Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder at queen alia heart institute : medium-term follow-up

الملخص EN

Objectives: Transcatheter closure of patent ductus arteriosus is a well-established procedure.

The aim of this study was to assess the medium term results of patent ductus arteriosus closure using the Amplatzer Duct Occluder.

Methods: From January 1998 to January 2005, 204 cases (77 males and 127 females) underwent an attempt of transcatheter closure of their patent ductus arteriosus at Queen Alia Heart Institute using the Amplatzer Duct Occluder TM device.

Their median age was 3.5 years (range 0.8-13 years), their median weight 14kg (range 6-32kg), their mean Qp/Qs was 2.3±0.6, their mean systolic pulmonary artery pressure was 38.44±7mmHg.

The mean narrowest diameter of the pulmonary end of the patent ductus arteriosus angiographically was 4.2±0.8mm (range 3-8mm).

The devices used were (6-4, 8-6, 10-8 and 12-10mm) delivered antegrade via 5-7 French sheaths.

All patients had chest X-ray and color flow echocardiographic follow-up at 24 hours, one, three, six months and yearly thereafter.

Results: There was immediate and complete closure of the ductus in 180 (88.24%) of cases.

The remaining 24 (11.76%) patients had a trivial residual shunt through the device mesh.

Follow-up color flow Doppler echocardiography revealed complete closure of patent ductus arteriosus in 96% of cases at 24 hours, and complete closure at one month follow-up in 100% of cases.

One patient developed aortic obstruction where the duct joined the aorta at a more acute angle, which was retrieved surgically.

Otherwise no other complications were reported.

Neither thromboembolization nor hemolysis or recanalization of the ductus was reported.

Furthermore, chest radiographs and Doppler echocardiography follow up revealed no evidence of wire fracture or device disruption or any episodes of infective endocarditis.

Conclusion: Since the initial clinical experience in 1998, the transcatheter closure of patent ductus arteriosus using the Amplatzer Duct Occluder has proven to be an easy procedure that could be mastered quickly but with caution and at the same time it is an effective procedure that has almost replaced surgery in our center.

Longer follow up will be needed to precisely define the safety and indications of this device.