Summary and Comparison of Patent Ductus Arteriosus Closure Devices.
A number of patent ductus arteriosus (PDA) occluding devices have been studied in an attempt to develop a transcatheter method of closure of PDA. Some devices were tested in only animal models, whereas others progressed to clinical trials in human subjects. Some devices have been discontinued, some received approval for general clinical use, and many have not yet received approval by regulatory authorities. No prospective randomized clinical trials have been undertaken and, therefore, data on separate clinical trials are used to determine relative efficacy of the devices. Selection of a method of PDA closure depends largely on its minimal diameter and to some degree on its shape. Silent PDAs do not need occlusion. Very small to small PDAs may be occluded by free or detachable Gianturco coils (Cook Cardiology, Bloomington, IN). Moderate-to-large PDAs require closure by devices, conventional surgery, and videothoracoscopic interruption. The choice in the latter group depends largely on the availability of a given method at a given institution at that particular time. Approval of several of the devices by regulatory authorities may result in conduct of prospective randomized clinical trials and use of a device or method most appropriate to the size and shape of the PDA.
Rao
P. Syamasundar
PS
Division of Pediatric Cardiology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA. raops@slu.edu