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Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):533-40. doi: 10.1016/j.acvd.2009.04.004. Epub 2009 Jul 9.

Significant persistent ductus arteriosus in infants less or equal to 6 kg: percutaneous closure or surgery?

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  • 1Service de cardiologie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31026 Toulouse, France. sylvia.abadir@gmail.com

Abstract

BACKGROUND:

Percutaneous closure of large persistent ductus arteriosus using the Amplatzer duct occluder is an alternative to surgery. However, this device is not recommended in infants weighing less than 6 kg.

AIM:

To evaluate the safety and effectiveness of this procedure in low-body-weight infants.

METHODS:

We reviewed retrospectively data for infants weighing less or equal to 6 kg who underwent percutaneous closure of significant persistent ductus arteriosus using the Amplatzer duct occluder in France between 1998 and 2007.

RESULTS:

Data for 58 patients (mean weight: 5 kg, range: 3.4-6; mean age: 5.5 months, range: 2.1-15.3) were reviewed. Mean angiographic persistent ductus arteriosus minimal diameter was 3.7 mm (range: 1-7.5). Implantation of the Amplatzer duct occluder was successful in 89.7% of cases. In six (10.3%) patients, the device was not implanted because it would have led to significant aortic obstruction. One procedure-related death occurred in a 4 kg infant (1.7%). Major and minor complications occurred in 6.9 and 31.0% of patients, respectively. Persistent ductus arteriosus diameter greater than 3.7 mm, type C (tubular shape) and diameter/patient weight ratio greater than 0.91 were significantly associated with an unsuccessful procedure and/or major complications. During a median 10-month follow-up, no late device embolization occurred.

CONCLUSIONS:

Although percutaneous closure of significant persistent ductus arteriosus with the Amplatzer duct occluder is effective in low-body-weight infants, the level and severity of complications indicate surgery as first-line treatment, at least until further studies are done to assess the safety and effectiveness of the new Amplatzer duct occluder II in low-body-weight infants.

PMID:
19664573
[PubMed - indexed for MEDLINE]
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