Clinical evaluation of transcatheter closure of PDA with different type of devices

Abstract:

Objective：To evaluate the feasibility，clinical outcome and resource utilization of transcatheter closure of patent ductus arteriosus（PDA） in children. Methods：From March 2009 to September 2011，successful transcatheter implantation of the Amplatzer duct occluder（ADO） was performed in 443 children（218 males and 225 females）；the median age was 7.8 years old（0.6-13 years） and the median weight was 17.5 kg（5.3-48 kg）. All of them were confirmed with PDA by echocardiography without any other defects. Some patients with small PDA were closed with coils，some with medium or large PDA were treated with ADO，ADO-Ⅱ or ventricular septal defect（VSD） occluder. The devices were released by retrograde or antegrade way based on the configuration and size of PDA. Results：Successful implantation of the device was achieved in 431 patients（97.3%）. Acute aortic stenosis resulting in occluder removal occurred in 4 cases，3 cases gave up treatment due to left pulmonary branch arterial stenosis，5 cases（large PDA complicated with pulmonary hypertension） gave up treatment due to positive results of experimental occlusion. Median pulmonary artery pressure was 32.5 mmHg（23-67 mmHg） and Qp/Qs was 1.62（1.4-3.2）. Forty-five patients with diameter of PDA<2 mm were treated with coils，53 patients were closed with ADO-Ⅱ，12 patients with diameter of PDA>2 mm were treated with VSD occluder，the others were closed with ADO. Twenty-five（5.8%） patients had trivial residual leak postoperatively and the symptom disappeared in 18 of them after 1 month during the follow-up and the symptom disappeared in all patients after 3 months. Six patients（1.3%） had mild aortic stenosis，however，the pressure gradient was less than 10 mmHg and remained unchanged in the follow-up. Two patients（0.46%） had rhrombocytopenia postoperatively，recovered after being treated for two weeks and remained in stable condition in the follow-up. One patient was found with hemolysis. One patient was found with mild tricuspid regurgitation in the follow-up. Conclusions：PDA with different sizes and morphology can be treated with different kinds of occluders. Carefulness is needed during the operation to avoid the impairment of tricuspid valve. Some patients with large PDA may have complications of residual shunt，aortic stenosis and platelet changes，therefore，more attention should be paid to.