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Initial clinical experience in transcatheter closure of large patent arterial ducts in infants using the modified and angled Amplatzler duct occluder

Published online by Cambridge University Press:  14 July 2006

Ishwarappa B. Vijayalakshmi ,
Narasimhan Chitra ,
Ravindran Rajasri  and
Karthik Vasudevan
Ishwarappa B. Vijayalakshmi
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Narasimhan Chitra
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Ravindran Rajasri
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Karthik Vasudevan
Affiliation:
Department of Pediatric Cardiology, Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
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Abstract

Objective: To establish the feasibility and efficacy of closing large patent arterial duct in infants, using the modified and angled variants of the Amplatzer duct occluder. Background: Closure of large patent arterial ducts by inserting devices in sick and underweight infants, particularly those weighing around 5 kilograms, remains a challenge. Bigger devices require larger delivery sheaths and may cause obstruction either to the aorta or left pulmonary artery. Negotiating a large device is difficult or impossible, as the sheath gets kinked. Because of these problems, such underweight infants with large ducts who are failing to thrive, and in left ventricular failure with associated lesions, are typically referred for surgery, often leading to higher morbidity and mortality. Methods: We attempted to close such large patent arterial ducts using the new Amplatzer occluder, modified with single layer of polyester, and the angled occluder, with no polyester material, inserted through a specially braided kink-resistant sheath. Results: Closure was achieved in 10 infants, with mean age of 8.2 months, mean weight of 5.5 kilograms, the lowest weighing 3.9 kilograms. The mean size of the patent ducts was 6.3 millimetres, with the largest measuring 8.6 millimetres. We implanted 6 modified and 4 angled occluders. In one patient, suffering from hydronephrosis, a 14/12 angled device embolized and was retrieved, but the patient died. In the remaining patients, all ducts were closed completely, with no obstruction to either the aorta or left pulmonary artery. On follow up, all showed excellent clinical improvement. Conclusion: Complete closure of very large patent arterial ducts is now possible, even in very sick and underweight infants, using the large but low profile custom-made angled or modified versions of the Amplatzer occluder.

Keywords

Low weightleft ventricular failurehydronephrosisRubella syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 4 , August 2006 , pp. 378 - 384
Copyright
© 2006 Cambridge University Press

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