacientes llevados a cierre percutáneo del conducto arterioso con el Amplatzer Duct Occluder II, enfatizando en los aspectos técnicos del procedimiento. Métodos: Analizamos los registros clínicos de 9 pacientes con conducto arterioso permeable, llevados a cierre percutáneo con el Amplatzer Duct Occluder II. La mediana de edad fue de 24 meses (8-51 meses) y del peso de 10.7 kg (6-16.3 kg). El diámetro mínimo del conducto arterioso permeable fue de 2.7 mm (1-5 mm). Resultados: El implante fue exitoso en todos los casos. Los dispositivos más utilizados (33.3%) fueron los de dimensiones 4-4 mm (3 pacientes), en 2 pacientes se utilizó de 3-4 mm y en el resto de los pacientes se emplearon oclusores de otros tamaños. Cuatro casos mostraron flujo residual leve inmediatamente después del cierre. El cierre total a las 24 h se logró en 8 de 9 niños (89%). No hubo embolización del dispositivo o mortalidad con el procedimiento y solo observamos una complicación menor. Conclusión: El Amplatzer Duct Occluder II en esta serie de casos fue efectivo en el 89% de los pacientes a las 24 h y en el 100% al seguimiento. Su implante fue seguro debido a que no hubo complicaciones mayores. La tasa de oclusión es comparable a la informada para el Amplatzer Duct Occluder I.

Introduction: In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. Objective: We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. Methods: We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7 kg (range 6-16.3 kg). The minimal ductus arteriosus diameter was 2.7 mm (1-5 mm). Results: Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4 mm (3 patients), in 2 patients were used 3-4 mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24 h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. Conclusions: The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24 hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I.

Clinical Study of Trans-catheter Closure of Patent Ductus Arteriosus with Occluder Devices among Children Aged 9 Months to 18 Years.

Background and Objectives: This study was aimed at determining our experience with occluder devices over last 5 years. The objective of this study is to compare the complication rates and efficacy of different devices used for the closure of PDA. Methods: A cross-sectional retrospective study in which a review of the records of all children who had PDA surgery in a paediatric cardiac center, Innova Childrens’ Heart Hospital, Hyderabad, India over a five year period (June 2007 and July 2011) was undertaken. The hospital records showed that from June 2007 to July 2011, a total of 456 children aged 9 months to 18 years had trans-catheter closure over the study period, of these, 159 underwent trans-catheter device closure of PDA. A team of experienced paediatric cardiologist performed all the procedures. Results: Out of the 159 cases, 134 (84.2%) were successful while 25 (15.7%) were complicated. Five (5) {20.0%} cases had temporary residual leak, 3 (12.0%) had failure of the procedure that required surgical intervention, 9 (36.0%) had protrusion of the device into the aorta without significant Doppler pressure gradient. There exist a relation between success, complication and device used for the procedure.The type of occluder device used for the procedure significantly affect the outcome (χ2 = 16.37; p = 0.02) Chinese occlude devise had the highest success rate. Twenty five (25.0) {15.7%} patients had complications in all. The commonest complication (protrusion of the device into the aorta) was seen in 3 (1.8%) cases with Chinese duct occluder, 3(1.8%) with Sear Heart R and 3 (1.8%) cases with ADOs. Non died from the procedure. Conclusion: The commonest complication is (protrusion of the device into the aorta) with Chinese occludes devise showing the highest success rate. The learning curve and accumulating experience play an indispensable role in choosing the proper device and its size.

Use of Amplatz(R) canine duct occluder for closing a patent ductus arteriosus in a small-sized dog / 동물의과학연구지

A 2-year-old intact female pomeranian dog presented dyspnea, labored breathing, cough, exercise intolerance, machinery heart murmur, and precordial thrill. A left-to-right patent ductus arteriosus (PDA) was diagnosed based on two-dimensional echocardiography, thoracic radiography, electrocardiography, and blood work. An angiography was performed to accurately evaluate the size and shape of the duct. An interventional approach for transcatheterial occlusion of the PDA was achieved using an Amplatz(R) Canine Duct Occluder (ACDO), which is a commercially available ductal occluding device. Due to the limited size of the dog's femoral artery, a device smaller [125% of minimal ductal diameter (MDD); recommended size: 150~200% of MDD] than recommended was mounted. After placement of the ACDO, precordial thrill and continuous heart murmur disappeared, and the patient was discharged the next day after stabilization with O2 supply. Upon follow up examination, dyspnea, labored breathing, cough, exercise intolerance, and cardiomegaly were improved with no complications after the procedure. The ACDO was well maintained in position. This case represents successful clinical application of the Amplatz(R) Canine Duct Occluder to achieve closure of a PDA using a slightly smaller device than the recommended size.

The hybrid perventricular closure of apical muscular ventricular septal defect with Amplatzer duct occluder / 소아과

PURPOSE: Apical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO). METHODS: We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side. RESULTS: The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients. CONCLUSION: Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.

Transcatheter Closure of Patent Ductus Arteriosus: The Penang Hospital’s Experience

Transcatheter closure of small and moderate sizes of Patent Ductus Arteriosus (PDA) is a standard and well accepted form of treatment. The aim of this study is to describe the experience of transcatheter closure of PDA in Penang Hospital. All patients who underwent transcatheter closure of PDA at our institution between 20th January 2006 and 27th June 2008 were retrospectively identified and studied. There were a total of 66 patients who had undergone transcatheter closure of PDA during this period which comprised of 24 male and 42 female. The PDA was closed by Amplatzer Duct Occluder (ADO) in 31 patients, Gianturco coil in 29 patients and other types of devices in 6 patients. There were 4 patients (6%) who had developed acute complication during the procedure (3 of them developed coil embolization and 1 had bleeding from puncture site). The PDA was successfully close in 95.5% of the study population without any residual PDA shunting. All the patients were alive but 5 of them (4.5%) have some abnormalities (2 has mild left pulmonary stenosis, 3 has small residual). Comparison between ADO and Gianturco coil revealed no significant difference in the outcome. Transcatheter closure of PDA has proven to be safe and effective with good midterm outcome. There was no significant difference between Amplatzer Ductal Occluder and Gianturco coil in term of the outcome.