Lung perfusion studies after transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder.
BACKGROUND
Reduced left lung perfusion has been described after transcatheter closure of the patent ductus arteriosus (PDA) with several prostheses. Although the Amplatzer ductal occluder (ADO) device is currently the most widely used occluder for closure of large-sized PDAs, the potential consequences of flow distribution to the lungs of this device have not been completely clarified. We evaluated lung perfusion following occlusion of PDA with the ADO device.


METHODS
Forty-seven patients underwent successful transcatheter PDA occlusion using the ADO device were included in this study. Lung perfusion scans were performed 6 months after the procedure.


RESULTS
Decreased perfusion to the left lung (defined as < 40% of total lung flow) was observed in 17 patients (36%), 5 of whom were low-weight symptomatic infants. Ductal ampulla length was significantly shorter and minimal ductal diameter to ampulla diameter ratio was significantly higher in patients with decreased left lung perfusion and correlated well with left lung perfusion values (r = 0.516 and r = -0.501, respectively). A cut-off value of ≤ 5.8 mm for the ductal ampulla length and ≥ 1.9 for ampulla diameter to ampulla length ratio showed high sensitivity and specificity for reduced lung perfusion.


CONCLUSIONS
The incidence of abnormal left lung perfusion is high 6 months after transcatheter closure of PDA with the ADO, more likely in the low weight symptomatic infants and in patients with a short duct or a relatively shallow duct having abrupt narrowing of a large ampulla.
Polat
Tugcin Bora
TB
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey. tugcin75@mynet.com
Celebi
Ahmet
A
Hacımahmutoglu
Sevim
S
Akdeniz
Celal
C
Erdem
Abdullah
A
Fırat
Fatih
F
D000293:Adolescent; D000418:Albumins; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000098:blood supply*; D008297:Male; D015609:Organotechnetium Compounds; D055420:Perfusion Imaging; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011652:Pulmonary Circulation; D011859:Radiography; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed
D000418:Albumins; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C075321:macro aggregates of albumin