Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T19:36:30.440Z Has data issue: false hasContentIssue false
  • English
  • Français

Initial clinical experience in transcatheter closure of large patent arterial ducts in infants using the modified and angled Amplatzler duct occluder

Published online by Cambridge University Press:  14 July 2006

Ishwarappa B. Vijayalakshmi ,
Narasimhan Chitra ,
Ravindran Rajasri  and
Karthik Vasudevan
Ishwarappa B. Vijayalakshmi
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Narasimhan Chitra
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Ravindran Rajasri
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Karthik Vasudevan
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To establish the feasibility and efficacy of closing large patent arterial duct in infants, using the modified and angled variants of the Amplatzer duct occluder. Background: Closure of large patent arterial ducts by inserting devices in sick and underweight infants, particularly those weighing around 5 kilograms, remains a challenge. Bigger devices require larger delivery sheaths and may cause obstruction either to the aorta or left pulmonary artery. Negotiating a large device is difficult or impossible, as the sheath gets kinked. Because of these problems, such underweight infants with large ducts who are failing to thrive, and in left ventricular failure with associated lesions, are typically referred for surgery, often leading to higher morbidity and mortality. Methods: We attempted to close such large patent arterial ducts using the new Amplatzer occluder, modified with single layer of polyester, and the angled occluder, with no polyester material, inserted through a specially braided kink-resistant sheath. Results: Closure was achieved in 10 infants, with mean age of 8.2 months, mean weight of 5.5 kilograms, the lowest weighing 3.9 kilograms. The mean size of the patent ducts was 6.3 millimetres, with the largest measuring 8.6 millimetres. We implanted 6 modified and 4 angled occluders. In one patient, suffering from hydronephrosis, a 14/12 angled device embolized and was retrieved, but the patient died. In the remaining patients, all ducts were closed completely, with no obstruction to either the aorta or left pulmonary artery. On follow up, all showed excellent clinical improvement. Conclusion: Complete closure of very large patent arterial ducts is now possible, even in very sick and underweight infants, using the large but low profile custom-made angled or modified versions of the Amplatzer occluder.

Keywords

Low weightleft ventricular failurehydronephrosisRubella syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 4 , August 2006 , pp. 378 - 384
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hijazi ZM, Geggel RL. Results of anterograde transcatheter closure of patent ductus arteriosus using single or multiple Gianturco coils. Am J Cardiol 1994; 74: 925–929.Google Scholar
Bilkis AA, Alwi M, Hasri S et al. The Amplatzer duct occluder: experience in 209 patients. J Am Coll Cardiol 2001; 37: 258–261.Google Scholar
Faella HJ, Hijazi ZM. Closure of the patent ductus arteriosus with the Amplatzer PDA device: immediate results of the international clinical trial. Catheter Cardiovasc Interv 2000; 51: 50–54.Google Scholar
Duke C, Chan KC. Aortic obstruction caused by device occlusion of patent arterial duct. Heart 1999; 82: 109–111.Google Scholar
Krichenko A, Benson LN, Burrows P, Moes CA, McLaughlin P, Freedom RM. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 1989; 63: 877–880.Google Scholar
Gross RE, Hubbard JP. Surgical ligation of a patent ductus arteriosus: report of first successful case. JAMA 1939; 112: 729–731.Google Scholar
Fischer G, Stieh J, Uebing A, Grabitz R, Kramer HH. Transcatheter closure of persistent ductus arteriosus in infants using the Amplatzer duct occluder. Heart 2001; 86: 444–447.Google Scholar
Ewert P, Kretschmar O, Nuernberg JH, Nagdyman N, Lange PE. First closure of a large patent ductus arteriosus in an infant with an angulated nitinol plug. Catheter Cardiovasc Interv 2002; 57: 88–91.Google Scholar
Masura J, Gavora P, Podnar T. Transcatheter occlusion of patent ductus arteriosus using a new angled Amplatzer duct occluder: initial clinical experience. Catheter Cardiovasc Interv 2003; 58: 261–267.Google Scholar