CLOSURE OF PATENT DUCTUS

ARTERIOSUS WITH THE AMPLATZER

DUCT OCCLUDER DEVICE

Vindeztrivthala V, Harimurti GM, Roebiono PS, Rahayoe AU.

Department Cardiology & Vascular Medicine,

Faculty of Medicine, University of Indonesia
National Cardiovascular Center Harapan Kita
Jakarta, Indonesia
 BACKGROUND

• Transcatheter occlusion of PDA has

become an increasingly important
therapeutic option.
• Several occlusion devices are available,
such as Gianturco coil, Rashkind
umbrella, buttoned device and
Amplatzer Duct Occluder (ADO).
 PURPOSE OF THE STUDY

To review our early experience in closing the

PDA with ADO at National Cardiovascular
Center, Jakarta, Indonesia
MATERIAL & METHOD

 Descriptive study
 All PDA patients who underwent
ADO deployment
 From mid November 2002 until
January 2004
 At National Cardiovascular
Center Harapan Kita, Jakarta,
Indonesia
MATERIAL & METHOD
 Diagnostic findings :
• Continuous murmur
• Trans thoracic echocardiogram (TTE)
• Cardiac catheterization and aortogram

 Variables :
• Age
• Gender
• Ductal diameters
• ADO's size
• Residual Shunt

 Follow up : TTE within 24 hours and 1 month

after the procedure
 PROCEDURE
• Children < 5 years : under general anesthesia
older : Pethidine and DBP
• Right femoral vein and artery were accessed
percutaneously, and 6 and 4 or 5 French sheaths were
placed respectively in each vessel
• Antibiotic prophylaxis IV Amoxycillin 50mg/kgBW was given
• No heparin was administered
• Right heart catheterization was performed in routine fashion
• Aortogram performed in the descending aorta using a pig tail
or NIH catheter via the femoral artery in lateral projection
• The narrowest portion of PDA size was measured
• ADO’s size : 2 mm larger than the narrowest portion of PDA
 PROCEDURE
• PDA was crossed with a 5 or 6 French multipurpose
catheter which was then exchanged for a 6 or 7 French
AMPLATZER delivery sheath using an exchange guide-
wire
• The sheath was positioned in the descending aorta
• The appropriate size ADO was screwed onto the
delivery cable and then introduced into the delivery
sheath
• ADO deployment was performed
• Aortogram was done to verify correct position of the
device
• ADO was released
• Another aortogram was reperformed to evaluate the
residual shunt
• Residual shunt was observed on TTE 24 hours and 1
week after procedure
The Ductus was Closed Completely
using the Amplatzer Duct Occluder
Device
 RESULTS

• 31 children and 2 adults

• 22 males and 11 females
• 9 month to 39 years (18.7 ± 7.42 years)
• Ductal diameters
– TTE : 3 to 12 mm (5.2 ± 1.42 mm)
– Aortogram : 2.2 to 11 mm (4.7 ± 1.73 mm)
• ADO's size : 4 to14 mm (7.1 ± 1.61 mm)
 RESULTS
• Successful deployment : 32 patients (97 %)
• Failed : 1 patient (3 %)
– due to faulty ADO (did not conform to its original configuration)
– the device was recaptured and the procedure was terminated to
none availability of the same size device at that time
• Complication during the procedures : none in all patients
• Residual shunt : 5 patients (16 %)
– trivial residual shunt noted on aortography directly after ADO
deployment
– complete closure was observed on TTE 24 hours after procedure
• No residual shunt on TTE 1 month follow up in all
patients
 DISCUSSION
• Transcatheter occlusion of PDA has become an
increasingly important therapeutic option
• In our study PDA is more frequent found in
children  ADO deployment mostly in children
• Feasibility ADO deployment appears high
(97.97%)
• High effectiveness appears by aortography after
ADO deployment, and complete closure PDA was
observed on TTE 24 hour after prosedure.
 CONCLUSIONS

• ADO device is a feasible, safe and

effective technique for closing PDA
in children and adults
• Will result in immediate occlusion of
the shunt without the need for
thoracotomy.