Slides Structural Heart Disease Congenital Heart Disease

Percutaneous Closure of Patent Ductus Arteriosus
• Natural course of patent ductus arteriosus
• Amplatzer duct occluder device
Natural course of patent ductus arteriosus
Persistent patent ductus arteriosus (PDA) is a common congenital heart disorder and is seen approximately in 0.01% to 0.08% of live births. In the presence of a large left to right shunt, the natural history is of shortened longevity with a mortality rate of 0.5% per year, the average age of death being in the third or early fourth decade of life. Closure of PDA is recommended not only for symptomatic relief in large left to right shunts, but also for preventing the occurrence of infective endarteritis, particularly in small ductii with an estimated incidence being 0.45% per year and other complications like aneurysm formation, left ventricular dysfunction, and progressive pulmonary hypertension. Surgical closure by ligation or division is an effective treatment but it carries the potential risk of morbidity and rarely, mortality associated with thoracotomy, specially in adults. Currently, the benefits of transcatheter closure of PDA compared to surgical closure seem obvious in terms of shorter in-hospital stay, high success rates, no scar, and little morbidity.

Amplatzer duct occluder device
This device has gained clinical popularity owing to its user-friendly delivery system needing low fluoroscopic time, easy repositioning, and adaptation to all anatomical variations of the PDA. In contrast to other occluders, the Amplatzer duct occluder (ADO) closes the ductus by stenting the communication with its tubular part, which forces the blood through a highly thrombogenic conduit. This achieves fixation, stability, and reduces the risk of embolization. Although the device is expensive, its virtually 100% occlusion rate obviates the future need for multiple devices.
The intermediate results of an international clinical trial on an Amplatzer duct occluder reported its use in 316 patients with a median PDA diameter of 3.8 mm. Complete closure was achieved in 76.3% cases in 24 hours, 94.6%. in 6 months, and 100% in 1 year. One patient had device embolization into aorta, which was retrieved back, but th patient died due to systemic complications. Other complications were seen in few patients and included hemolysis, left pulmonary artery stenosis, device protrusion into aorta causing coarctation, and device misplacement.

References
1. Arora R, Sengupta PP, Thakur AK, et al. Pediatric interventional cardiac symposium (PICS-VI). Device closure of patent ductus arteriosus. J Interv Cardiol. 2003;16:385-91.
2. Faella HJ, Hijaji ZM. Closure of patent ductus arteriosus with Amplatzer PDA device: Immediate results of the international clinical trial. Cathet Cardiovasc Intervent 2000;51: 50-54.

Comments

  • Guo-Wei He 2004-11-13 What is the smallest PDA you can close with this device? I have a patient who has a tiny PDA with diameter of only 1~2 mm. Can it be closed by the device?

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