Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-18T16:49:02.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Transcatheter occlusion of moderate to large patent arterial ducts, having a diameter above 2.5 mm, with the Amplatzer Duct Occluder. Comparisons with the Rashkind, buttoned devices, and coils in 116 consecutive patients

Published online by Cambridge University Press:  24 May 2005

François Godart ,
Christian Rey ,
Patrick Devos ,
Georges-Marie Brevière  and
Charles Francart
François Godart
Affiliation:
Department of Paediatric Cardiology, Cardiac Hospital, Lille, France
Christian Rey
Affiliation:
Department of Paediatric Cardiology, Cardiac Hospital, Lille, France
Patrick Devos
Affiliation:
Department of Biostatistics, University of Lille, Lille, France
Georges-Marie Brevière
Affiliation:
Department of Paediatric Cardiology, Cardiac Hospital, Lille, France
Charles Francart
Affiliation:
Department of Paediatric Cardiology, Cardiac Hospital, Lille, France
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim: To report results of transcatheter occlusion of moderate to large patent arterial ducts, having a minimum diameter above 2.5 mm, with the Amplatzer duct occluder, and to compare these with results achieved using Rashkind or Sideris devices and Cook detachable coils. Design and setting: Retrospective study conducted on intention-to-treat data from a tertiary referral centre. Patients: Since 1989, 116 consecutive patients, 77 females and 39 males, underwent percutaneous closure with several devices. We used the Rashkind double umbrella in 23 patients, the Sideris buttoned device in 39 patients, coils in 17 patients, and the Amplatzer duct occluder in 37 patients. The median age of the patients was 37 months, and the median weight 13 kg. The mean minimum diameter of the duct was 3.8 ± 1.22 mm, with a median of 3.5 mm, and range from 2.5 to 10 mm. Results: Implantation succeeded in all but 9 of the children (92%). The time of fluoroscopy was shorter, and full occlusion was better as judged on angiography, in patients closed using the Amplatzer device, despite closure of larger ducts, than in patients closed using other devices (p < 0.0001, p = 0.0003, and p = 0.0015 for the Rashkind, Sideris, and coils, respectively). Complications included embolisation in 2 patients, and haemolysis in 3 patients. In 12 patients, a second device was inserted because of residual shunting noted during follow-up. Complete occlusion was achieved earlier after implantation (p = 0.0002), and the rate of complete occlusion was better in patients receiving an Amplatzer device (97%, p = 0.024) than in patients undergoing closure with other devices. Conclusion: Transcatheter closure of moderate to large patent arterial ducts using the Amplatzer duct occluder is an effective and safe procedure, providing better results than those achieved using other occluders.

Keywords

Ductus arteriosuscatheter interventionmechanical devices
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 5 , October 2003 , pp. 413 - 419
Copyright
© 2003 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

Portsmann W, Wierny L, Warneke H. Closure of the persistent ductus arteriosus without thoracotomy. Ger Med Mon 1967; 12: 259–261.Google Scholar
Rashkind WJ, Mullins CE, Hellenbrand WE, Tait MA. Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA occluder system. Circulation 1987; 75: 583–592.Google Scholar
Wessel DL, Keane JF, Parness I, Lock JE. Outpatient closure of the patent ductus arteriosus. Circulation 1988; 77: 1068–1071.Google Scholar
Rao PS, Sideris EB, Haddad J, et al. Transcatheter occlusion of patent ductus arteriosus with adjustable buttoned device. Initial clinical experience. Circulation 1993; 88: 1119–1126.Google Scholar
Uzun O, Hancock S, Parsons JM, Dickinson DF, Gibbs JL. Transcatheter occlusion of the arterial duct with Cook detachable coils: early experience. Heart 1996; 76: 269–273.Google Scholar
Hijazi ZM, Geggel RL. Transcatheter closure of large patent ductus arteriosus (≥4 mm) with Gianturco coils: immediate and mid-term results. Heart 1996; 76: 536–540.Google Scholar
Rao PS, Kim SH, Choi JY, et al. Follow-up results of transvenous occlusion of patent ductus arteriosus with the buttoned device. J Am Coll Cardiol 1999; 33: 820–826.Google Scholar
Podnar T, Gavora P, Masura J. Percutaneous closure of patent ductus arteriosus: complementary use of detachable Cook patent ductus arteriosus and Amplatzer duct occluders. Eur J Pediatr 2000; 159: 293–296.Google Scholar
Masura J, Walsh KP, Thanopoulous BV, et al. Catheter closure of moderate- to large-sized patent ductus arteriosus using the new Amplatzer Duct Occluder: immediate and short-term results. J Am Coll Cardiol 1998; 31: 878–882.Google Scholar
Marwah A, Radhakrishnan S, Shrivastava S. Immediate and early results of closure of moderate to large patent arterial ducts using the new Amplatzer™ device. Cardiol Young 2000; 10: 208–211.Google Scholar
Krichenko A, Benson LN, Burrows P, Möes CAF, 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
Magee AG, Huggon IC, Seed PT, Qureshi SA, Tynan M, Association for European Cardiology. Transcatheter coil occlusion of the arterial duct. Results of European Registry. Eur Heart J 2001; 22: 1817–1821.Google Scholar
Godart F, Rodes J, Rey C. Severe haemolysis after transcatheter closure of patent arterial duct with the new Amplatzer™ duct occluder. Cardiol Young 2000; 10: 265–267.Google Scholar
Sorensen KE, Kristensen BO, Hansen OK. Frequency of occurrence of residual ductal flow after surgical ligation by color-flow mapping. Am J Cardiol 1991; 67: 653–654.Google Scholar
Zucker N, Qureshi SA, Baker EJ, Deverall PB, Tynan M. Residual patency of the arterial duct subsequent to surgical ligation. Cardiol Young 1993; 3: 216–219.Google Scholar
Galal O, Nehgme R, Al-Fadley F, et al. The role of surgical ligation of patent ductus arteriosus in the era of the Rashkind device. Ann Thorac Surg 1997; 63: 434–437.Google Scholar
Anonymous. Proposed standards for clinical evaluation of patent ductus arteriosus occlusion devices. Multiorganization advisory panel to FDA for pediatric cardiovascular devices. Cathet Cardiovasc Interv 2000; 51: 293–296.
Thanopoulos BD, Hakim FA, Hiari A, et al. Further experience with transcatheter closure of the patent ductus arteriosus using the Amplatzer Duct Occluder. J Am Coll Cardiol 2000; 35: 1016–1021.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
Fisher 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
Tometzki A, Chan K, De Giovanni J, et al. Total UK multi-centre experience with a novel arterial occlusion device (Duct Occlud pfm). Heart 1996; 76: 520–524.Google Scholar
Rosenthal E, Qureshi SA, Reidy J, Baker EJ, Tynan M. Evolving use of embolisation for occlusion of the arterial duct. Heart 1996; 76: 525–530.Google Scholar
Tometzki AJ, Arnold R, Peart I, et al. Transcatheter occlusion of the patent ductus arteriosus with Cook detachable coils. Heart 1996; 76: 531–535.Google Scholar
Anil SR, Sivakumar K, Kumar RK. Coil occlusion of the small patent arterial duct without arterial access. Cardiol Young 2002; 12: 51–56.Google Scholar
Joseph G, Zacharias TU, George B. Severe intravascular hemolysis after transcatheter closure of a large patent ductus arteriosus using the Amplatzer duct occluder: successful resolution by intradevice coil deployment. Catheter Cardiovasc Interv 2002; 55: 245–249.Google Scholar
Kong H, Wilkinson JL, Coe JY, et al. Corrosive behaviour of Ampltazer® devices in experimental and biological environments. Cardiol Young 2002; 12: 260–265.Google Scholar