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[Therapeutic catheterization: the percutaneous closure of a persistent ductus arteriosus and of interatrial
R Bermúdez-Cañete1, J M Velasco Bayón, J I Herraiz
1Unidad Médico-Quirúrgica de Cardiología Pediátrica, Hospital Ramón y Cajal, Madrid.
Insights
Percutaneous closure of patent ductus arteriosus (PDA) using occluder devices demonstrated high success rates. This minimally invasive technique proved safe and effective for closing PDAs and atrial septal defects (ASDs).
Area of Science:
- Interventional Cardiology
- Pediatric Cardiac Surgery
- Medical Device Technology
Background:
- Patent ductus arteriosus (PDA) and ostium secundum atrial septal defects (ASDs) are common congenital heart conditions.
- Traditional surgical closure can be invasive, prompting the development of less invasive percutaneous methods.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous closure for PDA and ASD using specific occluder devices.
- To assess the occlusion rates and device performance in a cohort of pediatric patients.
Main Methods:
- Percutaneous closure of 26 PDAs and 1 ASD was attempted between February and December 1990.
- USCI-Rashkind PDA double disc occluder and a "Lock Clamshell" occluder were utilized.
- Diagnosis and follow-up (24 hours, 6 months, 1 year) involved clinical assessment and Doppler echocardiography.
Main Results:
- Successful device implantation was achieved in 95% of cases (25 out of 27 patients).
- Total occlusion rates were 72% at 24 hours, 84% at 6 months, and 88% overall.
- One ASD closure achieved immediate total occlusion; one large PDA could not be occluded.
Conclusions:
- Percutaneous closure of PDA and ASD is a safe and effective therapeutic option.
- The studied occluder devices demonstrated favorable success rates and occlusion durability.
- Minimally invasive closure offers a viable alternative to surgical intervention for selected cardiac defects.
Abstract:
Between february and december 1990, we attempted percutaneous closure of patent ductus arteriosus (PDA) in 26 patients and in one ostium secundum atrial septal defect (ASD). One of the PDA was right sided with right aortic arch and two were post surgical leaks. We used the "USCI-Rashkind PDA double disc occluder" and the newly designed "Lock Clamshell" occluder for the ASD. Twenty seven patients (20 females and 7 males), aged 1.3 to 16 years (M = 5.6) and weighing 9.5 to 56 kg (M = 21.3), were studied. Diagnosis was made clinically with the aid of Doppler colour flow echocardiography, with follow-up studies at 24 hours, 6 months and 1 year after the procedure. Diameter of the ductus varied from 1.6 to 8.2 mm (M = 2.6). Successful implant of the device was achieved in 25 cases (95%), of which 18 (72%) were totally occluded at 24 hours and 21 (84%) after 6 months, remaining small residual leaks in four (16%). In only one patient total occlusion was demonstrated 1 year after device implantation. We achieved 22 (88%) total occlusions. One case was not possible to occlude, due to its large size. Angiocardiography demonstrated adequate anatomy in 18, and difficult in 8 patients. Twelve and 17 mm devices were used in 16 and 9 patients, respectively. Successful second implant with subsequent total occlusion was achieved in one patient with a previous moderate residual leak. The ASD was central and single, with a diameter of 20 mm. Immediate total occlusion was achieved. We conclude that percutaneous PDA closure is a safe and effective procedure.(ABSTRACT TRUNCATED AT 250 WORDS)