Transcatheter closure of tubular patent ductus arteriosus using muscular ventricular septal defect devices in infants and small children with congestive heart failure

Arch Cardiovasc Dis. 2022 Mar;115(3):134-141. doi: 10.1016/j.acvd.2022.01.003. Epub 2022 Feb 24.

Abstract

Background: Transcatheter closure of a patent ductus arteriosus in children is widely performed to reduce symptoms and decrease the risk of endocarditis. Most arterial ducts are closed successfully with dedicated devices. However, in a tubular or "type C" patent ductus arteriosus with congestive heart failure, the occlusion is more challenging with these devices, with a higher risk of complications, such as aortic or left pulmonary stenosis and device embolization.

Aim: To report our experience with muscular ventricular septal defect devices for patent ductus arteriosus occlusion in small children.

Methods: Retrospective observational series of patients weighing<10kg, with a tubular patent ductus arteriosus (typeC) and congestive heart failure, who underwent transcatheter closure with a muscular ventricular septal defect device between 2017 and 2019.

Results: Eight patients were included. The mean age and weight at closure were 6.3 months (range 1-18 months) and 5.3kg (range 2.4-8.2kg), respectively. All patent ductus arteriosus were occluded successfully using Occlutech® (N=3) or Amplatzer® (N=5) muscular ventricular septal defect devices. In four cases, the muscular ventricular septal defect device was used after failure to close the patent ductus arteriosus with a dedicated patent ductus arteriosus device. Two patients had mild left pulmonary artery stenosis, with a maximum velocity on continuous Doppler of 3m/s and 2.7m/s, respectively. After a mean follow-up of 28 months (range 14-41 months), all patients were asymptomatic with excellent results. The mild pulmonary stenosis improved, with a maximum velocity of 2.3m/s in both patients.

Conclusions: Closure of tubular patent ductus arteriosus in small children with congestive heart failure using a muscular ventricular septal defect device is safe in this preliminary experience. Further studies with more patients are warranted.

Keywords: Canaux artériels non restrictifs de type C; Congestive heart failure; Insuffisance cardiaque congestive; Off-label device; Prothèses hors indications; Unrestrictive type C patent ductus arteriosus.

Publication types

  • Observational Study

MeSH terms

  • Cardiac Catheterization
  • Child
  • Ductus Arteriosus, Patent* / diagnostic imaging
  • Ductus Arteriosus, Patent* / therapy
  • Heart Failure* / diagnostic imaging
  • Heart Failure* / etiology
  • Heart Failure* / therapy
  • Heart Septal Defects, Ventricular* / diagnostic imaging
  • Heart Septal Defects, Ventricular* / therapy
  • Humans
  • Infant
  • Pulmonary Valve Stenosis*
  • Retrospective Studies
  • Septal Occluder Device*
  • Treatment Outcome