Anatomic, haemodynamic and angiographic predictors of successful percutanous Patent Ductus Arteriosus closure

Abstract

Patent ductus arteriouses is the fifth or sixth most common congenital cardiac defect observed in most surveys carried out in different centers of the world. The incidence of isolated PDA has been estimated at 1:2000 to 1:5000 births which is about 10 to 12 percent of all varieties of congenital heart disease (Begum et al., 2004). Complications of PDA include congestive heart failure, repeated chest infections, pulmonary hypertension, and an increased risk of infective endocarditis. (Hill et al. , 2006 ) Available treatment modalities include surgical ligation or percutaneous transcatheter closure of PDA which has largely replaced surgical ligation in different age groups. Currently, surgical intervention is restricted to premature babies or small infants with large symptomatic PDA, cases with unfavorable duct anatomy, and whenever the cost of the closure devices is unaffordable. (Rao, 2001) A number of devices are currently available for percutaneous closure of PDA. For the smaller ducts(≤2.5 mm at the narrowest diameter), the Gianturco coil and its modification (Flipper coils and Nit-Occlud PDA occluders), have proven to be efficacious, utilizing delivery systems of 4F or 5F diameter, and allowing implantation from either the arterial or venous approach. (Sreeram &Yap., 2003) For ducts with minimum diameters exceeding 3mm however, coil implantation is associated with higher procedural complexity. The Amplatzer duct occluder (ADO) has proven to be an elegant device that allows moderate and larger sized ducts (up to 11 mm in narrowest diameter) to be successfully occluded. (Butera, 2004). PDAs larger than 12 mm in diameter can be closed with Amplatzer VSD or ASD occluders. (Spies et al., 2005) The results of transcatheter occlusion of PDA have been excellent as reported in several studies. Complete closure rates at follow-up exceed 90% to 95% in most studies. The most common complication is embolization of the device. Other potentially important complications are turbulence to flow in the proximal left pulmonary artery or descending aorta from a protruding device, hemolysis from high-velocity residual shunting, most of these are related to improperly sized device, also to PDA type and the use of multiple coils. (Anil et al., 2003) Therefore accurate assessment of the size, shape and anatomical type of the PDA represents a crucial step for choosing the most suitable technique that will guarantee complete closure of the PDA without complications, raising the need for additional parameters in pre-closure assessment of PDA. (Rao , 2003)