ABSTRACT
OBJECTIVE: To determine the efficacy, safety and immediate complications encountered during percutaneous device closure of patent ductus arteriosus (PDA). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Paediatric Cardiology, AFIC/NIHD, Rawalpindi, from January 2005 to December 2010. METHODOLOGY: Consecutive 500 patients who underwent attempted transcatheter PDA device closure were included in the study. Device type position, success of closure and complications were described as frequency percentage. RESULTS: In 491 cases (98.2%), PDA was successfully occluded including 4 cases (0.8%) where devices were dislodged but retrieved and redeployed in Cath laboratory. PDA occluder devices used in 448 cases (91%) while coils (single or multiple) were used in 42 cases (8.5%) and in one case (0.2%) ASD occluder device was used to occlude the PDA. There were 09 (1.8%) unsuccessful cases, 06 (1.2%) were abandoned as ducts were considered unsuitable for device closure, 02 (0.4%) devices dislodged and needed surgical retrieval and one case (0.2%) was abandoned due to faulty equipment. The narrowest PDA diameter ranged from 0.5-14 mm with mean of 4.5±2.4 mm. There was a single (0.2%) mortality. CONCLUSION: Transcatheter occlusion of PDA by coil or occluder device is an effective therapeutic option with high success rate. Complication rate is low in the hands of skilled operators yet paediatric cardiac surgical back-up cover is mandatory.
Subject(s)
Cardiac Catheterization/methods , Cardiac Surgical Procedures/methods , Ductus Arteriosus, Patent/surgery , Septal Occluder Device , Adolescent , Adult , Cardiac Catheterization/adverse effects , Child , Child, Preschool , Ductus Arteriosus, Patent/diagnostic imaging , Echocardiography, Doppler, Color , Equipment Design , Female , Humans , Incidence , Infant , Male , Middle Aged , Postoperative Complications/epidemiology , Radiography, Interventional , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To evaluate the results and complications associated with transcatheter closure of patent ductus arteriosus (PDA) in infants. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Paediatric Cardiology Department of Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from December 2010 to June 2012. METHODOLOGY: Infants undergoing transcatheter device closure of PDA were included. All patients were evaluated by experienced Paediatric Cardiologists with 2-D echocardiography and Doppler before the procedure. Success of closure and complications were recorded. RESULTS: The age of patients varied from 05 - 12 months and 31 (56.4%) were females. Out of the 55 infants, 3 (5.4%) were not offered device closure after aortogram (two large tubular type ducts and one tiny duct, considered unsuitable for device closure); while in 50 (96.1%) patients out of remaining 52, the duct was successfully closed with transcatheter PDA device or coil. In one infant, device deployment resulted in acquired coarctation, necessitating device retrieval by Snare followed by surgical duct interruption and another patient had non-fatal cardiac arrest during device deployment leading to abandonment of procedure and subsequent successful surgical interruption. Local vascular complications occurred in 12 (21.8%) of cases and all were satisfactorily treated. CONCLUSION: Transcatheter device closure of PDA in infants was an effective procedure in the majority of cases; however, here were considerable number of local access site vascular complications.
Subject(s)
Cardiac Catheterization/methods , Cardiac Surgical Procedures/methods , Ductus Arteriosus, Patent/surgery , Adolescent , Cardiac Catheterization/adverse effects , Child , Child, Preschool , Ductus Arteriosus, Patent/diagnostic imaging , Echocardiography, Doppler, Color , Female , Humans , Infant , Male , Postoperative Complications , Radiography , Treatment Outcome , Young AdultABSTRACT
We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.
