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Immediate aortic obstruction in young infants undergoing patent arterial duct closure with the duct occluder
Taniya Rachel Issacs1, Navaneetha Sasikumar1, Raman Krishna Kumar1
1Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Insights
Device displacement after patent ductus arteriosus (PDA) closure in infants can cause aortic obstruction. Exaggerated device recoil and tissue pliability are key factors, necessitating careful pre-deployment assessment.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect in infants.
- Transcatheter device closure is a frequent treatment for PDA.
- Device migration after PDA closure can lead to serious complications.
Purpose of the Study:
- To investigate the causes of immediate device displacement into the aorta after PDA closure in young infants.
- To identify factors contributing to device migration and subsequent aortic obstruction.
Main Methods:
- Retrospective analysis of three infants with PDA who experienced device displacement after duct occluder deployment.
- Comparison of device recoil (percentage shortening screw to pin distance ratio) between cases and 15 control infants with uneventful PDA closure.
- Analysis of aortic diameter and PDA length in cases and controls.
Main Results:
- Three young infants experienced immediate device displacement into the aorta after duct occluder deployment, requiring urgent surgical intervention.
- The percentage shortening screw to pin distance ratio, indicating device recoil, was significantly higher in cases (14.00 [12-15]) compared to controls (4.00 [2.30-7.50]), P = 0.011.
- Aortic diameter and PDA length were similar between cases and controls.
Conclusions:
- A combination of tissue pliability and exaggerated device recoil can lead to device migration and aortic obstruction in small infants undergoing PDA closure.
- Cautious assessment of device deployment and immediate post-release evaluation are crucial in young infants to prevent complications.
Abstract:
We report three young infants (118, 45, and 80 days; 3.5, 4.1, and 3.8 kg) with patent ductus arteriosus (PDA) who had a uniform pattern of immediate device displacement into the aorta after an apparently secure deployment of a duct occluder. All had aortic obstruction requiring urgent surgical relief. During the study period, 18 infants (<6 months) underwent PDA closure with the same device size (6-4 Lifetech duct occluder). The aortic diameter and PDA length were similar in cases versus the 15 controls with uneventful procedures. The percentage shortening screw to pin distance ratio, which indicates the degree of recoil of the device upon release, was significantly higher in the cases versus controls (14.00 [12-15] vs. 4.00 [2.30-7.50], P = 0.011). A combination of tissue pliability and exaggerated recoil can occasionally result in unforeseen device migration and resultant aortic obstruction in small young infants, meriting cautious assessment before deployment and immediately after release.
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