Percutaneous Patent Ductus Arteriosus (PDA) closure: When and how to close Coil VS Occluder “step by step” cases report

Abstract

Background: The PDA defines the pathological persistence after the birth of a fetal physiological communication between the aorta and the pulmonary artery frequently encountered in preterm infants and whose clinical and hemodynamic consequences depend on the importance of the shunt directly bound to the diameter of the canal. Percutaneous closure is the most frequent management modality with excellent immediate and long-term results (two modes of closure: using coil or Occluder). The surgery remains reserved for complex anatomies or associated with other surgical congenital anomalies. Case presentation: We detail in this document the two methods of percutaneous closure step by step illustrated by pediatric cases. The first case concerns a 7 years old girl of 17 kg weight with a history of heart murmur that presented in the TTE a PDA estimated at 1mm with LV dilation. The second case concerns a 12 years old girl of 30 kg weight with also a history of heart murmur that presented on TTE a PDA of 4.5mm with LV dilation. Therapeutic intervention: In the first case, we perform a closure with coil 5/5 by a unique femoral arterial approach as a standardized attitude in our center avoiding additional venous access. For the second case, we opted for closure with prosthesis N° 6/8 by a double femoral approach (arterial and venous access). Outcomes: The follow-up was favorable for both patients, with total sealing of the defect immediately after the procedures that persist during the 6 months of control. Conclusion: The closure of PDA in children is a challenging procedure whose safety requires a good pre-and per-procedural evaluation allowing the right choice of the method and size of the closing device. The respect of the different closure stages and the critical per procedural ultrasound and angiographic control reduce the rate of complications making this technique accessible and safe. In our series of 108 PDA closures by Coil in children, the unique femoral arterial approach is the standardized attitude in the first line in all patients avoiding additional venous access, which allows the Coil release in the basic technique while the arterial access allows opacification and measurement of the channel. The unique arterial approach has reduced the risk of local complications at the puncture site and the duration of the procedure without difference in closure efficiency and embolization risk. In our series of 92 PDA closures by Occluder in children the double femoral approach is the standardized attitude for all patients, the venous access allows the device release while the arterial access allows opacification/ measurement of the channel and control device deployment.