Figure 3: Aortogram in lateral (A) and right anterior oblique view (B) displaying a large patent ductus arteriosus, 5 mm in diameter. Aortograms in lateral (C) and right anterior oblique view (D) after implantation of a 10/8 mm Amplatzer ductal oceluder show the protrusion of the retention disc into the aortic lumen.

Mentions: In two patients, after the implantation of the ADO, the device was seen to protrude into the descending aorta, resulting in a peak velocity of 2 m/sec on Doppler echocardiography in one patient (No 6 in Table 2) and a peak velocity of 2.2 m/sec in the other patient (No 5, Fig. 3). The pressure gradient across the aortic isthmus was 2-4 mmHg in the catheterization laboratory in these two patients. One of the patients was 6 month-old, and the other was 7 month-old. Both patients weighed less than 7 kg. In 4 patients (No 5, 7-9 in Table 2), after the procedure, device encroachment was observed on the origin of the left pulmonary artery, resulting in abnormal flow at a peak velocity of 2-2.5 m/sec. In one of these patients, we observed a partial obstruction of the left pulmonary artery. This was a 7-month-old patient (No 5 in Table 2) with a 5 mm duct, with a systolic pulmonary artery pressure of 79 mmHg, and the PDA of this patient was closed using a 10/8 mm ADO. After the deployment of the ADO, the device was observed to protrude into the descending aorta, thereby resulting in a mild narrowing of the descending aorta with no significant pressure gradient in the catheterization laboratory. After the procedure, on the echocardiogram, device encroachment was observed on the origin of the left pulmonary artery, resulting in a peak velocity of 2.5 m/sec. In the lung perfusion scan, a diffusely decreased perfusion of the left lung was observed, with a quantitative lung perfusion scan evidencing a 39% flow to the left lung (Fig. 4). However, after the procedure, heart failure symptoms improved and the patient was discharged 2 days later. On the echocardiogram at 12 months after transcatheter closure of PDA, narrowing of descending aorta and left pulmonary artery was re-evaluated. Although the device was seen to protrude into descending aorta and left pulmonary artery, the peak velocity by Doppler echocardiography in descending aorta decreased from 2.2 m/sec to 1.6 m/sec (Fig. 5), and the peak velocity in left pulmonary artery decreased from 2.5 m/sec to 1.7 m/sec. In the other 3 patients, although device encroachment was also observed on the origin of the left pulmonary artery, no significant obstructions were noted to exist. On follow-up Dopper echocardiography, there was no significant pressure gradient in left pulmonary artery in these patients.

Jang GY, Son CS, Lee JW, Lee JY, Kim SJ - J. Korean Med. Sci. (2007)

Bottom Line: This procedure was conducted successfully in 114 patients (97.4%), using different devices.Minor complications occurred in 6 patients (5.1%); mild narrowing of the descending aorta (2) and mild encroachment on the origin of the left pulmonary artery (4).Although the transcatheter closure of PDA may be considered to be effective, several complications, including hemolysis, embolization, infective endocarditis, and the narrowing of adjacent vessels may occur in certain cases.

Affiliation: Department of Pediatrics, Korea University Hospital, 516 Gojan 1-dong, Danwon-gu, Ansan, Korea. jgynhg@dreamwiz.com

Abstract: To evaluate the short- and mid-term results and complications ensuing the transcatheter closure of patent ductus arteriosus (PDA). Between October 1999 and December 2005, 117 patients (34 males and 83 females) underwent attempted percutaneous closure of PDA with a minimum diameter of more than 3 mm. Follow-up evaluations were conducted at 1 day and 1, 3, 6, 12 months after the performance of the transcatheter closure. The median age of patients at catheterization was 11 yr (range, 0.6 to 68 yr), median weight was 30 kg (range, 6 to 74 kg), and the median diameter of PDA was 4 mm (range, 3 to 8 mm). This procedure was conducted successfully in 114 patients (97.4%), using different devices. Major complications were detected in 4 patients (3.4%); significant hemolysis (2), infective endocarditis (1), failed procedure due to embolization (1). Minor complications occurred in 6 patients (5.1%); mild narrowing of the descending aorta (2) and mild encroachment on the origin of the left pulmonary artery (4). Although the transcatheter closure of PDA may be considered to be effective, several complications, including hemolysis, embolization, infective endocarditis, and the narrowing of adjacent vessels may occur in certain cases.