Division or Occlusion of Patent Ductus Arteriosus?

Abstract

The traditional and most effective form of treatment of persistent ductus arteriosus is surgical ductal division. New therapeutic techniques such as intraluminal ductal occlusion are currently recommended to replace the traditional treatment procedure. The purpose of this paper is to analyze the state of the art of these new therapeutic modalities. From reports in the medical literature, the authors analyzed the indications, results, and complications of the intraluminal ductal occlusion procedures. They applied the Student's t test for independent samples to evaluate the results of intraluminal patent ductus arteriosus occlusion by means of umbrellas, buttons, coils, and Gianturco-Grifka and Amplatzer occluders, respectively, in 2,691 patients collected from the medical literature. According to their analysis the results of intraluminal ductal occlusion with coils were as follows: success 83.7 ±12.2%, failure 3.9 ±2.8%, incom plete ductal occlusion 17.5 ±15.3%, need for surgery 2.8 ±3.8%, need for a second intraluminal procedure 5.8 ±9.9%, and device embolization 6.2 ±7.2%. The use of the Gianturco-Grifka device showed the following results: success 96.0 ±5.6%, failure 4.0 ±5.6%, incomplete ductal occlusion 4.0 ±5.6%, need for surgery 0%, need for a second intraluminal procedure 4.0 ±5.6%, and device embolization 4.0 ±5.6%. The Amplatzer occluder showed the following results: success 92.8 ±6.1%, failure 7.2 ±6.1%, incomplete ductal occlusion 2.0 ±4.3%, need for surgery 0%, need for a second intraluminal procedure 0.8 ±1.7%, and device embolization 0.5 ±1.3%. According to the state of the art, intraluminal ductal occlusion with Gianturco-Grifka device and Amplatzer occluder reduces the proportion of incomplete obstructions and need for surgery. Additionally, the use of the Amplatzer occluder reduces need for a second procedure and the embolization rate. Although the results obtained with the new procedures are better than those obtained previously, they are still not totally satisfactory.

Get full access to this article

View all access options for this article.

References

Mavroudis C. , Backer CL , Gevitz M. : Forty-six years of patient ductus arteriosus division at Children's Memorial Hospital of Chicago. Standards for comparison . Ann Surg 220:402-409, 1994.

Forbes TL , Evans MG : Optimal elective management of patient ductus arteriosus in the older child . J Pediatr Surg 31:765-767, 1996.

Lloyd TR , Beekman RH : Transcatheter closure of atrial septal defect and persistence of ductus arteriosus . In: Textbook of Interventional Cardiology, vol. II, ed. 2, ed. by Topol EJ. Philadelphia: WB Saunders, 1994, pp 1298-1311.

Rao PS , Balfour IC , Chen SC : Effectiveness of five-loop coils to occlude patent ductus arteriosus . Am J Cardiol 80:1498-1501, 1997 .

Galal O. , Nehgme R. , al-Fadley F. , et al: The role of surgical ligation of patent ductus arteriosus in the era of the Rashkind device. Ann Thorac Surg 63:434-437, 1997.

Bermúdez-Cañete R. , Santoro G. , Bialkowsky J. , et al: Patent ductus occlusion using detachable coils. Am J Cardiol 82:1547-1549, 1998 .

Shim D. , Beekman RH III: Transcatheter management of patent ductus arteriosus . Pediatr Cardiol 19:67-71, 1998.

Daniels CJ , Cassidy SC , Teske DW , et al: Reopening after successful coil occlusion for patent ductus arteriosus. J Am Coll Cardiol 31:444-450, 1998.

Lee ML , Chaou WT , Wang JK : Transarterial occlusion of patent ductus arteriosus with Gianturco coils in pediatric patents: A preliminary result in central Taiwan. Int J Cardiol 30:57-63, 1994.

10.

Rao PS , Kim SH , Choi JY , et al: Follow-up results of transvenous occlusion of patent ductus arteriosus with buttoned device. J Am Coll Cardiol 33:820-826, 1999.

11.

Emmersten K. , Espersen GT , Sorensen KE : Transcatheter occlusion of patent ductus arteriosus (abstract). Ugeskr Laeger 161:3841-3844, 1999.

12.

Ledesma M. , Gómez FD , Alva EC , et al: Cierre transcateterismo del conducto arterioso mediante espirales (coils). Resultados inmediatos. Experiencia inicial en México. Arch Inst Cardiol Mex 66:419-422, 1996.

13.

Ono M. , Furuse A. , Kotsuke Y. , et al: Persistent hemolysis after coil occlusion of a patent ductus arteriosus in a patient with aortic regurgitation. Jpn Heart J 39:243-246, 1998.

14.

Patel HT , Cao QL , Rhodes J. , et al: Long-term outcome of transcatheter coil closure of small to large patent ductus arteriosus. Cathet Cardiovasc Interv 47:457-461, 1999.

15.

Munayer CJ , Ramírez RH , Aldana PT , et al: Dispositivo de Gianturco-Grifka en el cierre percutáneo del conducto arterioso permeable. Experiencia en 13 casos. Arch Inst Cardiol Mex 69:554-558, 1999.

16.

Masura J. , Walsh KP , Thanopoulous B. , et al: Catheter closure of moderate- to large-sized patent ductus arteriosus using the new Amplatzer duct occluder: Immediate and short-term results. J Am Coll Cardiol 31:878-882, 1998.

17.

Thanopoulos BD , Hakim FA , Hiari A. , et al: Further experience with transcatheter closure of the patent ductus arteriosus using the Amplatzer duct occluder . J Am Coll Cardiol 35:1016-1021, 2000 .

18.

Podnar T. , Matsura J. : Transcatheter occlusion of residual patent ductus arteriosus after surgical ligation. Pediatr Cardiol 20:126-130, 1999.

19.

Marwah A. , Radhakrishnan S. , Shrivastava S. : Immediate and early results of closure of moderate to large patent arterial ducts using the new Amplatzer device. Cardiol Young 10:208-211, 2000.

20.

Bjornstad PG , Westvik J. , Rian R. , et al: Catheter closure of open ductus arteriosus—the first 100 patients (abstract). Tidsskr Nor Laegeforen 120:1011-1014, 2000 .

21.

Chatterjee T. , Windecker S. , Pfammatter JP , et al: Non-surgical closure of patent ductus arteriosus: Acute and long-term results (abstract) . Schweiz Med Wochenschr 130:664-670, 2000.

22.

Saliba Z. , Aggoun Y. , Hausse AO , et al: Fermeture percutanee du canal arteriel par la prothese occlusive Amplatzer. Arch Mal Coeur Vaiss 93:533-538, 2000.

23.

Shrivastava S. , Marwah A. , Radhakrishnan S. : Transcatheter closure of patent ductus arteriosus . Indian Pediatr 37:1307-1313, 2000 .

24.

Bilkis AA , Alwi M. , Hasri S. , et al: The Amplatzer duct occluder: Experience in 209 patients J Am Coll Cardiol 37:258-261, 2001.

25.

Radhakrishnan S. , Marwah A. , Shrivastava S. : Non-surgical closure of large ductus arteriosus using Amplatzer duct occluder: Feasibility and early follow-up results. Indian J Pediatr 68:31-35, 2001.

26.

Koch A. , Hofbeck M. , Buheitel G. , et al: Advances in interventional occlusion of persistent ductus arteriosus : Comparison of results using different occlusion devices (abstract). Z Kardiol 90:120-126, 2001.

27.

Sandhu SK , King TD , Troutman WB , et al: Transcatheter closure of patent ductus arteriosus with the Amplatzer duct occluder: Short-term follow-up. J Invasive Cardiol 13:298-302, 2001.

28.

Gray DT , Weinstein MC : Decision and cost-utility analysis of surgical versus transcatheter closure of patent ductus arteriosus: Should you let a smile be your umbrella? (abstract) . Med Decis Making 18: 187-201, 1998.

29.

Prieto LR , De Camillo DM , Konrad D. , et al: Comparison of cost and clinical outcome between transcatheter coil occlusion and surgical closure of isolated ductus arteriosus. Pediatrics 101:1020-1024, 1998 .

30.

Hawkins JA , Minich LL , Tani LY , et al: Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus. J Thorac Cardiovasc Surg 112:1634-1638, 1996.

31.

Fedderly RT , Beckman RH III , Mosca RS , et al: Comparison of hospital charges for closure of patient ductus arteriosus by surgery and by transcatheter coil occlusion. Am J Cardiol 77:776-779, 1996.

32.

Raiij-maakers B. , Nijveld A. , van Oort A. , et al: Difficulties generated by the small, persistently patient arterial duct. Cardiol Young 9:392-395, 1999.

33.

Stromberg D. , Pignatelli R. , Rosenthal GL , et al: Does ductal occlusion with the Gianturco coil cause left pulmonary artery and/or descending aorta obstruction ? J Am Coll Cardiol 83:1229-1235, 1999 .

34.

Sun D. , Zhang B. , Zhu J. : Surgical treatment of difficult patent ductus arteriosus and relative operative complications (abstract). Zhonghua Wai Ke Za Zhi 34:273-275, 1996.

35.

Bonhoeffer P. , Borghi A. , Giusti S. , et al: Chiusura mediante protesi a doppio ombrellino di dotti ricanalizzati dopo legatura chirugica . G Ital Cardiol 22:1309-1314, 1992 .

36.

Szkutnik M. , Bermúdez CR , Bialkowsky J. , et al: Percutaneous closure of previously treated arterial duct (Abstract). Arch Inst Cardiol Mex 69 (suppl 5):63, 1999.