[Percutaneous closure of patent ductus arteriosus with the Amplatzer duct occluder].
METHODS
Percutaneous closure of a moderate-to-large sized patent ductus arteriosus using multiple coils or a Rashkind double-umbrella may be technically demanding and raises a significant rate of embolization and residual shunting. This is why we tried a new self-expandable device called Amplatzer Duct Occluder to close transvenously large ductuses in eighteen patients at a median age of 2.8 years (range: 0.7 to 34). They had a patent ductus arteriosus with a minimal diameter > 3 mm (mean: 5 +/- 2 mm). The device had a mean diameter of 9 +/- 2 mm and was delivered through a 6F venous sheath. Aortography was done 5 to 10 minutes after the release and follow-up evaluation was performed with color Doppler echocardiography within 24 h, 1 and 3 to 6 months after the procedure.


RESULTS
Placement was successful in all but the first patient (95%). Complete closure was achieved immediately in 4/17 patients (24%) and in 13/17 (76%) 24 h later. Two patients were lost for follow-up. Complete closure was confirmed in 14 of the 15 (93%) reviewed patients at 1 and 3 months. In all patients with a ductal diameter < or = 7.5 mm the closure was complete at 1 month. Embolization occurred in one patient with a 9.7 mm duct and surgery was undertaken. A mild and transient hematuria was observed in one patient. No pulmonary artery stenosis nor aortic obstruction were observed on follow-up.


CONCLUSIONS
The Amplatzer Duct Occluder device offers a safe and effective option to treat patients with a ductus arteriosus which minimal diameter is up to 7.5 mm.
Saliba
Z
Z
Service de cardiologie pédiatrique, hôpital Necker-Enfants malades, Paris.
Aggoun
Y
Y
Hausse
A O
AO
Acar
P
P
Bonnet
D
D
Fraisse
A
A
Sidi
D
D
Kachaner
J
J
Bonhoeffer
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D015150:Echocardiography, Doppler; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome
Fermeture percutanée du canal artériel par la prothèse occlusive Amplatzer.