6. At Birth
PVR/SVR from 10 to 1/3 in few s.
In the preterm infant:
osystolic steal, reversed flow, pulmonary
congestion
In the newborn:
ospontaneous constriction, due to increased PaO2,
then fibrous occlusion
PDA if the arterial duct is still patent after 1 month
8. What ONLY matters for clinical
implications of ISOLATED DBP is its size
What matters for percutaneous closure are
patient age and weight, PDA size, PDA
shape (size of the aortic isthmus, size of the
ampulla, lenght of the PDA, size of LPA...)
12. PDA in preterm infants
Attitude: closure
o medical treatment
o surgical treatment (ligation - suture)
medical - surgical implications, residual shunt
o percutaneous treatment (?????) few cases
reported - technical implications
13. PDA in babies, children, adults
Attitude: closure
• if ventricular overload
• if PH
• if murmur
• to prevent endocarditis?
• to allow intense physical activity?
17. Devices and ideas
How shall I close a hole?
Generally putting something
inside....or simply covering it....
cover
occlude
(dissection)
18. The beginning
Percutaneous transfemoral closure of the the patent
ductus arteriosus - an alternative to surgery
Porstmann W Semin Roentgenol. 1981
First percutaneous procedure: Rashkind 60s
19. Double umbrella Raskind device
To close a communication I want to
cover both sides
Drawbacks: residual shunt, obstruction,
migration, fracture, retrievability but no
repositionability…
21. Coils
oFrom venous or arterial side
oMultiple coils possible
oRetrievability and repositionability
oBetter for small PDA
oCheap
Drawbacks: residual shunt (hemolysis),
migration
22. Coils
o Not too large..
o Not tubular..
o Not window like..
o Not too small…
oNo tortuous..
Still I do use coils…..
26. Stenting the duct with an occlusive
device
The AGA system
ADO I ADO II
27. AGA system : ADO I
Advantages
• From the venous side
• Retrievable
• Repositionable
• High rate immediate
occlusion
• Occlusion of large PDA
Disadvantages
• Iatrogenic coarctation
• Absence of pulmonary disc
• Migration (aorta or PA)
• Difficult retrivability after
migration
• Residual shunt and
haemolysis
• Bleeding !
34. AGA system : ADO I
Large PDAs in small children
Concerns: Anatomy of the PDA, tricuspid angle,
rigidity of the system, small aortic isthmus
35. AGA system : ADO I
Large PDAs in very small children ???
Concerns: Anatomy of the PDA, tricuspid angle,
rigidity of the system +++, small aortic isthmus,
venous/arterial access.. (< 2Kg babies…)
38. The ADO II device
ADO II:fabric-free fine nitinol wire, 2 very low profile
disks, articulated connecting waist. Antegrade or
retrograde approach.
Advantages: reduced sheath sizes and softer shape
Reports: protrusion into the aortic isthmus or pulmonary
artery
40. ADO II AS
•Few preliminary reports
•Good results
•Easy, premounted (generally..), navigability +++
•No obstruction, no migration, no residual shunt,
variety of different anatomies …
Early clinical experience with a modified Amplatzer ductal Occluder for transcatheter arterial duct
occlusion in infants and small children. Kenny D et al, Catheter Cardiovasc Interv 2012
Closure of the patent ductus arteriosus with the new duct occluder II addotional sizes device.
Agnoletti G et al Catheter Cardiovasc Interv 2012
Closure of a large ductus arteriosus in a preterm infant using the ADO II AS device. Agnoletti G et al.
Heart 2012
52. Large PDA in small children
After failed percutaneous closure
Perventricular Device Closure of Patent Ductus Arteriosus:
A Secondary Chance
Ann Thorac Surg 2012
54. Conclusions
•All PDAs can be closed percutaneously ?
•All PDAs should be closed percutaneously ?
•Almost always feasible
•Almost always successful…
•Different devices for different patients…
•Complications can occur
