Utilization of Amplatzer Vascular Plugs for Closure of Patent Ductus Arteriosus in Pediatric and Adult patients.
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Shilpi Garg, M.D.
,
Oregon Health & Science University, Portland, OR
Laurie Armsby, M.D.
,
OHSU Cardiology, Portland, OR
Grant H. Burch, M.D.
,
Oregon Health & Science University, Portland, OR
Background:
Many strategies have been employed for transcatheter closure of patent ductus arteriosus (PDA). We assessed the safety and efficacy of Amplatzer Vascular Plugs (AVPs) II and IV in transcatheter PDA closure.
Methods:
A retrospective review was conducted of the 46 patients who had attempted PDA closure with AVP device from 2013 to 2018. All patient data were reassessed and expressed as medians with ranges.
Results:
46 patients (25 males) underwent attempted PDA closure and were 16 months (1.5 mo - 22 yr) and 10.1kg (3.8 - 78.3 kg) at the time of catheterization. Indication for PDA closure was left heart volume overload (67%), risk of infective endocarditis (20%) and pulmonary hypertension (13%). PDAs were classified based on a modified Krichenko’s classification system (Type A=12, B=0, C=9, D=4, E=14, F=8). Minimum ductal diameter was 2.7 mm (1.8 - 5.3 mm) and ductal length was 1.2 mm (3.2 - 10.8 mm). Two patients had failed attempted closure with Gianturco coil and Nit-Occlude devices prior to successful closure with an AVP. 56 devices were attempted in the 46 patients with devices placed in all patients. Devices in 3 pts were removed (2 pre-release) due to aortic/PA obstruction or operator choice. 43 PDA were successfully closed (AVP II = 34, AVP IV = 9). The three failures in our early experience were in two patients having large type E and F PDA and one with a moderate type F PDA and pre-existing LPA stenosis. Nine patients had minimal angiographic shunts (1 trivial, 8 trace) at the end of the procedure. Procedural fluoroscopy time was 17.3 minutes (6.8 - 52.3 minutes) and Dose Area Product was 612 cGy∙cm
2 (199 -7089 cGy∙cm
2). One patient had temporary loss of arterial pulse which returned after receiving heparin drip. There were no other complications. Echocardiographic follow-up 1 day - 6 months after the procedure showed no residual shunts with one patient being lost to follow-up. No patient had device related coarctation or left pulmonary artery stenosis.
Conclusions:
This study shows that AVP devices provide an effective method to close PDA of all types, except type B, with a low complication risk.
