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Published on: December 23, 2022
[Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in
José Rafael Parra-Bravo1, Adriana Apolonio-Martínez2, María de Jesús Estrada-Loza1
1Servicio de Cardiología y Hemodinamia, Hospital de Pediatría Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México, Distrito Federal, México.
Insights
Percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder may reduce left lung perfusion. Increased flow velocity in the pulmonary artery can indicate reduced perfusion, even without device protrusion.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Interventional Cardiology
Context:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Percutaneous closure is a standard treatment for PDA.
- Concerns exist regarding potential pulmonary perfusion deficits post-closure.
Purpose:
- To evaluate pulmonary perfusion after percutaneous PDA closure using the Amplatzer Duct Occluder.
- To assess the correlation between device characteristics, flow velocities, and lung perfusion.
Summary:
- Thirty patients underwent successful percutaneous PDA closure with the Amplatzer Duct Occluder.
- Lung perfusion scans at 6 months revealed reduced left lung perfusion (<40%) in 16.6% of patients.
- Factors like age, weight, and ductus arteriosus dimensions were linked to perfusion abnormalities.
Impact:
- Percutaneous closure of PDA with the Amplatzer Duct Occluder can potentially compromise left lung perfusion.
- Increased pulmonary artery flow velocity may serve as an early indicator of reduced perfusion.
- These findings highlight the importance of monitoring pulmonary perfusion post-intervention.
Objective:
The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan.
Methods:
Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion<40% was considered abnormal.
Results:
The device implantation was successful in all patients. Average perfusion of left lung was 44.7±4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery.
Conclusion:
The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.
