The Outcome of Trans-catheter Closure of Patent Ductus Arteriosus: A Single-Center Experience

Khan, Abdul Moeed; Ullah, Zia; Ilyas, Saadia; Wazir, Haseen Dil; Rehman, Yasir; Hussain, Ijaz; Sadia, Haleema

doi:10.7759/cureus.21577

Cited by 1 publication

(2 citation statements)

References 18 publications

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“…The reported incidence of hemolysis is 0.5 to 3% following coil occlusion of PDA [5]. However, significant hemolysis after occlusion with Amplatzer-type duct occluders is extremely rare [3,4]. A possible cause of hemolysis in our case was that the aortic disk was not fully formed which could have led to the failure of polyester fabrics in nitinol mesh to thrombose.…”

Section: Discussionmentioning

confidence: 75%

“…Hemolysis after PDA device closure is usually associated with the presence of residual duct flow [2]. Although in most cases, hemolysis settles on its own and requires supportive care only [3,4]; however, in some cases it may not settle spontaneously and may require additional procedures like putting additional coils, gel foam or thrombin instillation, balloon occlusion, or removing it surgically. We report a case of adult PDA device closure who persisted with hemolysis and was managed by transcatheter retrieval.…”

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confidence: 99%

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Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device

et al. 2023

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Background Hemolysis after Patent ductus arteriosus (PDA) device closure is rare. Although in most cases, hemolysis settles on its own; however, in some cases it may not settle spontaneously and may require additional procedures like putting additional coils, gel foam or thrombin instillation, balloon occlusion, or removing it surgically. We report a case of adult PDA device closure who persisted with hemolysis and was managed by transcatheter retrieval. Case presentation A 52-year-old gentleman presented to us with a diagnosis of large PDA with operable hemodynamics. Descending thoracic aortic Angio showed a large 11 mm PDA. Transcatheter device closure was done in the same sitting with a 16 × 14 Amplatzer Ductal Occluder I(ADO) device,;however, after device release, the aortic end of the device was not fully formed and there was residual flow. The next morning patient started with gross hematuria with persistent residual flow. We tried to manage with conservative means including hydration, and blood transfusion; however, residual flow persisted for 10 days and his hemoglobin dropped from 13 gm/dl preprocedural to 7 gm/dl, creatinine increased from 0.5 mg/dl to 1.9 mg/dl, bilirubin increased to 3.5 mg/dl & urine showed hemoglobinuria. As the patient continued to deteriorate it was planned to retrieve the device by transcatheter approach. 10 French amplatzer sheath was parked in the pulmonary artery near the ductus. We tried with a combination of multiple catheters and Gooseneck snare (10 mm) and finally, we successfully retrieved with a combination of Multipurpose (MP) catheter and 10 mm Gooseneck snare. After that, we closed the defect successfully with a double disk device (muscular Ventricular septal defect 14 mm Amplatzer). The patient’s hematuria settled and was discharged after 2 days with normal hemoglobin and creatinine. Conclusions Patent ductus arteriosus ADO 1 device should not be released if the aortic end of the disk is not fully formed Patient should be carefully monitored for hemolysis if evidence of residual shunt and given supportive treatment. If conservative treatment fails, residual flow needs to be eliminated. Transcatheter retrieval although technically challenging is a feasible treatment. A muscular VSD device is a good alternative to the usual PDA device to close PDA, especially in adults.

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Section: Discussionmentioning

confidence: 75%

mentioning

confidence: 99%

Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device

et al. 2023

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The Outcome of Trans-catheter Closure of Patent Ductus Arteriosus: A Single-Center Experience

Abstract: The objective is to share our experience of trans-catheter device closure of patent ductus arteriosus (PDA) and review its efficacy and immediate complications.

Cited by 1 publication

References 18 publications

Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device

Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device

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