Berger, Felix

Dähnert, Ingo

Haas, Nikolaus

Kececioglu, Deniz

Knirsch, Walter

Lewin, Martin

Uhlemann, Frank

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SHORT REPORTWalter Knirsch Æ Nikolaus A. HaasMartin A. G. Lewin Æ Ingo Da¨hnert Æ Deniz KececiogluFelix Berger Æ Frank UhlemannPercutanous closure of patent ductus arteriosus in small infantsof less than 8 kg body weight using different devicesReceived: 8 October 2003 / Accepted: 13 May 2004 / Published online: 28 July 2004 Springer-Verlag 2004Therapeutic closure of patent ductus arteriosus (PDA)may become necessary in small infants with congestiveheart failure refractory to medical management, regard-less of the age or weight of the patients. Percutanousclosure of PDA oﬀers an alternative to surgical treatment[3,4]. The aim of this retrospective, multicentre obser-vational trial was to evaluate the immediate results andmid-term clinical and echocardiographic follow-up ofpercutanous closure of PDA in young infants weighingless than 8 kg. Four centres were involved.Percutanous PDA closure was performed in 25 pa-tients (16 female, 9 male) with a body weight of less than8 kg (mean age 9.2 months, mean body weight 6.3 kg).The mean dimensions of the PDA were 5.9 mm at theaortic end and 2.7 mm at the pulmonary end with amean of 2.2 mm at the narrowest part. Mean pulmonaryartery pressure was 22.6 mm Hg, Qp:Qs = 2.2 to 1 andRp:Rs = 0.13 to 1. Two patients had an additional at-rial septal defect and one patient had an aorto-pulmo-nary collateral, which were closed during the samecardiac catheterisation (Table 1). Mean ﬂuoroscopytime was 15.0 min. For a tubular shaped PDA, thepreferred device was the pfm Ductocclud coil (pfm-AG,Cologne, Germany) or Cook detachable coils (CookInc., Bloomington, IN, USA). For a fenestrated PDA,the Amplatzer Duct Occluder (AGA Medical Corp.,Golden Valley, MN, USA) was used. The PDA wasclosed according to standardised procedures [5].The Amplatzer Duct Occluder (ADO) was used in 17patients, Cook detachable coils in six patients, and thepfm Ductocclud coil in two patients (Table 1). In twopatients (one with a body weight of 3.3 kg), percutanousPDA closure failed due to protrusion of the device intothe aorta or left pulmonary artery; these infants suc-cessfully underwent surgical PDA closure (Table 1).Complete closure was achieved in all patients: immediateocclusion in 13 patients, the following day in four pa-tients, and after mid-term follow-up (6 months) in sixpatients. In one patient, the Cook detachable coil mi-grated to the right pulmonary artery 1 day after theintervention; the coil was retrieved and the PDA wasclosed with an ADO (Fig. 1). In all patients, symptomsof heart failure resolved and medical treatment could beterminated. At mid-term follow-up (mean 18.8 months)Doppler echocardiography revealed mild ﬂow velocityacceleration in the left pulmonary artery in two patientsand in the descending aorta in one patient. Specialattention was given to monitoring femoral vesselpatency after catheterisation. There were no othercomplications (haematoma, femoral artery thrombosis,haemolysis, infection, haemorrhage or recanalisation).The rate of percutanous closure of PDA was com-parable to other studies in small children of less than10 kg body weight described by Aydogan et al. [1] (94%)or by Dalvi et al. [2] (90%), although we used otherdevice types, depending on the morphology of the PDA.We conclude that percutanous closure of PDA is afeasible, safe and eﬀective method in infants of between4 and 8 kg body weight.References1. Aydogan U¨ (2002) Arterial duct closure with detachable coils:application in the small child. Asian Cardiovasc Thorac Ann 10:124–128W. Knirsch (&) Æ F. BergerDepartment of Paediatric Cardiology,University Children’s Hospital, Steinwiesstrasse 75,8032 Zu¨rich, SwitzerlandE-mail: walter.knirsch@kispi.unizh.chTel.: +41-1-2667617Fax: +41-1-2667981N. A. Haas Æ M. A. G. Lewin Æ F. UhlemannDepartment of Paediatric Cardiology and Paediatric IntensiveCare, Olgahospital, Stuttgart, GermanyD. KececiogluDepartment of Paediatric Cardiology,University Children’s Hospital, Freiburg,GermanyI. Da¨hnertDepartment of Paediatric Cardiology, Heart Centrer,University of Leipzig, Leipzig, GermanyEur J Pediatr (2004) 163: 619–621DOI 10.1007/s00431-004-1487-9Table1Overviewofthe25patientswithabodyweightoflessthan8kgwithpercutanousPDAclosureusingdiﬀerentdevicesPatientSexAge(years)Bodyweight(kg)VenoussheathArterialsheathDevicesX-raytime(mins)OcclusionSpecialaspects1F1.437.8354AmplatzerDuctOccluder29.8During48hAorto-pulmonarycollateralclosureduringsameprocedure2Ff0.194.2054AmplatzerDuctOccluder14.3Immediately3M0.916.7454PfmDuctoccludcoil10.8After6months4Ff1.437.9055Cookdetachablecoil17.5Immediately5Ff1.068.0064AmplatzerDuctOccluder13.0Immediately6M0.144.7054AmplatzerDuctOccluder11.8Immediately7M0.767.5054AmplatzerDuctOccluder14.9Immediately8F0.456.9044PfmDuctoccludcoil18.6Immediately9M0.283.3363AmplatzerDuctOccluder;pfmDuctoccludcoil10.4Notpossible10F1.917.2064AmplatzerDuctOccluder14.0During48h11F0.697.6064AmplatzerDuctOccluder7.5After6months12F0.565.8064AmplatzerDuctOccluder20.2During48hLeftpulmonaryarteryﬂowvelocity<2m/s13F0.575.5564AmplatzerDuctOccluder13.1After6monthsLeftpulmonaryarteryﬂowvelocity<2m/s14M0.363.5064Cookdetachablecoil10.1During48h15F1.658.00-4Cookdetachablecoil4.9After6months16F1.138.0064AmplatzerDuctOccluder20.3ImmediatelyAtrialseptaldefectclosureduringsameprocedure17F0.885.3064AmplatzerDuctOccluder13.2ImmediatelyReducedarterialperfusionfor72h18M0.577.6064AmplatzerDuctOccluder9.2Immediately19F0.567.1064AmplatzerDuctOccluder9.4Immediately20F0.616.8064Cookdetachablecoil;AmplatzerDuctOccluder32ImmediatelyEmbolisation21F0.766.9064AmplatzerDuctOccluder20.5ImmediatelyDescendingaortaﬂowvelocityacceleration2.5m/s22M1.436.4064AmplatzerDuctOccluder7.8Immediately23M0.274.006–Cookdetachablecoil21.4After6monthsAtrialseptaldefectclosureduringsameprocedure24M0.114.104–Cookdetachablecoil19.3After6monthsRight-sidedPDA25F0.546.2064AmplatzerDuctOccluder11.3Notpossible6202. Dalvi B, Nabar A, Goyal V, Naik A, Kulkarni H, RamakanthanR (1998) Transcatheter closure of patent ductus arteriosus inchildren weighing <10 kg with Gianturco coils using the bal-loon occlusion technique. Cathet Cardiovasc Diagn 44: 303–3083. Masura J, Walsh KP, Thanopoulous B, Chan C, Bass J,Goussous Y, Gavora P, Hijazi ZM (1998) Catheter closure ofmoderate-to-large-sized patent ductus arteriosus using the newAmplatzer duct occluder: immediate- and short-term results.J Am Coll Cardiol 31: 878–8824. O’Donnell C, Neutze JM, Skinner JR, Wilson NJ (2001)Transcatheter patent ductus arteriosus occlusion: evolution oftechniques and results from the 1990s. J Paediatr Child Health37: 451–4555. Rosenthal E, Qureshi SA, Reidy J, Baker EJ, Tynan M (1996)Evolving use of embolisation coils for occlusion of the arterialduct. Heart 76: 525–530Fig. 1 Posterior-anterior chest X-ray ﬁlm showing the embolisedCook detachable coil in the right pulmonary artery. A 6 F longsheath was introduced into the right pulmonary artery and theCook detachable coil was retrieved into the sheath using a snarecatheter. Afterwards the sheath was used to implant the ADO621

Percutanous closure of patent ductus arteriosus in small infants of less than 8kg body weight using different devices

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Percutanous closure of patent ductus arteriosus in small infants of less than 8kg body weight using different devices

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