Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Closure: 1-Year Single Center Experience in Indonesia

Abstract

IntroductionSince the first successful percutaneous closure under transesophageal echocardiographic (TEE) guidance, many centers explored transcatheter procedures without fluoroscopy. This single-center study is aimed to show the feasibility and safety of percutaneous patent ductus arteriosus (PDA) closure under echocardiography-only guidance during our 1-year experience.MethodsPatients with PDA were recruited for percutaneous PDA closure guided by either fluoroscopy or echocardiography-only in National Cardiovascular Center Harapan Kita (ClinicalTrials.gov Identifier: NCT05321849, clinicaltrials.gov/ct2/show/NCT05321849). Patients were evaluated clinically and radiologically using transthoracic echocardiography (TTE) at 6, 24, and 48 h after the procedure. The primary endpoint was the procedural success. Secondary endpoints were the procedural time and the rate of adverse events.ResultsA total of 60 patients underwent transcatheter PDA closure, 30 patients with fluoroscopy and 30 patients with echocardiography guidance. All patients had successful PDA closure. There were only residual shunts, which were disappeared after follow-up in both groups, but one patient with a fluoroscopy-guided procedure had moderate tricuspid regurgitation with suspected thrombus in the tricuspid valve. The procedural time was not significantly different between the fluoroscopy and echocardiography groups.

Transesophageal echocardiography-guided percutaneous closure of multiple muscular ventricular septal defects with pulmonary hypertension using single device: A case report

“…Even though ALARA (as low as reasonably achievable) principle is used, it would be preferable to completely eliminate radiation exposure risks for both the operators and the patient. In our facility, the technique would be carried out initially without any fluoroscopy, or if the echocardiography window was insufficient intraprocedurally, the technique would be converted to the standardized fluoroscopy process ( 1 , 3 , 10 , 11 ).…”

“…Over the years, there have been more reports of skin injuries, such as redness, necrosis, and ulceration, which can be painful and disabling. There has also been an increase in the likelihood of developing neoplasms, radiation-induced cataracts, and hair loss ( 3 ).…”

“…The shape and diameter of the VSD may be estimated with precision using TEE. When employing TEE, the danger of oesophageal trauma and erosion should be taken into account ( 1 , 3 , 10 , 11 ).…”

“…However, multiple defects are often repaired using multiple devices and are typically guided by fluoroscopy ( 1 , 2 ). Eliminating radiation exposure during procedure is crucial since fluoroscopy effects are cumulative and raise serious issues, especially in the younger population ( 3 ). In this case report, we would like to highlight the feasibility of multiple defects VSD closure with single device using zero-fluoroscopy technique.…”

Transesophageal echocardiography-guided percutaneous patent ductus arteriosus closure without fluoroscopy

“…Using open surgery, thoracoscopy, or transthoracic PDA closure, surgical incisions and complications such as pulmonary collapse, pneumothorax, and pleural effusion cannot be avoided. PDA closure through the right femoral vein under the guidance of TEE is a safe and effective surgical approach [ 6 , 7 ]. However, reports regarding this technique are scarce.…”