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Transcatheter closure of persistent ductus arteriosus in adults
James R Bentham1, John D R Thomson, John L Gibbs
1Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom. jamie.bentham@well.ox.ac.uk
Insights
Transcatheter duct occlusion in adults is safe and effective. However, adult ductal anatomy presents unique challenges, requiring more complex techniques and longer procedure times compared to children.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- The arterial duct (ductus arteriosus) is a fetal blood vessel that normally closes shortly after birth.
- Failure of closure results in a patent ductus arteriosus (PDA), which can lead to heart failure and pulmonary hypertension.
- Transcatheter closure has become the preferred method for PDA treatment in children, but data in adults are less extensive.
Purpose of the Study:
- To evaluate the technical aspects and outcomes of transcatheter duct occlusion in adult patients.
- To compare the procedural complexity and outcomes between adults and children undergoing transcatheter duct closure.
Main Methods:
- A single-center retrospective review of all transcatheter duct closures performed between 2000 and 2012.
- Analysis of procedural techniques, device delivery, procedure duration, fluoroscopy time, and complications.
- Comparison of data between adult patients (age > 16) and pediatric patients.
Main Results:
- 31 adult patients (6% of total) underwent transcatheter duct closure.
- Crossing the duct from the pulmonary artery was not possible in 10 adult cases, necessitating alternative approaches like arterio-venous wire circuits for device delivery.
- Adult procedures had significantly longer procedure times (37 vs. 24 minutes) and fluoroscopy times (8.4 vs. 4.3 minutes) compared to children (P < 0.01 and P < 0.025, respectively).
- No major complications were reported in either group.
Conclusions:
- Transcatheter closure of the arterial duct in adults is a safe and effective treatment option.
- Adult ductal anatomy can be significantly different from that in children, leading to increased technical difficulty and procedural demands.
- Specialized techniques may be required for successful transcatheter duct occlusion in adults.
Objective:
To describe the technical aspects and outcome of duct occlusion in adults over a 12-year period.
Methods:
A single center review of all transcatheter duct closures performed between 2000 and 2012.
Results:
Of 518 transcatheter duct closures performed, 31 patients were over the age of 16 at the time of procedure (6%). In 10 of the 31 cases, it was not possible to cross the duct from the pulmonary artery. In 4 of those, the duct was small enough to be closed with coils delivered from the aorta (although 1 required a second procedure for a residual shunt). In the remaining 6 cases, it was necessary to cross the duct from the aorta and create an arterio-venous "circuit" using a snare to deliver an Amplatzer device from the femoral vein. In none of the 487 children who underwent transcatheter duct closure during the same time period was it necessary to deliver the device using an arterio-venous wire circuit. The increased complexity of the procedure in adults compared with children was further reflected by longer procedure times (median of 37 minutes in adults vs. 24 minutes in children [P < 0.01]) and longer fluoroscopy times (median of 8.4 minutes in adults vs. 4.3 minutes in children [P < 0.025]). There were no major complications.
Conclusions:
Closure of the arterial duct in adults is safe and effective but ductal anatomy may differ from that seen in childhood, making transcatheter closure technically much more demanding than in children.
