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Published on: May 9, 2013
Surgical removal of duct occluder device under mild hypothermia without cardiopulmonary bypass
Prashant N Mohite1, Sachin A Kuthe, Shyam K Thingnam
1Department of Cardiovascular and Thoracic Surgery, Postgraduation Institute of Medical Research and Education, Chandigarh, India. drprashantis@rediffmail.com
Insights
Device migration during patent ductus arteriosus closure is a rising complication. A novel technique successfully removed a dislodged duct occluder without cardiopulmonary bypass, avoiding major surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Percutaneous closure of patent ductus arteriosus (PDA) is increasingly common.
- Device migration is a significant complication of PDA closure.
- Current standard practice for migrated devices involves cardiopulmonary bypass.
Purpose of the Study:
- To describe a minimally invasive technique for removing a migrated Amplatzer duct occluder.
- To avoid the need for cardiopulmonary bypass in cases of device migration.
Main Methods:
- A 4-month-old infant experienced dislodgement of an Amplatzer duct occluder into the descending thoracic aorta.
- The migrated device was successfully retrieved using a posterolateral thoracotomy approach.
- The procedure was performed under mild hypothermia with juxtaductal aortotomy, avoiding cardiopulmonary bypass.
Main Results:
- Successful removal of the dislodged Amplatzer duct occluder.
- Avoidance of cardiopulmonary bypass and its associated risks.
- Demonstration of a feasible alternative surgical approach.
Conclusions:
- Minimally invasive thoracotomy can be an effective alternative to cardiopulmonary bypass for managing migrated duct occluder devices.
- This approach offers a potentially safer option for managing this complication in pediatric patients.
- Further studies are warranted to evaluate the long-term outcomes of this technique.
Abstract:
Because the use of percutaneous intervention is increasing for the closure of the patent ductus arteriosus, the procedure-related complications are also on rise, with migration of the device being most common. The routine practice is to remove the migrated duct occluder device under cardiopulmonary bypass. Amplatzer duct occluder used in a 4-month-old infant dislodged into the descending thoracic aorta. It was removed by the posterolateral thoracotomy under mild hypothermia through juxtaductal aortotomy between the aortic cross-clamps. The use of cardiopulmonary bypass is thus avoided.
