A beneficial technique for preventing the device protrusion to the aorta during percutaneous patent ductus arteriosus closure: “Balloon-assisted device releasing technique”

Abstract

Background:Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion.Methods:One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation.Results:There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1.Conclusion:The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.

Surgical removal of part of an occluder to treat iatrogenic coarctation of the aorta: a case report

“…Serious transcatheter closure-related complications, such as embolization and arterial injury [10], cannot be ignored. Embolism is commonly caused by insertion of an undersized device, incorrect positioning, and erroneous operation [11][12][13], whereas arterial injuries are caused by iatrogenic coarctation or aortic dissection due to smaller aortic dimension, poor arterial elasticity, and aortic wall abrasion secondary to the disk at the aortic side, among others [14,15]. Therefore, a correct-sized occluder should be selected when performing transcatheter closure and the condition at post-implantation morphologically examined [8].…”

“…Therefore, a correct-sized occluder should be selected when performing transcatheter closure and the condition at post-implantation morphologically examined [8]. The use of a balloon-assisted release method intraoperatively has been recommended to prevent the occluder from protruding to the aorta during the PDA catheter occlusion [14]. Ireneusz et al [16] reported an interesting case of a 10-month-old girl with severely narrowed aorta after the PDA transcatheter occlusion, requiring an emergency surgery to remove the occluder to prevent severe cardiac failure.…”