Related Experiment Videos
Transcatheter closure of patent ductus arteriosus
S Shrivastava1, A Marwah, S Radhakrishnan
1Escorts Heart Institute and Research Center, Okhla Road, New Delhi 110 025, India. savitri_sh@yahoo.com
Insights
Catheter closure of patent ductus arteriosus using spring coils and Amplatzer devices is effective. While small residual shunts can occur, especially with coils, most close spontaneously, making this an acceptable alternative to surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Surgical closure has historically been the standard treatment for PDA.
- Minimally invasive catheter-based interventions offer an alternative to surgery.
Purpose of the Study:
- To evaluate the short and intermediate outcomes of transcatheter closure of PDA.
- To compare the efficacy and safety of spring coils versus the Amplatzer duct occluder for PDA closure.
- To assess the rate of successful closure and complications associated with each device.
Main Methods:
- A retrospective analysis of 121 patients with PDA treated between 1996 and 1999.
- Patients received either spring coils or Amplatzer duct occluders.
- Outcomes included device deployment success, complete closure rates, and complication incidence.
Main Results:
- Successful deployment rates were 87.5% for coils and 95.5% for the Amplatzer device.
- Complete duct closure was achieved in 96% of coil patients at 1 year and 100% of device patients at 3 months.
- Complications included coil embolization (11 patients), pulmonary stenosis (1 patient), hemolysis (1 patient), and femoral artery pulse loss (1 patient).
Conclusions:
- Percutaneous closure of PDA using coils or the Amplatzer device is a viable and acceptable alternative to surgery.
- While residual shunts are more common with coil deployment, they often resolve spontaneously.
- Both methods demonstrate high success rates for PDA closure.
Objective:
To present short and intermediate results of catheter closure of patent ductus artereiosus using spring coils and Amplatzer duct occluder.
Setting:
Tertiary care referral hospital in New Delhi.
Method:
121 patients were diagnosed to be having patency of the arterial duct between October 1996 and December 1999. Their ages ranged between 4 mo and 480 mo (mean 80.5 mo). Before August 1998 only spring coils were used as an alternative to surgical closure of the duct, whereas between August 1998 and December 1999 both coils and device were used.
Results:
Spring coils were attempted in 48, Amplatzer duct occluder in 44 and 29 patients were referred for surgery. Coils were successfully deployed in 42/48 (87.5%) and device in 42/44 (95.5%) patients. Complete closure of the arterial duct was seen in 96% patients in the coil closure group at the end of one year and 100% closure was achieved in the device closure group at the end of 3 months in all the patients followed. Coil embolised in 11 patients, significant stenosis of left pulmonary occurred in one patient and severe hemolysis requiring blood transfusion occurred in one patient after coil closure. Six patients required a second procedure to close the residual shunt within 6 months of the initial coil deployment. One patient had loss of femoral artery pulses in right leg after device closure and required heparin infusion for 48 hours. There were 8 failed attempts. All these patients have been operated successfully.
Conclusion:
Percutaneous closure of the patent ductus arteriosus using Coils or the Amplatzer device is an acceptable method. Small residual shunts are common after the initial procedure especially after coil deployment but most close spontaneously.