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Risk factors associated with device embolisation or malposition during transcatheter closure of patent ductus arteriosus

Published online by Cambridge University Press:  14 December 2022

Zeeshan A. Mumtaz Open the ORCID record for Zeeshan A. Mumtaz [Opens in a new window] ,
Pramod Sagar Open the ORCID record for Pramod Sagar [Opens in a new window] ,
Kothandam Sivakumar Open the ORCID record for Kothandam Sivakumar [Opens in a new window] ,
Asish R. Mohakud ,
Monica Rajendran  and
Sreeja Pavithran
Zeeshan A. Mumtaz
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
Pramod Sagar
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
Kothandam Sivakumar*
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
Asish R. Mohakud
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
Monica Rajendran
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
Sreeja Pavithran
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
*
Author for correspondence: Dr. K. Sivakumar MD DM, Head of Department of Pediatric Cardiology, Madras Medical Mission, 4A Dr JJ Nagar, Mogappair, Chennai 600089, India. Tel: +919444449966. E-mail drkumarsiva@hotmail.com
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Abstract

Background:

Device embolisation is a serious adverse event during transcatheter duct closure. This study analyses risk factors for embolisation.

Methods:

Demographic parameters, echocardiographic anatomy, haemodynamics, and procedural characteristics of consecutive duct closures in a tertiary centre over 8 years were analysed. Procedures complicated by embolisation were compared to uncomplicated procedures.

Results:

Fifteen embolisations occurred during 376 procedures. All except one embolisation were in infants. The pulmonary artery: aortic pressure ratio was 0.78 ± 0.22. Embolisation was seen significantly more commonly in Type C tubular ducts. Vascular plugs were more significantly associated with embolisations. Logistic regression analysis showed device embolisation was significantly higher in age group of < 6 months compared to 6–12 months (p = 0.02), higher in those with tubular ducts versus conical ducts (p = 0.003), use of vascular plugs compared to conventional duct occluders (p = 0.05), and in duct closure with undersized devices (p = 0.001). There was no in-hospital mortality. Three patients needed surgical retrieval while others were successfully managed in catheterisation laboratory.

Conclusions:

Device embolisation complicates 4% of transcatheter duct closures, with need for surgery in one-fifth of them. Larger ducts with high pulmonary artery pressures in younger and smaller infants are more often associated with device embolisation. Tubular ducts are more prone for embolisation compared to usual conical ducts. Softer vascular plugs are often associated with embolisations. Intentional device undersizing to avoid vascular obstruction in small patients is a frequent risk factor for embolisation. Precise echocardiographic measurements, correct occluder choice, proper technique and additional care in patients with high pulmonary artery pressures are mandatory to minimise embolisations.

Keywords

Duct occluderAmplatzer vascular plugtranscatheter retrievaltubular arterial ductconical arterial duct
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 2041 - 2048
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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