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Transcatheter Patent Ductus Arteriosus Closure in Children With Different Devices and Long-Term Results
Kaan Yıldız1, Mustafa Kir1, Pinar Prencuva2
1Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, TUR.
Insights
Transcatheter closure is effective for pediatric patent ductus arteriosus (PDA). Amplatzer Duct Occluder II devices are preferred for smaller defects, while ADO I devices suit larger ones, offering high success rates.
Area of Science:
- Cardiology
- Pediatric Interventional Cardiology
- Medical Devices
Background:
- Transcatheter closure is the primary treatment for pediatric patent ductus arteriosus (PDA).
- Advancements in devices have improved transcatheter closure outcomes.
- This study evaluates different devices for PDA closure in children.
Purpose of the Study:
- To compare the effectiveness and safety of various transcatheter PDA closure devices in pediatric patients.
- To analyze long-term outcomes of transcatheter PDA closure.
- To identify optimal device selection based on PDA characteristics.
Main Methods:
- Retrospective evaluation of 235 pediatric patients (0-18 years) undergoing transcatheter PDA closure.
- Data collected between January 2005 and February 2020.
- Analysis included patient demographics, ductal anatomy, devices used, procedural details, and follow-up outcomes.
Main Results:
- Amplatzer Duct Occluder (ADO) II was used in 64.2% of cases, ADO I in 18.2%, and coils in 17.4%.
- The early closure rate was 92%, with a 96.0% overall procedural success rate.
- Mean follow-up was 9.7 years, demonstrating sustained efficacy.
Conclusions:
- Amplatzer Duct Occluder I devices are recommended for larger PDA defects.
- Amplatzer Duct Occluder II devices are preferred for small- to medium-sized PDAs.
- Transcatheter closure with these devices offers a safe and effective treatment option for pediatric PDA.
Introduction:
With the development of transcatheter interventional techniques and the introduction of next-generation duct occluder devices, transcatheter closure has become the first treatment option for patent ductus arteriosus (PDA) in pediatric patients. In this study, we compared the effectiveness and safety of different devices for transcatheter PDA closure in pediatric patients, focusing on long-term outcomes.
Methods:
A total of 235 patients aged 0-18 years who underwent transcatheter PDA closure at a tertiary care center between January 2005 and February 2020 were included. The medical records of the cases were retrospectively evaluated.
Results:
The median age of the patients was 2.3 years (range: 3.5 months to 17 years), with a mean weight of 12.8 kg (range: 5.7-43.2 kg). The mean PDA diameter at its narrowest point was 2.9 mm (range: 2.2-5.1 mm). Ductal anatomy was as follows: Type A in 98 (41.7%) patients, Type E in 36 (15.6%) patients, Type C in 32 (13.5%) patients, Type F in 27 (11.4%) patients, Type D in 23 (9.7%) patients, and Type B in 19 (8.1%) patients. Arterial access was used in 138 (57.1%) patients, venous + arterial access in 58 (24.6%) patients, and venous access only in 39 (16.5%) patients. Closure was performed with Amplatzer Duct Occluder (ADO; AGA Medical Corp., Golden Valley, MN, USA) II in 151 (64.2%) cases, ADO I in 43 (18.2%) cases, and coils in 41 (17.4%) cases. The mean fluoroscopy time and mean procedural time were 10.3 ± 4.2 minutes and 41 ± 7.2 minutes, respectively. The mean radiation dose was 1364 ± 497 cGy/min. The early closure rate after the procedure was 92%, while residual shunting on the first day post-procedure was observed in 1.8% of cases, decreasing to 0.1% at the one-month follow-up. The overall procedural success rate for all cases was 96.0%. The mean follow-up duration was 9.7 years (range: 2.9-13.8 years).
Conclusion:
For percutaneous PDA closure, ADO I devices are preferred for larger defects, whereas ADO II devices are prioritized for small- to medium-sized defects instead of coils.
