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Percutaneous closure of recanalised ductus arteriosus--a single-centre experience
Jacek Kusa1, Małgorzata Szkutnik, Jacek Baranowski
1Oddział Wrodzonych Wad Serca i Kardiologii Dzieci, Slaskie Centrum Chorób Serca, ul. Szpitalna 2, 41-800 Zabrze. jkusa@poczta.onet.pl
Insights
Percutaneous closure of residual ductus arteriosus shunts is effective and safe. Coil insertion is optimal for small shunts, preventing complications like infective endocarditis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Residual shunts in the ductus arteriosus can occur after initial closure.
- Management strategies for these residual shunts are not standardized.
Purpose of the Study:
- To report single-center experience with residual ductus arteriosus shunts.
- To propose a management strategy for these cases following percutaneous closure.
Main Methods:
- Retrospective analysis of 352 patients undergoing percutaneous closure of the ductus arteriosus.
- 13 patients with incomplete closure were treated with repeat percutaneous interventions, primarily coil embolization.
Main Results:
- 12 of 13 patients achieved shunt closure with coil insertion.
- One patient had a trivial residual shunt at one-year follow-up.
- One implant attempt failed, but the shunt occluded spontaneously.
Conclusions:
- Percutaneous treatment of residual ductus arteriosus shunts is safe and effective.
- Treating residual shunts prevents complications and the need for long-term antibiotic prophylaxis.
- Coil insertion is recommended for small residual shunts due to cost-effectiveness and efficacy.
- Vascular loops or catheter wedge techniques may be useful for complex residual shunts.
Introduction:
Restoration of blood flow through a previously occluded ductus arteriosus may occur in some patients. Treatment strategy in patients with such residual shunts has not yet been uniformly established.
Aim:
To present single-centre experience and to attempt to establish a strategy of management of patients with residual ductus arteriosus shunts following percutaneous closure.
Methods:
Of 352 patients who underwent percutaneous closure of ductus arteriosus, in 13 subjects complete closure failed (coils and Rashkind occluders were used in 10 and 3 patients, respectively). In these patients other percutaneous interventions aiming at total closure of residual shunt were attempted.
Results:
In 12 patients coils were inserted (one patient received two coils). Introduction of implant in one patient failed, but total occlusion of the shunt was confirmed one day after the procedure. Trivial residual shunt was observed in one patient after one-year follow-up.
Conclusions:
Percutaneous treatment of residual shunts within the ductus arteriosus is an effective and safe procedure. In our opinion identifying and treating such leaks is important, as it prevents complications and long-term need for antibiotic prevention of infective endocarditis. In the case of a small residual shunt, insertion of a coil seems to be the optimal therapy due to the low cost of the device, favourable design and high effectiveness. For patients in whom anatomy of the ductus arteriosus has been significantly changed, particularly in previously treated subjects, techniques using vascular loops or insertion using a catheter wedge may be helpful.
