Transcatheter occlusion of moderate to large sized patent ductus arteriosus using amplatzer duct occluder: an Attractive alternative to surgery

ABSTRACT

The PDA coming to medical attention in our set up are generally large and surgery has been the standard form of treatment. Use of coils and other devices for such large PDA's is challenging and may be accompanied by up to 38 percent incidence of residual shunts. The aim of this study was to assess the immediate and short-term results of anterograde catheter closure of moderate to large sized patent ductus arteriosus [PDA] using the new self-expandable, respositionable Amplatzer duct occluder [ADO] device. Thirteen patients [6M, 7F] underwent attempted transcatheter closure of a PDA using the ADO at a mean age of 9.1 years [range 2 to 15] and a mean weight of 24.8kg [range 8 to 53]. The mean PDA diameter at its narrowest segment was 4.8 +/- 1.5 mm. Follow-up evaluation was performed with chest x-ray and color flow mapping within 24 hours and at 1 month after closure. All thirteen patients had successful device placement. Angiography showed that 9 patients had complete immediate closure, 3 had a trace shunt [foaming through the device with no jet], and 1 had a small residual shunt [with a jet]. Within 24 h, color Doppler revealed complete closure in all patients. The median fluoroscopy time was 10.3 min [range 6.8 to 16], All patients were discharged home the next day. There were no complications. Of the 13 patients, 12 completed the 1-month follow-up, all [95 percent confidence interval [Cl] 86 percent to 100 percent] with complete closure. Anterograde transcatheter closure using the new ADO is an effective therapy for patients with moderate and large PDA diameter up to 10mm. It is a safe and attractive alternative to surgical closure