Development of catheter-based treatment of patent ductus arteriosus: a medium-sized centre experience.
BACKGROUND
Despite the availability of effective devices, percutaneous closure of patent ductus arteriosus (PDA) can be challenging in some situations.


OBJECTIVE
To describe our initial experience of percutaneous PDA closure.


METHODS
Between 2001 and 2007, 73 consecutive patients aged 3 months to 70 years underwent transcatheter PDA closure. An Amplatzer duct occluder (ADO) was chosen for ducts greater than 2 mm (n=50) and a Detachable coil (DC) for smaller ducts (n=23).


RESULTS
The diameter of the ducts ranged from 1 to 7.2 (mean 2.9+/-1.3) mm. The prostheses were implanted successfully in all patients. The complete closure rate reached 98% in the ADO group and 100% in the DC group at 12 months. Four (5.4%) patients showed asymptomatic device protrusion: three patients (5, 6 and 10 kg) into the aortic isthmus and one patient (7 kg) into the pulmonary artery (PA). One patient (7 kg) experienced transient severe bradycardia due to pulmonary air embolism. Another patient (3.3 kg) had a permanent asymptomatic occlusion of the femoral artery. In a third patient (17 kg), the ADO migrated asymptomatically into the descending aorta and was discovered 12 months later.


CONCLUSIONS
Even during the learning curve, percutaneous PDA closure can give excellent results. Strict adherence to protocols and careful follow-up assessments are mandatory. In small infants, the use of the ADO may lead to obstruction in the aorta or PA, or to device migration. Cautious surveillance for untoward events is essential, especially in small infants with large ducts.
Saliba
Zakhia
Z
Saint-Joseph university medical school, and Hôtel-Dieu de France hospital, Naccache boulevard, Beirut, Lebanon.
El-rassi
Issam
I
Helou
Dina
D
Abou-Jaoudeh
Pauline
P
Chehab
Ghassan
G
Daou
Linda
L
Khater
Daniele
D
Gerbaka
Bernard
B
Jebara
Victor
V
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011474:Prosthesis Design; D016896:Treatment Outcome; D055815:Young Adult