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Outcomes of transcatheter closure of ductus arteriosus in infants less than 6 months of age: a single-center experience

  • Choi, Gwang-Jun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Jinyoung (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yi-Seul (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Heirim (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, June (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, I-Seok (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2018.04.18
  • Accepted : 2018.07.31
  • Published : 2018.12.15

Abstract

Purpose: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. Methods: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6-12 months in the same study period were reviewed. Results: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was $3.3{\pm}1.5months$, and weight was $5.7{\pm}1.3kg$. The duct diameter at the narrowest point was $3.0{\pm}0.8mm$ as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6-12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P<0.01). Conclusion: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.

Keywords

References

  1. Baruteau AE, Hascoet S, Baruteau J, Boudjemline Y, Lambert V, Angel CY, et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis 2014;107:122-32. https://doi.org/10.1016/j.acvd.2014.01.008
  2. Behjati-Ardakani M, Rafiei M, Behjati-Ardakani MA, Vafaeenasab M, Sarebanhassanabadi M. Long-term results of transcatheter closure of patent ductus arteriosus in adolescents and adults with amplatzer duct occluder. N Am J Med Sci 2015;7:208-11. https://doi.org/10.4103/1947-2714.157478
  3. Delaney JW, Fletcher SE. Patent ductus arteriosus closure using the $Amplatzer^{(R)}$ vascular plug II for all anatomic variants. Catheter Cardiovasc Interv 2013;81:820-4. https://doi.org/10.1002/ccd.24707
  4. Sinha SK, Razi M, Pandey RN, Kumar P, Krishna V, Jha MJ, et al. Prospective evaluation of the feasibility, safety, and efficacy of Cocoon Duct Occluder for transcatheter closure of large patent ductus arteriosus: a single-center study with short- and medium-term follow-up results. Anatol J Cardiol 2017;18:321-7.
  5. Backes CH, Rivera BK, Bridge JA, Armstrong AK, Boe BA, Berman DP, et al. Percutaneous patent ductus arteriosus (PDA) closure during infancy: a meta-analysis. Pediatrics 2017 Feb;139(2). pii: e20162927. https://doi.org/10.1542/peds.2016-2927.
  6. Kang SL, Jivanji S, Mehta C, Tometzki AJ, Derrick G, Yates R, et al. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv 2017;90:1135-44. https://doi.org/10.1002/ccd.27212
  7. Dimas VV, Takao C, Ing FF, Mattamal R, Nugent AW, Grifka RG, et al. Outcomes of transcatheter occlusion of patent ductus arteriosus in infants weighing $\leq$6 kg. JACC Cardiovasc Interv 2010;3:1295-9. https://doi.org/10.1016/j.jcin.2010.08.022
  8. Abadir S, Boudjemline Y, Rey C, Petit J, Sassolas F, Acar P, et al. Significant persistent ductus arteriosus in infants less or equal to 6 kg: percutaneous closure or surgery? Arch Cardiovasc Dis 2009;102:533-40. https://doi.org/10.1016/j.acvd.2009.04.004
  9. Baspinar O, Sahin DA, Sulu A, Irdem A, Gokaslan G, Sivasli E, et al. Transcatheter closure of patent ductus arteriosus in under 6 kg and premature infants. J Interv Cardiol 2015;28:180-9. https://doi.org/10.1111/joic.12196
  10. Sivakumar K, Francis E, Krishnan P. Safety and feasibility of transcatheter closure of large patent ductus arteriosus measuring >or=4 mm in patients weighing https://doi.org/10.1111/j.1540-8183.2008.00348.x
  11. Backes CH, Kennedy KF, Locke M, Cua CL, Ball MK, Fick TA, et al. Transcatheter occlusion of the patent ductus arteriosus in 747 infants <6 kg: insights from the NCDR IMPACT Registry. JACC Cardiovasc Interv 2017;10:1729-37. https://doi.org/10.1016/j.jcin.2017.05.018
  12. Krichenko A, Benson LN, Burrows P, Moes CA, McLaughlin P, Freedom RM. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 1989;63:877-80. https://doi.org/10.1016/0002-9149(89)90064-7
  13. Baspinar O, Irdem A, Sivasli E, Sahin DA, Kilinc M. Comparison of the efficacy of different-sized Amplatzer duct occluders (I, II, and II AS) in children weighing less than 10 kg. Pediatr Cardiol 2013;34:88-94. https://doi.org/10.1007/s00246-012-0393-6

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