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Published on: December 23, 2022
[Percutaneous closure of persistent ductus arteriosus in low-weight infants]
Insights
Percutaneous closure of persistent ductus arteriosus using the Amplatzer Duct Occluder is effective in infants under 6kg. This procedure shows a low complication rate, with significant clinical improvement observed post-intervention.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Persistent ductus arteriosus (PDA) is a common congenital heart defect.
- Surgical closure is standard, but percutaneous closure with the Amplatzer Duct Occluder is an alternative.
- This device is typically not recommended for infants weighing less than 6kg.
Purpose of the Study:
- To evaluate the efficacy and safety of the Amplatzer Duct Occluder for PDA closure in low-weight infants (<6kg).
Main Methods:
- Retrospective analysis of medical records of infants <6kg who underwent PDA closure with the Amplatzer Duct Occluder (Jan 2010-Dec 2014).
- Included 14 patients (mean weight 5.7kg).
- Assessed procedural success, occlusion rates, complications, and clinical outcomes.
Main Results:
- Successful implantation in 93% of cases; immediate occlusion rate was 71%.
- Complications occurred in two patients (cardiac tamponade, partial disk protrusion).
- PDA morphology (C-type) and PDA diameter/weight ratio >0.95 predicted failure; low weight (<6kg) did not predict failure. No late embolization.
Conclusions:
- Percutaneous closure of PDA with the Amplatzer Duct Occluder is feasible and effective in infants weighing up to 6kg.
- The procedure demonstrates a relatively low complication rate.
- Significant clinical improvement, including pulmonary pressure normalization, was observed during follow-up.
Introduction:
The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg.
Aim Of The Study:
The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children.
Patients And Methods:
The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed.
Results:
Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure.
Conclusion:
This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.
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