Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults

Sudhakar P, John Jose, Oommen K George, Sudhakar P, John Jose, Oommen K George

Abstract

Background: Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center.

Methods: This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications.

Results: Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook's detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77mmHg to 33mmHg;P=0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred.

Conclusions: In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.

Keywords: Amplatzer duct occluder; Cera device; Lifetech duct occluder; Patent ductus arteriosus; Residual shunt.

Copyright © 2017. Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Study flow chart.
Fig. 2
Fig. 2
PDA morphological types and devices. Arrows indicate PDA.Top panel shows PDA morphological types based on Krischenko classification. Bottom panel shows the correspondingpost-deployment angiographic pictures.
Fig. 3
Fig. 3
PDA devices and sizes.
Fig. 4
Fig. 4
Pre- procedure and follow up chest radiograph and electrocardiograms. Panel A: pre-procedure chest radiograph. Panel B: follow upchest radiograph. Panel C: pre-procedure electrocardiogram. Panel D: Follow up electrocardiogram.

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