A Retrospective Study of 1526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus

Abstract

Background:Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices.Methods:One thousand five hundred and twenty-six patients (537 boys, 989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications.Results:Median age and median weight were 4.0 years (range: 0.3–52.0 years old) and 15.3 kg (range: 4.5–91.0 kg), respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 mm, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I (ADO I, 1280, 85.8%), Cook detachable coils (116, 7.8%), ADO II (ADO II, 68, 4.6%), muscular VSD occluder (12, 0.8%), and Amplatzer vascular plug (16, 1.0%).Conclusions:Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

“…The mortality rate for transcatheter PDA occlusion is nearly zero (0-0.9%). Procedure-related major and minor complications are rare, ranging 0-9.1% and 0-16.2%, respectively [17][18][19][20][21][22][23][24][25][26][27]. Similarly, our results showed zero mortality rate and the equal occurrence of major and minor complications (4.2%).…”

“…Studies analyzing the efficiency of coil occlusion of PDA reported that complete closure rate varied from 63.4 to 96.6% at the end of the procedure, and from 80.5% to 96.2%, at one year [15][16][17][18][19]. When present, the residual ductal shunt was almost invariably hemodynamically insignificant.…”

“…In our study, out of seven patients with residual ductal flow none had hemolytic anemia. According to the literature, the rate of complete closure of the PDA using ADO varied from 56.6% to 100% immediately after the procedure, and from 99.7% to 100% at one year [17][18][19][20][21][22][23]. The studies of PDA closure with ADO showed that, if present, there was only a small residual shunt after the procedure comparable to that seen with coil placement.…”

“…The single most common procedural complication is probably device embolization (0-6%), with coils being more prone to embolize than ADOs [17][18][19][20][21][22][23][24][25][26]28]. In most cases, embolized devices could be readily retrieved without consequences.…”

“…Apart from the device embolization, another concern is the possibility of device protrusion into surrounding vascular structures, i.e., the descending aorta and the pulmonary arteries. A number of studies have reported the problem of device protrusion and impingement on the lumen of the left pulmonary artery and occasionally the descending aorta, with the incidence ranging 0-14% [17][18][19][20][21][22][23][24][25][26]. This was more commonly seen in infants and small children and in patients requiring the placement of additional devices for PDA closure.…”