Outcomes of transcatheter closure of patent ductus arteriosus at Chris Hani Baragwanath Hospital, South Africa: review of 15 years experience

  • Dr Paul Adams, Chris Hani Baragwanath Hospital,The University of the Witwatersrand, South Africa
  • Dr Matthew Chersich, Reproductive Health and HIV Research Unit , The University of the Witwatersrand, South Africa
  • Dr Lungile Pepeta, Chris Hani Baragwanath Hospital, The University of the Witwatersrand, South Africa
  • Dr Hopewell Ntsinjana, Chris Hani Baragwanath Hospital, The University of the Witwatersrand, South Africa
  • Dr Firosa Motara, Chris Hani Baragwanath Hospital, The University of the Witwatersrand, South Africa
  • Prof Antoinette Cilliers, Chris Hani Baragwanath Hospital, The University of the Witwatersrand, South Africa

    • Objectives
    Review outcomes of transcatheter closure of patent ductus arteriosus (PDA), role of PDA shape and changes in practice over time.
    Methods
    Retrospective analysis of patient files and clinic database was performed on children who had transcatheter PDA closure at Chris Hani Baragwanath Hospital between 01/01/1993 and 30/06/2008.
    Results
    Over 15 years, 1254 PDAs were diagnosed, of which 293 required closure (167 had surgery and 139 transcatheter closure). Median age at transcatheter closure was 1.8 years (IQR=1-4.5years); 66.2% were female (92/139). Mean PDA diameter was 3.2mm (sd=1.6mm), with an average 2:1 shunt. Transcatheter closure was performed using COOK Flipper coils (n= 93; 18 required multiple coils) or Amplatzer devices (n=46: 37 with ADO1, 8 AVP and 1 ADO2). Twenty children required repeat procedures. Early occlusion rates for coils were 52% (39/75); late occlusion occurred in 90.6% (68/75). Amplatzer devices, available since 2003, are now overwhelmingly used. Amplatzer early occlusion rates were 94.3% (33/35) with 100% late occlusion. Outcome was related to PDA shape; 88% of type A and E closed successfully, 67% type B, 28% type C and 0% of type D; P<0.001. Surgical closure reduced over time: from 94 (1993–1997), to 40 (1998–2002) and 32 (2003–2008).
    Conclusion
    Transcatheter PDA occlusion is safe and effective in our setting, with outcomes similar to reports elsewhere. Shape and size of PDAs are important determinants of device selection and procedure outcome. Transcatheter occlusion helps minimise surgical waiting lists. Overall findings support more widespread use of transcatheter closure in similar settings.