Sachan Mohit, Himanshu Kumar, Jha Mukesh J, Sinha Santosh K, Razi Mahmodullah, Sharma Awadhesh K, Aggarwal Puneet, Shukla Praveen, Pandey Umeshwar, Verma Rakesh
Department of Cardiology, LPS Institute of Cardiology and Cardiac Surgery, Kanpur, India.
Department of Cardiology, ABVIMS and Dr RML Hospital, New Delhi, India.
J Saudi Heart Assoc. 2025 Jan 26;37(1):5. doi: 10.37616/2212-5043.1415. eCollection 2025.
To evaluate the feasibility, safety, and efficacy of transcatheter closure (TCC) of patent ductus arteriosus (PDA) using anatomo-haemodynamic landmark without any arteriography.
In this prospective, non-randomized study, all consecutive patients with PDA undergoing transcatheter closure at LPS Institute of Cardiology, Kanpur, India between January 2019 and June 2024 were evaluated. TCC was performed using anatomical and haemodynamicl landmark without aortogram, and device was deployed through antegrade route only. Transthoracic echocardiography with colour-Doppler imaging was used to confirm position of the device before final deployment. Primary outcome was procedural and fluoroscopy time, and major complications (access site complications, device embolization, residual shunt ≥ grade 3, haemolysis, flow acceleration in left pulmonary artery and descending thoracic aorta, and death). Success was defined as complete closure of shunt without any major complications.
TCC was successfully performed through antegrade route in 250 patients (age: 2.3 ± 1.2 years; weight: 10.3 ± 9.8 kg) while 16 patients were excluded for various reasons. Mean diameter of duct was 6.7 ± 4.5 mm. Male and female comprised 176 (70.4%) and 74 (29.6%) respectively. PDA were type A (n = 195; 78%), B (n = 27; 10.8%), C (n = 20; 8%), and (n = 8; 3.2%). TCC was successful in all patients although dislodgement was noted in 1 (0.04%). Lifetech duct occluder and Konar MFO were most commonly used devices in 156 (62.4%) and 33 (13.2%) patients respectively. Immediate closure was achieved in 233 (93.2%) patients while remaining 17 (7.8%) with grade I or II shunt on echocardiogram had complete closure in 2 days. Device embolization was observed in 1 (0.4%) patient while flow acceleration in DTA were observed in 5 (2%) patients. Procedure was successful in 99.6% using antegrade while TCC using isolated venous route was successful in 94%.
TCC of PDA using anatomo-haemodynamic landmark and avoiding arterial access is feasible, safe, and effective, with excellent results on short and medium-term follow-up.
评估在不进行任何血管造影的情况下，使用解剖血流动力学标志经导管闭合动脉导管未闭（PDA）的可行性、安全性和有效性。
在这项前瞻性、非随机研究中，对2019年1月至2024年6月期间在印度坎普尔LPS心脏病学研究所接受经导管闭合术的所有连续性PDA患者进行评估。经导管闭合术采用解剖和血流动力学标志，无需主动脉造影，且仅通过顺行途径植入装置。在最终植入前，使用经胸超声心动图彩色多普勒成像确认装置位置。主要结局指标为手术时间和透视时间，以及主要并发症（穿刺部位并发症、装置栓塞、残余分流≥3级、溶血、左肺动脉和胸降主动脉血流加速以及死亡）。成功定义为分流完全闭合且无任何主要并发症。
250例患者（年龄：2.3±1.2岁；体重：10.3±9.8kg）通过顺行途径成功进行了经导管闭合术，16例患者因各种原因被排除。导管平均直径为6.7±4.5mm。男性176例（70.4%），女性74例（29.6%）。PDA类型为A（n = 195；78%）、B（n = 27；10.8%）、C（n = 20；8%）和（n = 8；3.2%）。所有患者经导管闭合术均成功，尽管有1例（0.04%）出现装置移位。Lifetech动脉导管封堵器和Konar MFO分别是156例（62.4%）和33例（13.2%）患者最常用的装置。233例（93.2%）患者实现即刻闭合，其余17例（7.8%）超声心动图显示为I级或II级分流的患者在2天内实现完全闭合。1例（0.4%）患者观察到装置栓塞，5例（2%）患者观察到胸降主动脉血流加速。顺行途径手术成功率为99.6%，单纯静脉途径经导管闭合术成功率为94%。
使用解剖血流动力学标志且避免动脉穿刺的PDA经导管闭合术是可行、安全且有效的，短期和中期随访结果良好。
