Abstract
Transcatheter closure of patent ductus arteriosus (PDA) was one of the first interventions established in invasive cardiology and is now more than 30 years old. The challenges for successful closure with the first devices in children consisted of handling the rather large introducer sheaths and stiff application systems. Today, interventional closure can be performed with different types of plugs, occluders, and coils. Thus, beyond infancy, transcatheter closure can be successfully performed in almost all cases. Challenging from the technical standpoint can be the closure of window-type ducts, in which excessive protrusion of the device into the descending aorta should be avoided, as well as the closure of tubular ducts, in which secure anchoring of one or more devices in the vessel can be very difficult. For the combination of a coarctation and an open duct, different strategies can be considered. In selected cases, use of a covered stent can be helpful. From the physiological standpoint, open ducts in patients with pulmonary hypertension with or without concomitant congenital heart diseases can be challenging because testing of vasoreactivity with temporarily blocked duct and the option of subsequent treatment with vasodilators may be necessary prior to making the decision whether the patient may benefit from definitive duct occlusion or not. Large ducts in infants less than 8 kg can be difficult to treat due to a relative mismatch of introducers, plugs, or occluders to the small anatomic dimensions. The implantation of multiple coils can be associated with a higher risk of device embolization. Unfortunately, for the large group of preterm infants with very low body weights and large ducts of tubular shape there is currently no standardized interventional therapy available.
Similar content being viewed by others
References
SR Anil K Sivakumar AK Philip et al. (2003) ArticleTitleClinical course and management strategies for hemolysis after transcatheter closure of patent arterial ducts Cathet Cardiovasc Interv 59 538–543 Occurrence Handle10.1002/ccd.10593
A Celiker A Bilgic D Alehan et al. (1996) ArticleTitleTranscatheter closure of patent ductus arteriosus using controlled-release coils Acta Paediatr Jpn 38 500–505 Occurrence Handle8942011
C.R. Bard, Inc. Product information “BARD PDA Umbrella” USCI Division Headquarters, C. R. Bard, Inc., Billerica, MA
S Dittrich F Berger JH Nürnberg et al. (1997) ArticleTitleReactivity of patent ductus arteriosus—management during transcatheter occlusion Monatsschr kinderheilkd 145 798–801 Occurrence Handle10.1007/s001120050179
C Duke KC Chan (1999) ArticleTitleAortic obstruction caused by device occlusion of patent arterial duct Heart 82 109–111 Occurrence Handle10377324
P Ewert O Kretschmar JH Nuernberg et al. (2002) ArticleTitleFirst closure of a large patent ductus arteriosus in an infant with an angulated nitinol plug. Total UK multi-centre experience with a novel arterial occlusion device (Duct Occlud pfm) Cathet Cardiovasc Interv 57 88–91 Occurrence Handle10.1002/ccd.10270
HJ Faella ZM Hijazi (2000) ArticleTitleClosure of the patent ductus arteriosus with the amplatzer PDA device: immediate results of the international clinical trial Cathet Cardiovasc Interv 51 50–54 Occurrence Handle10.1002/1522-726X(200009)51:1<50::AID-CCD11>3.0.CO;2-6
G Fischer J Stieh A Uebing et al. (2001) ArticleTitleTranscatheter closure of persistent ductus arteriosus in infants using the Amplatzer duct occluder Heart 86 444–447 Occurrence Handle10.1136/heart.86.4.444 Occurrence Handle11559687
TJ Forbes A Harahsheh E Rodriguez-Cruz et al. (2004) ArticleTitleAngiographic and hemodynamic predictors for successful outcome of transcatheter occlusion of patent ductus arteriosus in infants less than 8 kilograms Cathet Cardiovasc Interv 61 117–122 Occurrence Handle10.1002/ccd.10751
RG Grifka (2001) ArticleTitleTranscatheter PDA closure using the Gianturco–Grifka vascular occlusion device Curr Interv Cardiol Rep 3 174–182 Occurrence Handle11322921
RE Gross JP Hubbard (1939) ArticleTitleSurgical ligation of a patent ductus arteriosus: a report of first successful case J Am Med Assoc 112 729–731
F Hakim AA Hawelleh et al. (1999) ArticleTitleSimultaneous stent implantation for coarctation of the aorta and closure of patent ductus arteriosus using the Amplatzer duct occluder Cathet Cardiovasc Interv 47 36–38 Occurrence Handle10.1002/(SICI)1522-726X(199905)47:1<36::AID-CCD6>3.0.CO;2-Q
G Joseph A Mandalay TU Zacharias et al. (2002) ArticleTitleSevere intravascular hemolysis after transcatheter closure of a large patent ductus arteriosus using the Amplatzer duct occluder: successful resolution by intradevice coil deployment Cathet Cardiovasc Interv 55 245–249 Occurrence Handle10.1002/ccd.10046
RK Kumar SR Anil BR Kannan et al. (2004) ArticleTitleBioptome-assisted coil occlusion of moderate-large patent ductus arteriosus in infants and small children Cathet Cardiovasc Interv 62 266–271 Occurrence Handle10.1002/ccd.20039
D Laohaprasitiporn A Nana J Soongswang et al. (2002) ArticleTitleTranscatheter coil occlusion of small patent ductus arteriosus: experience at Siriraj Hospital J Med Assoc Thai 85 S630–S639 Occurrence Handle12403241
TP Lê P Vaessen F Freudenthal et al. (2003) NitOcclud (nickel–titanium spiral coil) PS Rao MJ Kern (Eds) Catheter Based Devices for the Treatment of Non-coronary Cardiovascular Disease in Adults and Children Lippincott Williams & Wilkins Philadelphia 259–264
J Masura P Gavora T Podnar (2003) ArticleTitleTranscatheter occlusion of patent ductus arteriosus using a new angled Amplatzer duct occluder: initial clinical experience Cathet Cardiovasc Interv 58 261–267 Occurrence Handle10.1002/ccd.10413
J Munayer Calderon H Ramirez Reyes T Aldana Perez et al. (1999) ArticleTitleGianturco–Grifka device in the percutaneous closure of patent ductus arteriosus Arch Inst Cardiol Mex 69 554–558 Occurrence Handle10742852
E Onorato M Mbala-Mukendi F Casilli et al. (2004) ArticleTitleAmplatzer muscular VSD occluder for catheter closure of a 20 mm hypertensive patent ductus arteriosus. A case report and literature review Minerva Cardioangiol 52 219–223 Occurrence Handle15194983
RH Pass Z Hijazi DT Hsu et al. (2004) ArticleTitleMulticenter USA Amplatzer patent ductus arteriosus occlusion device trial: initial and one-year results J Am Coll Cardiol 44 513–519 Occurrence Handle10.1016/j.jacc.2004.03.074 Occurrence Handle15358013
SB Perry JE Lock (1992) ArticleTitleFront-loading of double-umbrella devices, a new technique for umbrella delivery for closing cardiovascular defects Am J Cardiol 70 917–920
W Porstmann L Wierny H Warnke (1967) ArticleTitleDer Verschluß des Ductus arteriosus persistens ohne Thorakotomie Thoraxchirurgie 15 109–203
WJ Rashkind CC Cuasco (1979) ArticleTitleTranscatheter closure of patent ductus arteriosus. Successful use in a 3.5.kilogram infant Pediatr Cardiol 1 3–7
WJ Rashkind CE Mullins WE Hellenbrand et al. (1987) ArticleTitleNonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA occluder system Circulation 75 583–592 Occurrence Handle3545534
M Sadiq NH Malick SA Qureshi et al. (2003) ArticleTitleSimultaneous treatment of native coarctation of the aorta combined with patent ductus arteriosus using a covered stent Cathet Cardiovasc Interv 59 387–390 Occurrence Handle10.1002/ccd.10501
R Schrader R Hofstetter D Fassbender et al. (1999) ArticleTitleTransvenous closure of patent ductus arteriosus with Ivalon plugs. Multicenter experience with a new technique Invest Radiol 34 65–70 Occurrence Handle10.1097/00004424-199901000-00010 Occurrence Handle9888056
EB Sideris PS Rao (2001) ArticleTitleButtoned device occlusion of patent ductus arteriosus Curr Interv Cardiol Rep 3 71–79 Occurrence Handle11177722
H U Sievert Bauer N Bruns et al. (1994) ArticleTitleSevere mechanical hemolysis after incomplete ductus arteriosus closure: implantation of a second Rashkind occluder Z Kardiol 83 458–461 Occurrence Handle8067049
A Tometzki K Chan J DeGiovanni et al. (1996) ArticleTitleTotal UK multi-center experience with a novel arterial occlusion device (Duct Oclud pfm) Heart 76 520–524 Occurrence Handle9014802
H Tomita S Fuse T Akagi et al. (1998) ArticleTitleHemolysis complicating coil occlusion of patent ductus arteriosus Cathet Cardiovasc Diagn 43 50–53 Occurrence Handle10.1002/(SICI)1097-0304(199801)43:1<50::AID-CCD14>3.0.CO;2-X Occurrence Handle9473189
VE Verin SV Saveliev SM Kolody et al. (1993) ArticleTitleResults of transcatheter closure of the patent ductus arteriosus with the Botallooccluder J Am Coll Cardiol 22 1509–1514 Occurrence Handle8227812
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ewert, P. Challenges Encountered During Closure of Patent Ductus Arteriosus. Pediatr Cardiol 26, 224–229 (2005). https://doi.org/10.1007/s00246-005-1010-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-005-1010-8