Transcatheter Closure of Persistent Ductus Arteriosus Using the Amplatzer Duct Occluder in Infants

Background: Despite technical improvements over the years, interventional closure of persistent ductus arteriosus in infants remains a challenge. Objectives: To assess safety, efficacy, and follow up results of closure of symptomatic persistent ductus arteriosus in infants using the self-expanding and repositionable Amplatzer device. Setting: Queen Alia Heart Institute (QAHI), a tertiary cardiac center, Amman-Jordan. Patients and Methods: Between June 2000 and May 2004, a total of 21 infants (12 males, 9 females) with symptomatic persistent ductus arteriosus were considered for treatment by transcatheter. Their age ranged from six months to 12 months (median 9.5 months) and bodyweights ranged from 5.5–9.8kg (median 7.4 kg). Indications for closure were one or more of the followings: failure to thrive, frequent respiratory symptoms, tiring on feeding, cardiomegaly on chest X-ray and left atrial and ventricular overload on 2-dimensional echocardiography. The procedure was carried out under sedation with fluoroscopic control. The Amplatzer duct occluder device was used. Results: Concurrent angiographies showed immediate closure in 16 patients while 5 had trivial shunting. Within 24 hours, Doppler examination showed complete closure in all patients. (Closure rate: 100%). There was no mortality related to the procedure, no aortic obstruction, left pulmonary artery stenosis or device embolisation. One patient had loss of femoral artery pulse that was successfully treated by intravenous heparin. Technical problems occurred in three patients during delivery of the device which was solved by changing the delivery sheath or using a snare to stabilize the sheath. There have been no late complications or re-opening of the duct on follow-up till date. Patients with recurrent respiratory symptoms had no significant recurrences, infants who had failed to thrive had significantly increased growth and all have normal left atrial and ventricular measurements. Conclusion: Transcatheter closure using the Amplatzer duct occluder is an efficacious and safe treatment for symptomatic patent ductus arteriosus in infants.