Percutaneous closure of hypertensive ductus arteriosus.
BACKGROUND
The Amplatzer duct occluder (ADO) has been used with success to close large patent ductus arteriosus (PDA), but some problems exist especially with hypertensive PDAs, such as incomplete closure, haemolysis, left pulmonary artery stenosis, obstruction of the descending aorta and progressive pulmonary vascular disease.


RESULTS
We analysed a group of 168 patients with isolated PDA and pulmonary artery systolic pressure (PSAP) > or =50 mm Hg. Mean age was 10.3 +/- 14.3 years (median 3.9), PDA diameter was 6.4 +/- 2.9 mm (median 5.9), PASP was 63.5 +/- 16.2 mm Hg (median 60), Qp/Qs was 2.7 +/- 1.2 (median 2.5), total pulmonary resistance index (PRI) was 3.69 +/- 2.15 (median 3.35) and vascular PRI was 2.73 +/- 1.72 (median 2.37). We used ADOs in 145 (86.3%) cases, Amplatzer muscular ventricular septal defect occluders (AMVSDO) in 18 (10.7%), Amplatzer septal occluders (ASO) in three (1.8%) and the Gianturco-Grifka device in two (1.2%) cases. Device diameter was 106.3% +/- 51% higher than PDA diameter. PASP decreased after occlusion to 42.5 +/- 13.3 mm Hg (p<0.00001). Immediately after closure, no or trivial shunt was present in 123 (74.5%) cases. Immediate complications were device embolisation in five (3%) cases and descending aortic obstruction in one case. The overall success rate was 98.2%. Follow-up in 145 (86.3%) cases for 37.1 +/- 24 months (median 34.1) showed further decrease of the PASP to 30.1 +/- 7.7 mm Hg (p<0.0001).


CONCLUSIONS
Percutaneous treatment of hypertensive PDA is safe and effective. ADO works well for most cases, but sometimes other devices (MVSDO or ASO) have to be used. When cases are selected adequately, pulmonary pressures decrease immediately and continue to fall with time.
Zabal
Carlos
C
National Institute of Cardiology Ignacio Chavez, Juan Badiano 1, Tlalpan, Mexico City, Mexico. zabal@cardiologia.org.mx
García-Montes
José Antonio
JA
Buendía-Hernández
Alfonso
A
Calderón-Colmenero
Juan
J
Patiño-Bahena
Emilia
E
Juanico-Enriquez
Antonio
A
Attie
Fause
F
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device; D055815:Young Adult