Percutaneous Closure of a Moderate to Large Tubular or Elongated Patent Ductus Arteriosus in Children Younger Than 3 Years: Is the ADO II Appropriate?

Abstract

Protrusion of the Amplatzer duct occluder (ADO) II device into the aortic isthmus or the pulmonary artery causing obstruction and residual flow has been reported, but the same has not been widely studied in small children with a patent ductus arteriosus (PDA) anatomy not considered suitable for closure with the ADO I device. This study aimed to report the safety and efficacy of the ADO II device in children younger than 3 years with a tubular or elongated PDA and to analyze the possible reasons for residual flow in children with such a PDA. In this study, 17 children younger than 3 years (mean age, 10.3 ± 7 months; mean weight, 6 ± 3.6 kg) underwent attempted closure of a tubular or elongated PDA (mean diameter at the narrowest point, 4.1 ± 1.1 mm) with the ADO II device between July 2010 and July 2012. Of the 17 patients, 16 (2 boys and 14 girls) completed the follow-up evaluation. A complete echocardiographic evaluation was performed on all the patients before PDA closure and at the follow-up visit, and the results were compared with those of previous published studies. Of the 16 patients, the 15 who completed the follow-up evaluation had successful device closure (1 device embolization). Residual flow was present in six patients immediately after deployment, which was reduced to three patients at the last follow-up visit. Five of nine patients closed with a 6-mm-long device had residual flow compared with only one of seven patients closed with a 4-mm-long device. After device closure, significant elevations of the left and right pulmonary artery velocities occurred in three and two patients, respectively; in 12 patients, descending thoracic aortic (DTA) velocities increased mildly. There was trend toward a fall in the elevated pressures at the last follow-up visit, although one patient had an elevation in right pulmonary artery velocity at last the follow-up echocardiogram compared with the echocardiogram immediately after closure. Hence, in children younger than 3 years with or without pulmonary arterial hypertension, closure of a PDA not amenable to closure with the ADO I device is feasible using the ADO II device, with an increased incidence of clinically nonsignificant complications. Selection of device dimensions according to the manufacturer's recommendation may not be the optimal strategy.

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

“…Transcatheter PDA closure of infants is relatively difficult in procedural technique and higher in complication rates, hence, proper case selection is very important. [ 20 21 ] According to our experience, if the PDA ductus of infants do not cause any hemodynamic changes including PAH, cardiomegalia, decline in heart function or congestive heart failure, the PDA closure procedure can be performed when the patient is at the age of 2 or 3 years old under regular follow-up visits. As for large PDA of infants, with no appropriate closure device available, surgical ligation may be safer and more efficient.…”

Echocardiography-guided percutaneous closure of perimembranous ventricular septal defects without arterial access and fluoroscopy

“…One is the high exposure to radiation, especially for infants and children [13,14]. The other one is the increased potential risks of vascular complications caused by femoral artery puncturing for angiography [15,16]. Arterial access in children is reported to cause a high rate of complication, of which a significant proportion requires intervention [17,18].…”

Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients

“…[29] ADO II device protrusion into the left pulmonary artery or the descending aorta is a possible complication of the procedure, although several studies have described the safety and efficacy of the device. [29303132333435]…”