Trans-catheter closure of patent ductus arteriosus-What is the best device?
BACKGROUND
Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA) has evolved to be the procedure of choice. Gianturco and Flipper coils are the most commonly used coils in the United States for closure of small and moderate size PDAs. For larger PDAs, interventionalists in the United States commonly use the Amplatzer Duct Occluder (ADO) and those in Europe use the ADO or the Nit-Occlud Coils (NOC). A comparison between Gianturco coils, Flipper coils, ADO, and NOC has never been made.


OBJECTIVE
To compare the success and complication rate associated with the four different devices used for transcatheter closure of PDA. Success was defined as complete closure of PDA with absence of a residual shunt (R.S.) at six months follow-up.


METHODS
Two institutions collaborated in combining their data to evaluate the results of transcatheter closure of PDA.


RESULTS
Totally, 546 patients underwent successful PDA occlusion at both institutions. Gianturco and Flipper coils were used in 120 (22%) and 119 (22%) patients respectively. A total of 152 (28%) patients received ADO and 155 (28%) patients received NOC. Immediate R.S. were noted in 226 (41.4%) patients in the entire study group with the NOC group having the highest percentage of R.S. (80/155, 51.6%, P = 0.004). Of the 484 patients with follow-up echocardiograms at 6 months, 35 (7.2%) patients had persistent R.S. The NOC (3/143, 2.1%) and ADO (5/150, 3.3%) groups had the least R.S. at six months follow-up.


CONCLUSIONS
Per our definition of success, the Nit-Occlud coils and the Amplatzer duct-occluder devices had significantly higher success rate for PDA occlusion versus the coils. © 2010 Wiley-Liss, Inc.
Ghasemi
Abdolrahim
A
Department of Pediatric Cardiology and Cardiac Surgery, Shaheed Behshti University of Medical Science, Tehran, Islamic Republic of Iran.
Pandya
Swati
S
Reddy
Surendranath Veeram
SV
Turner
Daniel R
DR
Du
Wei
W
Navabi
Mohamad Ali
MA
Mirzaaghayan
Mohammad Reza
MR
Kiani
Abdolrazagh
A
Sloan
Katherine
K
Forbes
Thomas J
TJ
D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007492:Iran; D008297:Male; D008824:Michigan; D018579:Patient Selection; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography