TRANSCATHETER DEVICE CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH TRANSVENOUS APPROACH ONLY; AN EXPERIENCE OF 55 CASES

Abstract

Objective: To determine the success, technique, and immediate complications after patent ductus arteriosus
(PDA) device closure under transthoracic echocardiography (TTE) guidance.
Study Design: Quasi-experimental.
Place and Duration of Study: Pediatric cardiology department of Armed forces institute of cardiology/National
institute of heart disease (AFIC/NIHD) Rawalpindi Pakistan, from Jun 2015 to Oct 2016.
Material and Methods: A total of 55 patients with moderate to large patent ductus arteriosus (PDA) underwent
device closure using only femoral vein puncture. After crossing the PDA from pulmonary artery side; pigtail
catheter was placed in aorta to delineate the location, size and type of PDA. All patients had single procedure.
Clinical, hemodynamics, follow-up morbidity and troubleshooting data were collected.
Results: Successful closure of the ductus was achieved in all the cases. The mean age was 9 months (range 3-24
months) 60% were female. All procedures were carried out under general anaesthesia. In three patients there was
residual flow across the duct that closed spontaneously after 24 hours. All infants were discharged next morning
confirming adequate closure and general status of the child. No emergency surgical exploration or death occurred
during this period.
Conclusion: Device closure of PDA without femoral arterial puncture is a safe procedure provided good
echocardiographic guidance is available for final placement. This procedure is especially useful for small infants
with large PDA in which femoral puncture can be limb threatening due to prolonged large size femoral arterial
sheath.