Study Evaluates Feasibility of Closure for Hemodynamically Significant Patent Ductus Arteriosus
May 8, 2017—In a study published online in Catheterization and Cardiovascular Interventions, Patrice Morville, MD, and Ahmad Akhavi, MD, concluded that it is feasible to close hemodynamically significant patent ductus arteriosus (PDA), with relative safety, in premature infants who have severe and complex disease; however, success requires perfect selection of the occluder and exact positioning by ultrasound. Prof. Morville and Dr. Akhavi are with the American Memorial Hospital in Reims, France.
According to the study, the advent of the Amplatzer Duct Occluder II Additional Sizes (ADOIIAS; Abbott Vascular [formerly St. Jude Medical]) provided the potential to close hemodynamically significant PDA and led researchers to analyze the feasibility, safety, and efficacy of the device. However, treatment of a PDA in very premature neonates is still a dilemma for the neonatologist who has to consider its significance and choose between different treatment options. Because both surgical ligation and medical therapy have their drawbacks, interventional catheterization might provide an alternative means of closing hemodynamically significant PDA, noted the investigators.
As summarized in Catheterization and Cardiovascular Interventions, 32 premature infants with complications related to hemodynamically significant PDA, as defined by ultrasound, underwent transcatheter closure between September 2013 and June 2015. The procedures were performed in the catheterization laboratory by venous cannulation and without angiography. The position of the occluder was directed by x-ray and ultrasound. In particular, the investigators analyzed procedural details, device size selection, complications, and short-term and midterm outcomes.
The 32 infants, who were born at gestational ages ranging between 23.6 and 36 weeks (mean, 28 ± 3 weeks) underwent attempted transcatheter PDA closure using the ADOIIAS device. The mean age and weight at the time of procedure were 25 days (range, 8–70 days) and 1,373 g (range, 680–2480 g), respectively. Ten infants weighed ≤ 1,000 g. All ducts were tubular.
The mean PDA and device waist diameters were 3.2 ± 0.6 mm (range, 2.2–4 mm) and 4.4 ± 0.6 mm, respectively, and the mean PDA and device lengths were 5.2 ± 2.0 mm (range, 2–10 mm) and 3.4 ± 1.3 mm. Median fluoroscopy and procedural times were 11 minutes (range, 3–24 min) and 28 minutes (range, 10–90 min), respectively. Complete closure was achieved in all but one patient, and there were no device migrations. A left pulmonary artery obstruction developed in one patient. Five infants died. Four of the deaths were related to complications of prematurity, and one death in a 680-g infant was related to the procedure, reported the investigators in Catheterization and Cardiovascular Interventions.