Transcatheter closure of persistent ductus arteriosus in infants using the Amplatzer duct occluder
1Department of Paediatric Cardiology and Biomedical Engineering, Christian Albrechts University of Kiel, Schwanenweg 20, D-24105 Kiel, Germany. fischer@pedcard.uni-kiel.de
Insights
Transcatheter closure using the Amplatzer duct occluder is a viable alternative to surgery for infants with a persistent ductus arteriosus. Further improvements to the implantation system are needed for it to become the preferred treatment.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
Background:
- A persistent ductus arteriosus (PDA) is a common congenital heart defect in infants.
- Surgical ligation has been the traditional treatment for PDA.
Purpose of the Study:
- To assess the efficacy and safety of transcatheter closure with the Amplatzer duct occluder in infants with PDA.
- To compare this novel approach with surgical treatment.
Main Methods:
- Twelve infants under one year of age with significant PDA were included.
- Transcatheter closure was attempted using the Amplatzer duct occluder, a device designed to stent the duct.
- Patients had varying duct sizes and some presented with pulmonary hypertension.
Main Results:
- Successful complete duct occlusion was achieved in 10 out of 12 infants.
- Procedure-related challenges were noted in nine cases, leading to extended procedure and fluoroscopy times.
- Two infants required surgical ligation due to failed transcatheter closure.
Conclusions:
- Transcatheter closure with the Amplatzer duct occluder presents a promising alternative to surgery for infants with PDA.
- Enhancements to the implantation system are required to establish this as the primary treatment modality.
Aim:
To evaluate whether transcatheter closure with the Amplatzer duct occluder offers an alternative to surgical treatment in infants with a persistent ductus arteriosus.
Methods:
12 patients under 1 year of age (age 1-11 months, body weight 2.6-8.7 kg) with clinical and echocardiographic findings of a significant duct were considered for transcatheter closure with the Amplatzer occluder. The device is made of a Nitinol and polyester fabric mesh and provides occlusion by stenting the duct. Measured angiographically, the narrowest diameter of the ducts ranged from 1.5-5 mm; in six patients pulmonary hypertension was also present.
Results:
The devices were implanted and complete duct occlusion was demonstrated during follow up in 10 patients. Procedure related difficulties occurred in nine of the 12 cases and led to relatively long procedure and fluoroscopy times (procedure time 50-180 minutes, median 80 minutes; fluoroscopy time 4.9-49 minutes, median 16 minutes). In two infants transcatheter closure could not be achieved and surgical duct ligation had to be carried out.
Conclusions:
In small infants with a persistent ductus arteriosus the Amplatzer duct occluder offers an alternative to surgical treatment, but further improvement of the implantation system is necessary before the procedure can be recommended as the treatment of choice.
