Challenging closure of huge hypertensive patent ductus arteriosus using Amplatzer septal occluder: PSU experience

  • Dr Supaporn Roymanee, Prince of Songkla University, Had Yai, Thailand, Thailand
  • Dr Saranwan Phetphisal, Prince of Songkla University, Had Yai, Thailand, Thailand
  • Dr Nakharin Tonklang, Prince of Songkla University, Had Yai, Thailand, Thailand
  • Dr Saranyou Suwan-uksorn, Thailand
  • Dr Treechada Visartpong, Prince of Songkla University, Had Yai, Thailand, Thailand
  • Dr Sririchai Chewathanakornkul, Prince of Songkla University, Had Yai, Thailand, Thailand
  • Dr Tawai Ngernsritakul, Thailand

    • Objective: To report a challenging huge hypertensive patent ductus arteriosus (PDA) closed by transcatheter technique.
    Method and Result: A 38-year-old cachetic female with NYHA FC III dyspnea underwent transcatheter closure of hypertensive PDA. Right and left heart catheterization had taken only under room air and oxygen inhalation (selective pulmonary vasodilators are unavailable). The aortogram revealed huge aneurysmatic and calcified PDA 24 mm with ampulla diameter of 40 mm (aorta only 20 mm). Both pulmonary arteries (PA) also had become aneurysmatic with its size nearly 60 mm. There was systemic pulmonary artery pressure (PAP) and no any change of PAP before and after oxygen inhalation. However, Qp:Qs was increased from 1.5 to 2.8, pulmonary vascular resistance was decreased from 9.2 to 2.6, Rp:Rs was decreased from 0.67 to 0.23, and aortic saturation was increased from 95% to 99%. Intention to trial occlusion using Amplatzer septal occluder (ASO) 26 mm, we expected that 40 mm-left atrial disc would fit at aortic ampulla, however device passed through the huge PDA and huge PA aneurysm. Subsequently, ASO 38 mm was successfully placed. After last 30 minutes, the PAP was 116/40 mmHg (mean 74) while systemic pressure was 122/64 mmHg (mean 88) and no aortic desaturation. The device was implanted without obstruction to aorta or PA branches. There was mild residual central shunt and transient microscopic hematuria which both disappeared completely 48 hours later.
    Conclusion: According to new innovation of device technology and technique leading to successful and safety closure of huge hypertensive ductus arteriosus