Early Results of Transcatheter Closure of Patent Ductus Arteriosus: Retrospective Study of 61 Patients

Abstract

Introduction

Patent ductus arteriosus (PDA) accounts for 6 - 11% of all congenital heart defects.^1,2 Complications of PDA include congestive heart failure, repeated chest infections, pulmonary hypertension, and an increased risk of infective endocarditis. Transcatheter closure of PDA has largely replaced surgical ligation in different age groups.^3-7 Currently, surgical intervention is restri-cted to premature babies or small infants with large symptomatic PDA, cases with unfavorable duct ana-tomy, and whenever the cost of the closure devices is unaffordable.¹

      PDA was the first example of congenital heart dis-ease to be treated by transcatheter closure, which beco-mes an established form of treatment for the majority of patients with PDA and as a safe alternative to sur-gery.

            The per-cutaneous technique was first described by Porstmanur et al.,⁸ since then various devices such as Rashkind PDA umbrella,⁹ button device,¹⁰ PDA coils¹¹ and most recently the Amplatzer duct occluder (ADO) have been introduced.^12,13 The ADO device was designed to provide the most desirable characteri-stics for a percutaneous closure device that can be used in most if not all patients with PDA. These include user - friendly delivery system, high complete closure rate, small delivery system (allowing its use in small infants), trans-venous delivery route, ability to adapt to various PDA sizes and types, and the ability to retrieve or reposition the device prior to release from a secure delivery system.

      Common complications of trans-catheter closure of PDA include residual shunt, left pulmonary artery (LPA) obstruction, protrusion of the device into the aorta, and embolization of the device.^14-16 Incidence of complications increases with certain types and large size ducts, and with the use of multiple coils for occlu-sion.¹⁷ There are only a few reports correlating out-come and complications with the learning curve and experience.^18-20 In this study, we are reporting our ini-tial experience with PDA closure using Amplatzer duct occluder (ADO). Our focus was on reporting the complications of trans-catheter closure of PDA using PDA closure devices.

      This study was carried out to evaluate the safety and efficacy of Amplatzer device for the transcatheter closure of PDA in our setup.