Catheter Closure of Clinically Silent Patent Ductus Arteriosus Using the Amplatzer Duct Occluder II-Additional Size: A Single-Center Experience

Abstract

Transcatheter closure is the treatment of choice for most patent ductus arteriosus (PDA) in infants, children, and adults. However, there is a controversy regarding transcatheter closure of clinically silent PDAs. Some authors favor device closure to eliminate the lifelong risk of infective endarteritis while others recommend avoiding PDA closure in such patients. The study describes our experience of closing the silent PDAs using the Amplatzer duct occluder II-additional size (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN). Materials and methodsFrom April 2018 through March 2021, 52 consecutive pediatric patients aged 18 years and less with clinically silent PDA who had transcatheter closure at our center were enrolled. Patients were excluded if they had clinically detected PDAs; had surgical ligation of PDA with no residual shunt; had left heart dilatation on echocardiography; or moderate-sized PDAs closed with ADO II-AS. In addition, patients with an innocent murmur or murmur due to an associated lesion were included. This study was retrospective, and all of the 52 patients underwent PDA device closure using ADO II-AS. ResultsFifty-two consecutive patients were enrolled with a median age of 17 months, range (97-2.5) 94.5 months. Mean weight was 11.29 kilogram, range (24.8-3.5) 21.3 kilogram, and mean follow-up was 13.5 months, range (29-0) 29 months. Thirty-one (59.6%) were females, and 21 (40.4%) were males. The mean procedure time was 30.6 min, range (60-10) 50 min, and mean fluoroscopic time was 5.5 min, range (28-1.7) 26.3 min. The mean volume of contrast given was 9.1 milliliter, range (30-4) 26 milliliter. Forty-five (45; 88.2%) patients had immediate closure of PDA. No patients had anesthetic or vascular complications; however, two patients had procedural complications. Device placement was unsuccessful in one patient with Downs syndrome. The mean follow-up for our patients was 13.5 months, range (29-0) 29 months; the patients were asymptomatic at the follow-up, and none of the patients had any residual leak. None of the patients showed coarctation or left pulmonary artery stenosis at the latest follow-up. ConclusionThe usefulness of catheter-based therapy for silent PDA is less well-established by current evidence. Further studies are needed to justify the intervention solely based on the premise that the silent duct is a substrate for infective endarteritis; however, our reason to close silent PDA was to do so primarily because of social reasons. This study found that device closure of silent PDA is safe and effective using an ADO II-AS device with minimal risk of embolization and a low residual shunt rate. Coils have been used to close small PDAs, however, with higher rates of embolization and device malpositioning. We believe ADO-II AS offers an advantage of safety and efficacy over coils. In addition, the study highlights the advantage of using an ADO II-AS device, which can be delivered via a four French delivery system with no arterial complications.

Application of single venous approach under echocardiographic without angiography in closure of Patent Ductus Arteriosus

“…To avoid radiation and contrast agents the single femoral artery approach under TTE guidance was applied to transcatheter device ADO II closure of PDA in recent literatures [16][17] .For the arterial access, ADO II occluder was not only a problem of vascular complications, but also unsuitable for PDA patients with diameter lager than 5.5 mm [18] .Besides, single TTE guidance also has inherent drawbacks compared with uoroscopic guidance, such as a smaller image interface and limited operating view [19] .To our knowledge, few literatures were reported for transcatheter closure of patent ductus arteriosus from single venous approach under echocardiographic without angiography.We are the rst to systematically report the single venous approach and to provide a detailed analysis.In this study,60 cases in Group 1 were reported by single venous approach under echocardiographic without Angiography with satisfying feasibility and safety.The single venous approach under echocardiographic without angiography successfully avoided the vascular complications and reduced the damage caused by contrast agents and X-rays..It is especially suitable for patients with contrast allergy and infants. The single venous approach in Group 1 greatly reduced operation time and contrast volume compared with the control group in Group 2.The reduction in operative time and contrast volume usage re ected the reduction in radiation dose, which was bene cial to both patients and doctors [20].Of course, the reliability of TTE measurements is critical for proper device size.In Paudel's study [21],TTE measurements are comparable to angiographic measurements, thereby assisting in appropriate device size selection.In Group 2, the shape, position and size of PDA were evaluated by preoperative echocardiography instead of descending aortography and the position of the occluder was determined by the aortography and echocardiography performed before releasing the device,making the entire procedure easier and less invasive.…”

Radiation Dose Exposure to Patients During Transcatheter Patent Ductus Arteriosus Closure via the Arterial Route

“…Patients with small or tiny PDAs were selected for transcatheter closure via an arterial route after a detailed assessment at the outpatient clinic. The authors demonstrated in another study [11] that hemodynamic catheterization assessment might not be required in clinically silent PDAs. As a result, transcatheter closure of the small/tiny PDA without hemodynamic evaluation may significantly reduce the radiation dose.…”

Transcatheter Closure of Patent Ductus Arteriosus in infants between 2-10 kg

“…United States Food and Drug Administration (FDA) approval of the Amplatzer Piccolo Occluder for use in premature infants ≥700 g was obtained on January 11, 2019 (2). ADO-II AS has been used with high procedural success in transcatheter PDA closure in larger, small babies, and premature infants in many centers in the United States and Europe (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). After the FDA approval of The Amplatzer Piccolo Occluder in premature infants ≥700 g, it has been widely used as a good alternative to surgery in premature PDA that does not respond to conservative and medical treatments (13,14).…”