Long-Term Follow-up of Patent Ductus Arteriosus Closure with the Amplatzer Duct Occluder in Children

Abstract

Background: Transcatheter closure of patent ductus arteriosus (PDA) has become an alternative treatment to surgery. We evaluated the long-term results of the transcatheter closure of PDA with the Amplatzer Duct Occluder (ADO) in children.
Methods: Between May 2004 and October 2012, 138 children with PDA (43 males and 95 females) underwent transcatheter PDA closure. Clinical, electrocardiographic, echocardiographic, and hemodynamic data were assessed pre and postprocedurally and at follow-up.
Results: The mean age of the patients at procedure was 3.53 ± 2.43 years (range = 1.1 to 9.5 years), mean weight was11.9±4.6 kg (range = 6 to 29 kg), median pulmonary end diameter of the PDA was 5 mm (range = 4 to 15 mm), and median diameter of the ADO was 8 mm (range = 6 to 16 mm). The mean follow-up time was 43.4 ± 23.5 months (range = 13.5 to98 months).The devices were successfully deployed in 136 (98.5%) patients. Device embolization occurred in 2 patients, immediately in one patient and during the first postprocedural night in the other patient. The first patient had percutaneous device retrieval, followed by implantation of a larger device. The second patient had surgical device removal and PDA ligation. Immediately after device implantation, trivial to mild residual shunts were detected in 112 (80%) patients; all the shunts, however, disappeared 24 hours after the procedure. One patient had left pulmonary artery stenosis with a gradient of 25 mm Hg at 24 hours', 40 mmHg at one month's, and 64 mmHg at 6 months' follow-up. There were no cases of late embolization, aortic obstruction, late hemolysis, infective endocarditis, or death.
Conclusion: Transcatheter PDA closure with the ADO was safe and effective, with a high success rate at long-term follow-up.