First tarnscatheter closure of a patent ductus arteriosus (PDA) was carried out in 1979. Since then, a tremendous advance in PDA devices, sheaths and innovation of low profile delivery systems has been occurred. Nowadays, transcatheter closure of the PDA is a standard of care beyond neonatal period. In addition, it can be done safely as an alternative for surgery even in very small infants.1
Comparing to surgical approach, transcatheter PDA closure is associated with lower risk and fewer adverse outcomes. Of note, safety concerns with transcatheter closures are higher in smaller infants; complications such a coil or device malposition, arrhythmia and/or hypotension requiring intervention occur more frequently in infants weighing less than 6 kg comparing to larger infants (adverse event rate 27% versus 8%). 2,3 There are many different devices can be potentially used to close the PDA in children and infants; these include coils, Vascular Plugs and Amplazter Duct Occluders, etc. The decision which device to use is dependent on the preference of the operator, PDA type and size, patient size and the size of the delivery system. The rule of the thumb is to use the smallest available delivery system which is currently 4-Fr and to avoid arterial access whenever it is possible. This is critical, especially in premature neonates as the vascular complications are correlated inversely with their weight. In general, for a small PDA with its narrowest point of <2 mm, closure can be achieved by deploying a coil, or an Amplatzer Duct Occluder II (ADO II) device. For a large PDA, other devices may be preferred such as a Vascular Plug or an Occlutech Duct Occluder. These devices usually will be seated within the duct with no retention discs protruding outside the PDA which could potentially interfere with the …show more content…
Though ADO II AS device not been approved by FDA yet, it has been proven to be feasible, effective with a low complication rate when it was used in children as well as in infants. Furthermore, the success of occlusion of PDA with no obstruction of Aorta and/or left pulmonary artery in small infants weighing as less as 1700 grams was demonstrated in both animals and humane studies. …show more content…
When arterial access is avoided, aortoangiogram still can be achieved utilizing the venous access. For example, a 4-Fr introducer sheath can be tracked over a 0.025-inch guidewire across the right ventricle into the pulmonary artery. Then, it can be manipulated to cross the PDA with the tip seating in the descending aorta. The needed measurements to choose the device size are ampulla size (aortic end of the PDA), narrowest pulmonary diameter, length of PDA and descending aorta. After delineating the anatomy and landmarks of the PDA (Fig. 1), appropriate device will be chosen and deployed using the venous access. After deploying the device and before the detaching from the delivery system, repeated PDA angiogram should be performed to confirm positioning and stability of the device (Fig. 2). Furthermore, most interventionalists like to repeat the angiogram after detaching the delivery system (Fig. 3). 4-5
Echocardiographically guided transcatheter PDA closure has been described recently as the preferred method of PDA closure when surgical closure is contracted or when transporting unstable infant carries a high risk. This approach can be carried out at the bedside using venous access only sparing the infants possible arterial access complications. In addition, it has been shown to be safe and feasible in premature infants weighing less than 1500 grams.
Comparing to surgical approach, transcatheter PDA closure is associated with lower risk and fewer adverse outcomes. Of note, safety concerns with transcatheter closures are higher in smaller infants; complications such a coil or device malposition, arrhythmia and/or hypotension requiring intervention occur more frequently in infants weighing less than 6 kg comparing to larger infants (adverse event rate 27% versus 8%). 2,3 There are many different devices can be potentially used to close the PDA in children and infants; these include coils, Vascular Plugs and Amplazter Duct Occluders, etc. The decision which device to use is dependent on the preference of the operator, PDA type and size, patient size and the size of the delivery system. The rule of the thumb is to use the smallest available delivery system which is currently 4-Fr and to avoid arterial access whenever it is possible. This is critical, especially in premature neonates as the vascular complications are correlated inversely with their weight. In general, for a small PDA with its narrowest point of <2 mm, closure can be achieved by deploying a coil, or an Amplatzer Duct Occluder II (ADO II) device. For a large PDA, other devices may be preferred such as a Vascular Plug or an Occlutech Duct Occluder. These devices usually will be seated within the duct with no retention discs protruding outside the PDA which could potentially interfere with the …show more content…
Though ADO II AS device not been approved by FDA yet, it has been proven to be feasible, effective with a low complication rate when it was used in children as well as in infants. Furthermore, the success of occlusion of PDA with no obstruction of Aorta and/or left pulmonary artery in small infants weighing as less as 1700 grams was demonstrated in both animals and humane studies. …show more content…
When arterial access is avoided, aortoangiogram still can be achieved utilizing the venous access. For example, a 4-Fr introducer sheath can be tracked over a 0.025-inch guidewire across the right ventricle into the pulmonary artery. Then, it can be manipulated to cross the PDA with the tip seating in the descending aorta. The needed measurements to choose the device size are ampulla size (aortic end of the PDA), narrowest pulmonary diameter, length of PDA and descending aorta. After delineating the anatomy and landmarks of the PDA (Fig. 1), appropriate device will be chosen and deployed using the venous access. After deploying the device and before the detaching from the delivery system, repeated PDA angiogram should be performed to confirm positioning and stability of the device (Fig. 2). Furthermore, most interventionalists like to repeat the angiogram after detaching the delivery system (Fig. 3). 4-5
Echocardiographically guided transcatheter PDA closure has been described recently as the preferred method of PDA closure when surgical closure is contracted or when transporting unstable infant carries a high risk. This approach can be carried out at the bedside using venous access only sparing the infants possible arterial access complications. In addition, it has been shown to be safe and feasible in premature infants weighing less than 1500 grams.