How to Avoid Arterial Access During Transcatheter Closure of Patent Ductus Arteriosus Using Anatomo-haemodynamic Landmark.

Abstract

Objective: To evaluate the feasibility, safety, and efficacy of transcatheter closure (TCC) of patent ductus arteriosus (PDA) using anatomo-haemodynamic landmark without any arteriography.

Method: In this prospective, non-randomized study, all consecutive patients with PDA undergoing transcatheter closure at LPS Institute of Cardiology, Kanpur, India between January 2019 and June 2024 were evaluated. TCC was performed using anatomical and haemodynamicl landmark without aortogram, and device was deployed through antegrade route only. Transthoracic echocardiography with colour-Doppler imaging was used to confirm position of the device before final deployment. Primary outcome was procedural and fluoroscopy time, and major complications (access site complications, device embolization, residual shunt ≥ grade 3, haemolysis, flow acceleration in left pulmonary artery and descending thoracic aorta, and death). Success was defined as complete closure of shunt without any major complications.

Result: TCC was successfully performed through antegrade route in 250 patients (age: 2.3 ± 1.2 years; weight: 10.3 ± 9.8 kg) while 16 patients were excluded for various reasons. Mean diameter of duct was 6.7 ± 4.5 mm. Male and female comprised 176 (70.4%) and 74 (29.6%) respectively. PDA were type A (n = 195; 78%), B (n = 27; 10.8%), C (n = 20; 8%), and (n = 8; 3.2%). TCC was successful in all patients although dislodgement was noted in 1 (0.04%). Lifetech duct occluder and Konar MFO were most commonly used devices in 156 (62.4%) and 33 (13.2%) patients respectively. Immediate closure was achieved in 233 (93.2%) patients while remaining 17 (7.8%) with grade I or II shunt on echocardiogram had complete closure in 2 days. Device embolization was observed in 1 (0.4%) patient while flow acceleration in DTA were observed in 5 (2%) patients. Procedure was successful in 99.6% using antegrade while TCC using isolated venous route was successful in 94%.

Conclusion: TCC of PDA using anatomo-haemodynamic landmark and avoiding arterial access is feasible, safe, and effective, with excellent results on short and medium-term follow-up.