title: Percutaneous treatment of moderate-to-large patent ductus arteriosus with different devices: early and mid-term results.
abstract: 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.
authors.affiliation: Second University of Naples, V Monaldi Hospital, Naples, Italy. santoropino@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santoro
authors.forename: Maurizio Cappelli
authors.initials: MC
authors.lastname: Bigazzi
authors.forename: Marianna
authors.initials: M
authors.lastname: Carrozza
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Palladino
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.forename: Carmela
authors.initials: C
authors.lastname: Scarpati
authors.forename: Michele
authors.initials: M
authors.lastname: Dalto
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: 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