Significant persistent ductus arteriosus in infants less or equal to 6 kg: percutaneous closure or surgery?
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.
Abadir
Sylvia
S
Service de cardiologie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31026 Toulouse, France. sylvia.abadir@gmail.com
Boudjemline
Younes
Y
Rey
Christian
C
Petit
Jérome
J
Sassolas
François
F
Acar
Philippe
P
Fraisse
Alain
A
Dauphin
Claire
C
Piechaud
Jean-François
JF
Chantepie
Alain
A
Lusson
Jean-René
JR
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