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Trans-catheter closure of large PDA in adult patients with Amplatzer device: case series
Zahra Khajali1, Ata Firouzi1, Homa Ghaderian2
1Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
Insights
Trans-catheter closure using Amplatzer devices is a feasible method for treating large patent ductus arteriosus in adults with pulmonary hypertension. While complications can occur, this technique offers an advantageous approach for managing this condition.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a congenital heart defect that can lead to serious complications if not closed after birth.
- Trans-catheter closure with occluder devices is the preferred method for PDA, with surgical ligation reserved for specific cases.
- Large PDAs in adults, especially those with pulmonary hypertension, present unique management challenges.
Purpose of the Study:
- To describe the hemodynamic and morphological characteristics of adult patients with large PDA and pulmonary hypertension.
- To evaluate the feasibility and outcomes of trans-catheter closure using Amplatzer devices in this patient population.
Main Methods:
- Retrospective analysis of five adult patients (aged 21-44 years) with large PDA and pulmonary hypertension.
- Trans-catheter closure performed using Amplatzer ventricular septal defect occluder devices.
- Assessment of procedural success, device function, and complications.
Main Results:
- Successful trans-catheter closure was achieved in all five patients.
- One patient experienced device embolization to the pulmonary artery within 24 hours, requiring surgical intervention.
- The Amplatzer ventricular septal defect muscular occluder demonstrated efficacy in closing large PDAs in adults.
Conclusions:
- Trans-catheter closure of large patent ductus arteriosus in adult patients with pulmonary hypertension is a feasible and effective treatment option.
- The Amplatzer 'double disk' occluder may be advantageous for this procedure, despite potential complications.
- Careful patient selection and procedural technique are crucial for optimizing outcomes.
Abstract:
Ductus arteriosus is a physiological structure if not closed after birth, may lead to many complications. Today, trans-catheter closure of patent ductus arteriosus with Occluder devices is the preferred method. Surgical ligation is used only in certain cases such as large symptomatic patent ductus arteriosus in very small infants and premature babies; unfavourable structure of the duct or economic considerations. In this article, we described haemodynamic and morphological characteristics of five patients with large patent ductus arteriosus which were occluded with Amplatzer device.From 23 January, 2010 to 31 July, 2018, five patients referred to our clinic with large patent ductus arteriosus and pulmonary arterial hypertension for further evaluation. After assessing them with various diagnostic methods, we decided to close defect with ventricular septal defect Occluder device. Patients aged 21-44 years and one of them was male. Ductus closure was successfully done with ventricular septal defect Occluder device. Closure was successful for all of them but in one case, whose device was embolized to pulmonary artery after 24 hr and he underwent surgery.Trans-catheter closure of large patent ductus arteriosus in adult patients with pulmonary hypertension is feasible. Despite the fact that complications may occur even with the most experienced hands, the 'double disk' Amplatzer ventricular septal defect muscular Occluder could be advantageous in this setting.
