Percutaneous Closure of Patent Arterial Ducts in Adults; Procedural and Clinical Results

  • Dr Rafael Hirsch, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
  • Dr Alex Dadashev, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
  • Mrs Elena Gleimer, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
  • Prof Abid Assali, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
  • Prof Ran Kornowski, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
  • Prof Leonard Blieden, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel

    • Background: Clinically important patent arterial ducts (PDA) requiring intervention are rare in adults.
    Aim: To examine the procedural and clinical outcome of PDA closure in an adult congenital heart unit.
    Results: In 14 years, thirty three pts (24 female) had PDA closure; mean age at catheterization was 39.6ąSE 2.7 years (range 18-72). 23 pts had a continuous murmur.FC was II or worse in 21 pts. LV diastolic diameter was 56ąSE 1.3 mm and left atrial area 24ąSE 1.1 cm2. LV systolic function was impaired in 6 and diastolic function in 7. Duct diameter by echo was 4.8ąSE 0.3 mm and by angiography 3.8ąSE 0.2 mm. Qp/Qs=1.6ąSE 0.07. LVEDP was 17ąSE 1.2 mmHg. Mean pulmonary artery pressure was 22ąSE 2 mmHg and cardiac index 3.2ąSE 0.1 l/min x msq. Devices used (no): Rashkind umbrella (3), Gianturco coils (8), Amplatzer PDA occluders (19) and NitOcclud (3). Procedural success and complications: One patient with Amplatzer device and 2 with coils had mild residual leaks. One coil embolized to the pulmonary artery and was successfully retrieved. There were no late complications. Clinical outcome: LV diastolic diameter decreased to 52ąSE 2.6 mm (p=0.001) and left atrial area to 21ąSE 1.4 cm2 (p=0.003). 13/21 pts with pre-catheterization reduced NYHA FC improved by one FC. One patient died 3 years post procedure from worsening heart failure despite initial improvement.
    Conclusions: Clinically significant PDAs in adults of all ages can be treated successfully and safely with percutaneous devices with a significant clinical benefit.