Minimally Invasive Per‐Catheter Patent Ductus Arteriosus Occlusion in Dogs Using a Prototype Duct Occluder

Abstract

Background: Per-catheter patent ductus arteriosus (PDA) occlusion in dogs with devices intended for humans is associated with technical difficulties, high rates of procedure abandonment, device migration, and residual ductal flow.Hypothesis: Use of a custom-made canine duct occluder (Amplatz Canine Duct Occluder, ACDO) would be feasible in dogs of varying weights and somatotypes and effective in occluding a wide range of PDA shapes and sizes.Animals: Eighteen client-owned dogs of various breeds with PDA. Weights ranged from 3.8 to 32.3 kg (median, 17.8 kg), and angiographic minimal ductal diameters ranged from 1.1 to 6.9 mm (median, 3.7 mm). Ductal morphologies included types IIA, IIB, and III.Methods: Per-catheter PDA occlusion with the ACDO was performed in all dogs. Persistent or recurrent ductal flow was assessed at the end of the procedure by angiography and at 1 day, 3 months, and !12 months after the procedure by echocardiography.Results: Successful ACDO placement was achieved in all 18 dogs. One dog required a 2nd procedure with a larger ACDO after the 1st device migrated to the pulmonary vasculature. Complete occlusion was confirmed in 17 of 18 dogs during the procedure, as well as at 1 day and 3 months after the procedure, and in 12 of 13 dogs evaluated at ! 12 months after the procedure.Conclusions and Clinical Importance: Per-catheter PDA occlusion in dogs with the ACDO is feasible and effective in dogs of a wide range of weights and somatotypes and with PDAs of varying shapes and sizes.

Transthoracic echocardiographically-guided interventional cardiac procedures in the dog

“…11 We initially considered, but ultimately did not perform the procedure on dogs that weighed 3.5 kg because they were judged to be too small for safe catheterization and deployment of the ACDO. 20, 21 We also excluded any dogs in which the minimal ductal diameter could not be easily measured via TTE, or in which image quality was considered insufficient for safe and reliable detection of guide wires and catheters. Dogs with a minimal ductal diameter 9.5 mm were excluded because they exceeded the limits of the largest available ACDO (14 mm).…”

“…Small dogs have been considered problematic for placement of ACDO, because of the requirement of relatively large sheaths (minimum 5Fr) to accommodate the device. 20,21 Therefore, patients that have sub-optimal TTE acoustic windows for the PDA imaging, or are too small for safe placement of ACDO, should have closure performed by alternate procedures (fluoroscopic or TEE guided ACDO deployment or surgical closure).…”

Echocardiographic Evaluation of Congenital Cardiopathies Before and After Intervention

“…The procedure (surgical or interventional) and device choices are based on a combination of factors, including the PDA morphology, the minimal ductal diameter (MDD), and the size of the patient. ACDO has been found to be effective in the occlusion of PDA of different shapes and sizes [40][41][42][43]. The cylindrical shape of type III PDA (see below) has proven to be problematic because the ACDO is difficult to anchor in this case.…”

“…Overall, the average difference between the two methods is small but the divergence between the TTE MDD measurements and those obtained by angiography can often be large for a given individual [47].…”

Evaluation of echocardiographic markers in dogs with patent ductus arteriosus after ductal closure

“…Surgical ligation and interventional closure with embolic coils or Amplatz canine ductal occluder are the most common method for treating PDA in dogs [9,10,16]. Although successful closure of PDA can be determined by loss of heart murmur by auscultation or echocardiographic evaluation on the shunt flow at pulmonary artery (PA), long-term outcome after the ductal closure can be more accurately assessed by echocardiography and cardiac biomarker assay [7,8,[17][18][19].…”