Patent Ductus Arteriosus Device Closure with Venous Only Access - A Retrospective Analysis

Abstract

BACKGROUND Patent ductus arteriosus (PDA) can be closed percutaneously by a device with and without arterial access. The conventional technique involves a femoral arterial as well as femoral venous access for closure. Here we discuss our institutional data in closing the PDA without arterial access. We wanted to study retrospectively the feasibility and outcome of PDA device closure in young children via femoral vein without femoral arterial access. METHODS From November 2011 to 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 the study. Detailed 2D echocardiography and Doppler assessment were performed before the procedure. During transcatheter closure, fluoroscopic injections were done in two views by the catheter stationed at the PDA ampulla into the descending thoracic aorta. All PDAs were closed by Amplatzer duct occluder-I (ADO1 device). The detailed echocardiographic assessment was performed in each case before releasing the device from the delivery cable and at 5 minutes and 10-minute intervals thereafter till there was no significant flow across the duct. Echocardiography was performed immediately after the device deployment, at 12 hours and 24 hours. RESULTS Total 201 patients underwent PDA device closure via femoral venous access. The mean age was 1 year and 6 months (range 6 months to 47 years). The mean weight was 15 kg (range 5 to 66 kg). Females constituted 67.6 % (136 patients). 9 patients (4.4 %) had Down syndrome and 12 (5.9 %) had additional cardiac problems. In 108 patients, 6x8 size device was placed (53.7 %), in 44 patients, 4x6 size device (21.9 %), 30 patients with 8x10 size devices (14.9 %) and a few patients with other sizes. Two patients developed immediate complications which were addressed appropriately. CONCLUSIONS PDAs can be safely closed without arterial access. Operators’ skill and experience determine a successful outcome. Patient selection and detailed assessment of PDA before the procedure is of paramount importance. This transcatheter closure without arterial access makes the procedure simpler with low morbidity and complications. KEY WORDS Congenital Heart Disease, Patent Ductus Arteriosus, Device Closure, Amplatzer Duct Occluder