title: Significant persistent ductus arteriosus in infants less or equal to 6 kg: percutaneous closure or surgery?
abstract: BACKGROUND
  Percutaneous closure of large persistent ductus arteriosus using the Amplatzer duct occluder is an alternative to surgery. However, this device is not recommended in infants weighing less than 6 kg.
  
  
  OBJECTIVE
  To evaluate the safety and effectiveness of this procedure in low-body-weight infants.
  
  
  METHODS
  We reviewed retrospectively data for infants weighing less or equal to 6 kg who underwent percutaneous closure of significant persistent ductus arteriosus using the Amplatzer duct occluder in France between 1998 and 2007.
  
  
  RESULTS
  Data for 58 patients (mean weight: 5 kg, range: 3.4-6; mean age: 5.5 months, range: 2.1-15.3) were reviewed. Mean angiographic persistent ductus arteriosus minimal diameter was 3.7 mm (range: 1-7.5). Implantation of the Amplatzer duct occluder was successful in 89.7% of cases. In six (10.3%) patients, the device was not implanted because it would have led to significant aortic obstruction. One procedure-related death occurred in a 4 kg infant (1.7%). Major and minor complications occurred in 6.9 and 31.0% of patients, respectively. Persistent ductus arteriosus diameter greater than 3.7 mm, type C (tubular shape) and diameter/patient weight ratio greater than 0.91 were significantly associated with an unsuccessful procedure and/or major complications. During a median 10-month follow-up, no late device embolization occurred.
  
  
  CONCLUSIONS
  Although percutaneous closure of significant persistent ductus arteriosus with the Amplatzer duct occluder is effective in low-body-weight infants, the level and severity of complications indicate surgery as first-line treatment, at least until further studies are done to assess the safety and effectiveness of the new Amplatzer duct occluder II in low-body-weight infants.
authors: Service de cardiologie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31026 Toulouse, France. sylvia.abadir@gmail.com
authors: Sylvia
authors: S
authors: Abadir
authors: Younes
authors: Y
authors: Boudjemline
authors: Christian
authors: C
authors: Rey
authors: Jérome
authors: J
authors: Petit
authors: François
authors: F
authors: Sassolas
authors: Philippe
authors: P
authors: Acar
authors: Alain
authors: A
authors: Fraisse
authors: Claire
authors: C
authors: Dauphin
authors: Jean-François
authors: JF
authors: Piechaud
authors: Alain
authors: A
authors: Chantepie
authors: Jean-René
authors: JR
authors: Lusson
mesh_terms: D001835:Body Weight; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017023:Coronary Angiography; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome