Percutaneous Closure of Patent Ductus Arteriosus in Children Using ADO I and ADO II Devices: A Thirteen Year Single Centre Experience

Abstract

Objective: Transcatheter closure of patent ductus arteriosus (PDA) has taken its place as the first choice in the treatment of PDA thanks to the development of new devices and techniques. In this study, we present our cases with PDA closed with Amplatzer duct occluder I (ADO I), Amplatzer duct occluder II (ADO II) and discuss the efficacy and safety of transcatheter PDA closure with these devices in children. Method: Between January 2010 and January 2023, a total of 373 patients underwent PDA closures using ADO I (n=40), and ADO II (n=333) devices in the Pediatric Cardiology Clinic of our hospital and PDA closure was successfully performed in 370 patients. These cases were analysed retrospectively. Results: The mean age of our patients was 3 (0.2-17) years. The mean narrowest diameter of the PDA was 2.48±0.80 mm. Median procedure and fluoroscopy times were 55, and 11 minutes, respectively. The procedure was successful in 99.1% of the cases. PDA was successfully treated in 387 patients using ADO I (n=39), ADO II (n=331) devices. Minimal residual shunt was detected as a minor complication only in 7 patients in the acute phase. In 4 of these 7 patients, residual shunt disappeared completely in the follow-up period, but it persisted in 3 patients. Major complications in our study were device embolisation in 2 patients who underwent ADO I and infective endocarditis that developed in 1 patient 2 weeks after the procedure. In our patient with device embolisation, the device was tried to be removed with the help of a snare, but it failed, so it was surgically removed and the PDA was closed surgically. In our case with infective endocarditis, the device was surgically removed and the PDA was surgically closed. In one patient, the mean pulmonary artery pressure measured during the procedure was found to be high with 29 mmHg, but the procedure was continued because the pulmonary vasoreactivity test was positive. In the procedure performed with ADO I device, the PDA was closed by opening the first disc without releasing the device, but the procedure was not continued because the patient developed desaturation. Conclusion: Transcatheter PDA closure can now be successfully performed in many centres. In this study, we evaluated the cases of PDA closure performed with ADO I and ADO II devices, in the last 13 years. As a result of our study, in accordance with the literature data, we have shown that transcatheter PDA closure using ADO I, ADO II devices is an effective and safe method with low complication rates in children.

Keywords

• patent ductus arteriosus
• amplatzer duct occluder
• percutaneous closure
• pediatric