Transcatheter Closure of Patent Ductus Arteriosus in infants between 2-10 kg

Yıl 2023, Cilt: 17 Sayı: 1, 30 - 38, 30.01.2023

Ahmet Vedat Kavurt Seçil Sayın Bilal Özelce Denizhan Bağrul Alper Gürsu İbrahim Ece İbrahim İlker Çetin

https://doi.org/10.12956/tchd.1190725

Öz

Objective: The aim of this study was to present our experiences on transcatheter patent ductus arteriosus (PDA) closure with different devices, mostly the Amplatzer Piccolo Occluder, in infants weighing between 2-10 kg.

Material and Methods: In this study, the files of 31 patients who underwent transcatheter PDA closure between December 2019 and August 2022 were reviewed retrospectively.

Results: Transcatheter PDA closure was performed on 31(14 female) infants weighing between 2-10 kg. The mean age of patients was 10.7±6.7 months (2-28), and the mean weight was 6.6±2 kg (3-9.9). The median narrowest diameter of the ductus was 2.2 mm (IQR 2-3) and the median ductus length was 6 mm (IQR 4.75-8). The procedural success rate of all interventional procedures was 88% (30 of 34). Complications occurred in a total of four patients including failure of device implantation in one patient, post-procedural device embolization in 2 patients, and the significant residual shunt in one patient. None of the patients required surgery. In 34 interventional procedures, 3 of which were reintervention, 34 devices were used. Twenty-seven (79%) of them were Amplatzer Piccolo Occluder. The median fluoroscopy and procedural times were 10.5 minutes (IQR 7.25-18.5) and 40 minutes (IQR 35-57.5) respectively. The mean duration of follow-up was 10.3±8.8 months (1-32 months).

Conclusion: In our experience, transcatheter treatment of PDA with the Amplatzer Piccolo Occluder device which was our first choice for appropriate duct anatomy and size in infants weighing between 2-10 kg, is safe and effective.

Anahtar Kelimeler

Amplatzer Piccolo Occluder, device embolization, patent ductus arteriosus, transcatheter closure, Prematüre bebek

Patent Duktus Arteriyozus 'un Transkateter Kapatılması; 2-10 kg arası bebeklerde

Öz

Amaç: Bu çalışmanın amacı, 2-10 kg arası bebeklerde çoğunlukla Amplatzer Piccolo Occluder olmak üzere farklı cihazlarla transkateter patent duktus arteriyozus (PDA) kapatma konusundaki deneyimlerimizi sunmaktır.

Gereç ve Yöntemler: Bu çalışmada Aralık 2019-Ağustos 2022 tarihleri arasında transkateter PDA kapatılan 31 hastanın dosyaları geriye dönük olarak incelendi.

Bulgular: Toplam 31(14 kadın), 2-10 kg ağırlığındaki, bebeğe transkateter PDA kapaması yapıldı. Hastaların yaş ortalaması 10.7±6.7 ay (2-28) ve ortalama ağırlık 6.6±2 kg (3-9.9)’du. Duktusun en dar ortanca çapı 2.2 mm (IQR 2-3) ve ortanca duktus uzunluğu 6 mm (IQR 4.75-8)’di. Tüm girişimsel prosedürlerin prosedürel başarı oranı %88’di (30/34). Bir hastada cihaz implantasyonu başarısızlığı, 2 hastada işlem sonrası cihaz embolizasyonu ve bir hastada önemli rezidüel şant olmak üzere toplam dört hastada komplikasyon meydana geldi. Hiçbir hastada ameliyat gerekmedi. Üçü yeniden müdahale olmak üzere 34 girişimsel işlemde 34 cihaz kullanıldı. Bunların 27’si (%79) Amplatzer Piccolo Occluder’dı. Ortanca floroskopi ve prosedür süreleri sırasıyla 10.5 dakika (IQR 7.25-18.5) ve 40 dakika (IQR 35-57.5)’dı. Hastaların ortalama takip süresi 10.3±8.8 ay (1-32 ay)’dı.

Sonuç: Deneyimlerimize göre 2-10 kg arası bebeklerde uygun duktus anatomisi ve boyutu için ilk tercihimiz olan Amplatzer Piccolo Occluder cihazı ile PDA’nın transkateter tedavisi güvenli ve etkilidir.

Anahtar Kelimeler

Amplatzer Piccolo Occluder, cihaz embolizasyonu, Prematüre bebek

Kaynakça

• Latson LA, Hofschire PJ, Kugler JD, Cheatham JP, Gumbiner CH, Danford DA. Transcatheter closure of patent ductus arteriosus in pediatric patients. J Pediatr 1989;115:549-53.
• Sathanandam SK, Gutfinger D, O’Brien L, Forbes T J, Gillespie MJ, Berman DP, et al. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv 2020;96:1266-76
• Bhat YA, Almesned A, Alqwaee A, Al Akhfash A. Catheter Closure of Clinically Silent Patent Ductus Arteriosus Using the Amplatzer Duct Occluder II-Additional Size: A Single-Center Experience. Cureus 2021;13:e17481.
• Santoro G, Giordano M, Gaio G, Palladino MT, Capozzi G, Iacono C et al. Transcatheter Closure of Arterial Duct in Infants < 6 kg: Amplatzer Duct Occluder Type I vs Amplatzer Duct Occluder II Additional Sizes. Pediatr Cardiol 2018;39:627-32.
• Barcroft M, McKee C, Berman DP, Taylor RA, Rivera BK, Smith CV et al. Percutaneous Closure of Patent Ductus Arteriosus. Clin Perinatol 2022;49:149-66.
• Morville P, Akhavi A. Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS. Catheter Cardiovasc Interv 2017;90:612-7.
• Pamukcu O, Tuncay A, Narin N, Baykan A, Korkmaz L, Argun M et al. Patent Ductus Arteriosus closure in preterms less than 2kg: Surgery versus transcatheter. Int J Cardiol 2018;250:110-15.
• Baspinar O, Sahin DA, Sulu A, Irdem A, Gokaslan G, Sivasli E, et al. Transcatheter closure of patent ductus arteriosus in under 6 kg and premature infants. J Interv Cardiol 2015;28:180-9.
• O’Byrne ML, Millenson ME, Grady CB, Huang J, Bamat NA, Munson DA et al. Trends in transcatheter and operative closure of patent ductus arteriosus in neonatal intensive care units: Analysis of data from the Pediatric Health Information Systems Database. Am Heart J 2019;217:121-30.
• Mahmoud HT, Santoro G, Gaio G, D’Aiello FA, Capogrosso C, Palladino MT, et al. Single-center experience in percutaneous closure of arterial duct with Amplatzer duct Occluder II additional sizes. Catheter Cardiovasc Interv 2017;89:1045-50.
• Malekzadeh-Milani S, Akhavi A, Douchin S, Dauphin C, Chalard A, Mauran P, et al. Percutaneous closure of patent ductus arteriosus in premature infants: A French national survey. Catheter Cardiovasc Interv 2020;95:71-7.
• Rodríguez Ogando A, Planelles Asensio I, de la Blanca ARS, Ballesteros Tejerizo F, Sánchez Luna M, Gil Jaurena JM, et al. Surgical Ligation Versus Percutaneous Closure of Patent Ductus Arteriosus in Very Low-Weight Preterm Infants: Which are the Real Benefits of the Percutaneous Approach?. Pediatr Cardiol 2018;39:398-410.
• Pepeta L, Greyling A, Nxele MF, Makrexeni Z, Jiyana S. Ductal closure in infants under 6 kg including premature infants using AmplatzerTM duct occluder type two additional sizes: a single-centre experience in South Africa. Cardiovasc J Afr 2020;31:33-9.
• Regan W, Benbrik N, Sharma SR, Auriau J, Bouvaist H, Bautista-Rodriguez C, et al. Improved ventilation in premature babies after transcatheter versus surgical closure of patent ductus arteriosus. Int J Cardiol 2020;311:22-7.
• Drighil A, Al Jufan M, Al Omrane K, Al Atta J, Al Omrani A, Al Fadley F. Safety of transcatheter patent ductus arteriosus closure in small weight infants. J Interv Cardiol 2012;25:391-394.
• Saliba Z, El-Rassi I, Helou D, Chehab G, Abdel-Massih T, Daou L, et al. Analyzing the failures of percutaneous closure of the patent ductus arteriosus in patients over 5 kg. J Invasive Cardiol 2012;24:434-8.
• Philip R, Rush Waller B, Agrawal V, Wright D, Arevalo A, Zurakowski D, et al. Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device. Catheter Cardiovasc Interv 2016;87:310-7.
• Krichenko A, Benson LN, Burrows P, Möes CA, Laughlin P, Freedom RM. Angiographic classification of the isolated, CNY persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 1989;63:877–80.
• Jux C. Piccolo devices in premie ductus arteriosi. Int J Cardiol 2020;311:37-8.
• Park YA, Kim NK, Park SJ, Yun BS, Choi JY, Sul JH. Clinical outcome of transcatheter closure of patent ductus arteriosus in small children weighing 10 kg or less. Korean J Pediatr 2010;53:1012-7.
• Backes CH, Rivera BK, Bridge JA, Armstrong AK, Boe BA, Berman DP, et al. Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis. Pediatrics 2017;139:e20162927.
• Méot M, Haddad RN, Patkai J, Abu Zahira I, Di Marzio A, Szezepanski I et al. Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants. Children (Basel) 2021;8:1138.
• Baspinar O, Irdem A, Sivasli E, Sahin DA, Kilinc M. Comparison of the efficacy of different-sized Amplatzer duct occluders (I, II, and II AS) in children weighing less than 10 kg. Pediatr Cardiol 2013;34:88-94.
• Eilers L, Qureshi AM. Advances in Pediatric Ductal Intervention: an Open or Shut Case?. Curr Cardiol Rep 2020;22:14.
• Tanidir IC, Baspinar O, Saygi M, Kervancioglu M, Guzeltas A, Odemis E. Use of Lifetech™ Konar-MF, a device for both perimembranous and muscular ventricular septal defects: A multicentre study. Int J Cardiol 2020;310:43-50.