Related Experiment Videos
Transcatheter patent ductus arteriosus occlusion: application in the small child
D G Nykanen1, A M Hayes, L N Benson
1Department of Pediatrics, University of Toronto Faculty of Medicine, Ontario, Canada.
Insights
Transcatheter patent ductus arteriosus occlusion is feasible in children under 10 kg using a modified delivery system. A 17-mm device may compromise left pulmonary artery flow and should be used cautiously.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Transcatheter occlusion of the patent ductus arteriosus (PDA) is established as safe and effective in children over 10 kg.
- Limited data exists on the application of this technique in smaller infants.
Purpose of the Study:
- To evaluate the feasibility and outcomes of transcatheter PDA occlusion in children weighing less than 10 kg.
- To describe modifications to the delivery system for improved application in this pediatric population.
Main Methods:
- A retrospective review of 74 consecutive patients weighing less than 10 kg who underwent transcatheter PDA occlusion.
- Analysis of device implantation, complications, residual shunting, and pulmonary artery flow alterations.
Main Results:
- A 12-mm device was used in 50 patients, and a 17-mm device in 24.
- Complications included device embolization (3) and one removal due to hemolysis.
- Altered left pulmonary artery flow was observed in 9.9% of patients, more frequently with the 17-mm device.
Conclusions:
- Transcatheter PDA occlusion is feasible in small children (<10 kg), especially with a modified delivery system.
- The 17-mm device should be reserved for symptomatic children due to potential impairment of left pulmonary artery flow.
Objectives:
This study intended to evaluate application of transcatheter occlusion of the patent ductus arteriosus in children < 10 kg body weight.
Background:
Transcatheter occlusion of the patent ductus arteriosus in the child weighing > 10 kg has been proved safe and effective.
Methods:
We reviewed 74 consecutive patients weighing < 10 kg (median 8.1 kg, range 3.98 to 10) and aged 4 to 30 months (median 13 months) who underwent patent ductus arteriosus occlusion between June 1986 and November 1992. A modification of the delivery system to facilitate application in small children is described.
Results:
A 12-mm device was implanted in 50 patients and a 17-mm device in 24. Three device embolizations occurred early in the experience, and one required removal because of hemolysis associated with a moderate residual shunt. One 17-mm device was removed at catheterization because of acute compromise to left pulmonary artery flow after implantation. Prevalence of residual shunting was 33% at 6 months, 20% at 12 to 18 months and 17% at 2-year follow-up and was not related to device, age, weight or size of the patent ductus. Altered flow to the left pulmonary artery was noted in seven patients (9.9%), with more significant compromise associated with the 17-mm device.
Conclusions:
Transcatheter patent ductus arteriosus occlusion is feasible in the small child < 10 kg, particularly with the use of a modified delivery system. However, implantation of a 17-mm device in this patient population may impair flow to the left lung and should be reserved for the symptomatic child.