A Device Closure with and without Arterial Access

Abstract

Background: All PDAs that are apparent by physical examination should be closed. In 2003, the AMPLATZER duct occluder was the first FDA-approved device for PDA closure. PDA device closure can be performed without an arterial access. We are presenting our experience in closing the PDA with and without arterial access. Methods: From February 2012 till Augost 2014, all patients underwent transcatheter PDA closure were included. Since 2013 we are intending to close the PDA without arterial access. Device closure was performed for any hemodynamically significant PDA. Detailed Echocardiographic evaluation of the heart with hemodynamic Doppler assessment was performed. Results: During the period, 45 patients underwent PDA device closure. All have venous access, 14 patients (31%) have additional arterial access. Since 2013 our protocol is to do PDA device closure without an arterial access except in selected patients when arterial access was considered necessary. Pre procedure angiograms were performed in tow projections by the venous catheter positioned at the PDA descending aorta junction in 32 patients (71%), and by the arterial accessed cathter in 13 patients (29%). PDA was closed by ADO1 device in 25 patient (56%), Occulotech PDA device in 18 patients (40%), and by coils in 2 patients (4.4%). Post PDA device angiograms were performed through the side port of the long delivery sheath. Detailed echocardiographic assessment was performed 2 to 4 hours after intervention as well as in the next day. No major immediate complications. One patient developed mild pericardial effusion 24 hours after the procedure. Comparing the differences between those with and without arterial access revealed that the procedure time, the fluoroscopic time as well as the amount of the contrast dose used were less in those with no arterial access. Conclusion: PDA device closure without an arterial access can be performed safely and effectively. Patient selection and appropriate preintervention detailed echocardiography and procedure planning are essential for accomplishing device closure of PDA with or without arterial access. The procedure is simplified considerably and many patients can be discharged on the day of the procedure.