Non-surgical closure of large ductus arteriosus using Amplatzer Duct Occluder feasibility and early follow-up results.

The aim of the study was the assess feasibility of closing large patent arterial ducts (PDA) in infants and children using the new Amplatzer Duct Occluder. All patients diagnosed to be having PDA were considered as potential candidates to undergo the device closure. 19 patients were diagnosed to be having PDA larger than 4 mm. There were 10 males and 9 females, their age ranged from 6 months to 120 months with a mean of 45 months. Mean body weight was 14.5 kg with a range from 7 kg to 23 kg. The procedure was carried out under Ketamine sedation and local anesthesia. The device was implanted by the transvenous route in all. Mean PDA diameter was 5 mm (range 4 mm-6.7 mm). Complete closure was achieved in 16/18 (88%) within 24 hours of the procedure. All patient have been followed for 3 months, and have documented complete closure, there is no evidence of aortic or left pulmonary stenosis in any of our patients. The unsuccessful attempt was in a malnourished patient (weighing 4.7 kg) with an arterial duct measuring 6.7 mm on angiography. This duct was considered too big for device closure and the procedure was abandoned. This patient subsequently has undergone successful surgical ligation. Catheter closure of large PDA in small children is feasible, safe and efficacious. However, it may still not be possible to close large PDA in very small or underweight children, for the fear of causing obstruction to the descending aorta. Further long-term is follow-up required to show sustained benefits without any side effects.