Percutaneous treatment of moderate-to-large patent ductus arteriosus with different devices: early and mid-term results.
BACKGROUND
Transcatheter closure is now accepted as the first-choice therapeutic option in patients with patent ductus arteriosus (PDA). However, this procedure is still challenging in large PDA and/or younger patients. This study evaluated feasibility and results of this approach in large, symptomatic PDA using different devices.


METHODS
Between April 2000 and July 2004, 57 patients underwent attempt of transcatheter closure of a large PDA at our Institution. Nineteen patients (33.3 %) were on pharmacologic therapy for congestive heart failure. PDA diameter was 3.2+/-1.2 mm (range 1.8-9 mm), resulting in a pulmonary to systemic flow ratio of 2.1+/-1.8 (range 1.4-5).


RESULTS
The procedure was successfully performed in 54 patients (94.7%), using the Amplatzer duct occluder (ADO) device (34 patients) or a multiple detachable coil approach (20 patients). Complete PDA occlusion was recorded in 77.8% of patients at 24 hours, 92.6% at 1 month, and 94.4% at last follow-up control (23+/-12 months). PDA morphology and pulmonary to systemic flow ratio did not influence the success rate of the procedure or the residual shunt. A trend toward a higher occlusion rate at any follow-up point was recorded in the ADO group (79.5 vs 75.0% at 24 hours, 97.1 vs 85.0% at 1 month, and 97.1 vs 90% at last follow-up control, p = NS for all comparisons).


CONCLUSIONS
Percutaneous closure might be considered effective and safe also in large, clinically significant PDA, by tailoring the device choice to the patient size and ductal morphology. In this setting, the multiple coil option revealed as effective as the ADO device over a mid-term follow-up.
Santoro
Giuseppe
G
Second University of Naples, V Monaldi Hospital, Naples, Italy. santoropino@tin.it
Bigazzi
Maurizio Cappelli
MC
Carrozza
Marianna
M
Palladino
Maria Teresa
MT
Sarubbi
Berardo
B
Scarpati
Carmela
C
Dalto
Michele
M
Russo
Maria Giovanna
MG
Calabrò
Raffaele
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013997:Time Factors