Mehboob Sultan

Transcatheter device closure of patent ductus arteriosus.

OBJECTIVE To determine the efficacy, safety and immediate complications encountered during percutaneous device closure of patent ductus arteriosus (PDA). STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Department of Paediatric Cardiology, AFIC/NIHD, Rawalpindi, from January 2005 to December 2010. METHODOLOGY Consecutive 500 patients who underwent attempted transcatheter PDA device closure were included in the study. Device type position, success of closure and complications were described as frequency percentage. RESULTS In 491 cases (98.2%), PDA was successfully occluded including 4 cases (0.8%) where devices were dislodged but retrieved and redeployed in Cath laboratory. PDA occluder devices used in 448 cases (91%) while coils (single or multiple) were used in 42 cases (8.5%) and in one case (0.2%) ASD occluder device was used to occlude the PDA. There were 09 (1.8%) unsuccessful cases, 06 (1.2%) were abandoned as ducts were considered unsuitable for device closure, 02 (0.4%) devices dislodged and needed surgical retrieval and one case (0.2%) was abandoned due to faulty equipment. The narrowest PDA diameter ranged from 0.5-14 mm with mean of 4.5±2.4 mm. There was a single (0.2%) mortality. CONCLUSION Transcatheter occlusion of PDA by coil or occluder device is an effective therapeutic option with high success rate. Complication rate is low in the hands of skilled operators yet paediatric cardiac surgical back-up cover is mandatory.

Patent Ductus Arteriosus Device Occlusion in a Patient with Primary Ciliary Dysfunction and Interrupted Inferior Vena Cava: An Interventional Challenge

Trans-catheter occlusion of patent ductus arteriosus (PDA) using antegrade approach through the femoral vein is well established approach commissioned in the catheter lab. However, in patients with interrupted inferior vena cava (IVC), it is not always practicable to close the ductus by employing the usual antegrade approach. While a detailed echocardiographic evaluation of systemic venous drainage is needed prior to any percutaneous intervention procedure, cardiac catheterization is still the gold standard to delineate the systemic venous drainage 1. Furthermore, it is also required to be aware of any substitute approaches if available, if interrupted IVC comes as a revelation during the course of the catheter procedure.