Transcatheter Closure of Patent Ductus Arteriosus using novel technique (only venous access)

Background
Transcatheter closure (TCC) of Patent Ductus Arteriosus (PDA) requires both arterial and venous access. Aortogram is used to assess size and shape of ductus pre-implantation, and device position, profile and residual shunt during and after procedure. Angiograms expose patients to radiation and possible untoward effects of contrast agent. Also, arterial access increases local site complication, and procedure time. Transrthoracic echocardiography may be utilized to guide in PDA closure to avoid radiation exposure as well as contrast agent.

Methods
with PDA underwent TCC with Cocoon Duct Occluder (CDO, Vascular Innovation, Thialand) at LPS Institute of Cardiology, Kanpur. Ductus was sized by 2D echo in multiple views. Only femoral vein was accessed with long hydrophilic delivery sheath based on device profile which was chosen on size of ductus. Multipurpose catheter (MPA) was parked into descending thoracic aorta across PDA over 0.35" terumo wire under fluoroscopic guidance. Small amount of contrast was injected through MPA to further validate size of ductus. CDO was implanted by standard technique through delivery sheath using combination of fluoroscopic and echocardiographic guidance. Device embolization, residual shunt, haemolysis, left pulmonary artery (LPA) stenosis, procedural and fluoroscopy time, and mortality were assessed. Patients were followed-up by 2D echo at 24 hours and 6 month post implantation.

Results
TCC was performed successfully among 39 patients (age: 2.11±1.1years; weight: 7.2±3.1 kg). The mean narrowest diameter was 6.1±0.4 mm. Fluoroscopy and procedural time were 3.8±1.4 min and 21.9±1.9 min respectively. Amount of contrast material used was 5.7±1.9 ml. Post-procedural echocardiography revealed immediate and complete closure among 34(87.2%) patients while 5(12.8%) had residual shunt. At 24 hour, all the remaining patients achieved complete closure which was maintained at 6 month. Haemolysis, embolization, stenosis of LPA or descending aorta, and death were not reported till 6-month follow-up.

Conclusions
Echo-assisted transcatheter closure of PDA using CDO is feasible, safe, and effective with excellent results.