Vinayakumar1, Sajeer2, Suresh3
Patent ductus arteriosus (PDA) can be closed percutaneously by device with and without an arterial access. Conventional technique involves a femoral arterial as well as a femoral venous access for closure. Here we summarize our experience in closing the PDA without an arterial access.
Methods
From November 2011 till March 2018, 228 patients were evaluated clinically and echocardiographically for PDA device closure and 201(88%) were found suitable. These 201 patients who underwent transcatheter PDA closure via femoral venous access were included in study. Detailed 2D echocardiography and doppler assessment was performed before procedure. During transcatheter closure angiograms were performed in two views by the venous catheter positioned at the PDA ampulla into the descending aorta. All PDAs were closed by Amplatzer duct occluder-I (ADO1 device). Detailed echocardiographic assessment was performed in each case before releasing the device from the delivery cable and at 5 minutes and 10-minute interval thereafter till there was no significant flow across the duct. Echocardiography was performed immediately after the device deployment, at 12 hours and at 24 hours.
Total 201 patients underwent PDA device closure via femoral venous access. The mean age was 1year and 6 months (range 6months to 47 years). The mean weight was 15kg (range 5 to 66kg). Females constitute 67.6% (136 patients). 9 patients (4.4%) have Down syndrome. 12 (5.9%) have additional cardiac problems. In 108 patients 6x8 size device was placed (53.7%), 44 patients 4x6 size device (21.9%), 30 patients with 8x10 size device (14.9%) and few patients with other sizes. Two patients developed immediate complications which were addressed appropriately.
PDA device closure without an arterial access can be performed safely and effectively by an experienced interventional cardiologist. Patient selection and detailed assessment of PDA prior to procedure is of paramount importance. This transcatheter closure without an arterial access makes procedure simpler with low morbidity and complications.
Congenital heart disease; Patent ductus arteriosus; Device closure; Amplatzer duct occluder
