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A novel approach to ductal spasm during percutaneous device occlusion of patent ductus arteriosus

Published online by Cambridge University Press:  22 December 2015

Rik De Decker ,
George Comitis ,
Jenny Thomas ,
Elmarie van der Merwe  and
John Lawrenson
Rik De Decker*
Affiliation:
Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
George Comitis
Affiliation:
Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
Jenny Thomas
Affiliation:
Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
Elmarie van der Merwe
Affiliation:
Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
John Lawrenson
Affiliation:
Tygerberg Children’s Hospital and University of Stellenbosch, Cape Town, South Africa
*
Correspondence to: Dr R. De Decker, MSc, MBChB, DCH FCPaed(SA), Cert Med Genet (SA), Department of Cardiology, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch 7700, South Africa. Tel: +2 7 21 685 5111; Fax: +27 21 6891287; E-mail: [email protected]
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Abstract

Ductal spasm is a rare yet important complication of device occlusions of patent ductus arteriosus. Spasm may result in failure of the procedure, under-sizing of the device, or embolisation of the implanted device as the spasm resolves after the procedure. We describe a novel protocol that rapidly and completely reversed the spasm in eight prematurely born infants who experienced ductal spasm during cardiac catheterisations for patent ductus arteriosus occlusion.

In total, eight infants born between 25 and 34 weeks of gestation presented for transcatheter patent ductus arteriosus occlusion between 13 and 87 months of age. All eight patients experienced ductal spasm either immediately before, during, or soon after induction of anaesthesia or only after entering the ductus arteriosus with a catheter. After detection of the spasm, the anaesthetist, in each case, changed the mode of anaesthesia from inhaled sevoflurane to total intravenous anaesthesia with propofol, reduced the inhaled oxygen fraction to 21%, and initiated a continuous intravenous infusion of prostaglandin E1.

The first two steps (total intravenous anaesthesia and FiO2 0.21) resulted in only partial relaxation of the spasm. Complete relaxation was attained after intravenous prostaglandin E1 infusions of only 10–15 minutes’ duration. While maintaining this protocol, six ducti were successfully occluded and two were considered to be unsuitable for device occlusion and were referred for surgery.

Ductal spasm during transcatheter occlusion may be reliably resolved and the procedure safely completed by a simple anaesthetic protocol, including the continuous infusion of intravenous prostaglandin E1.

Keywords

Patent ductus arteriosusdevice occlusionductal spasmprematurely bornnovel protocol
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1352 - 1358
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Copyright
© Cambridge University Press 2015 

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