Safety and Feasibility of Transcatheter Closure of Large Patent Ductus Arteriosus Measuring ≥4 mm in Patients Weighing ≤6 kg

Objectives: The study aims to find safety of transcatheter closure of large patent ductus arteriosus (PDA) >= 4 mm in patients weighing <= 6 kg. Background: Large PDA >= 4 mm in patients <= 6 kg challenge the interventionist due to need for large delivery sheath, kink of delivery sheath, and encroachment of aorta or pulmonary artery (PA) by the device. Many institutions refer them for surgery. Methods: Preterm neonates and ducts with coarctation were exlcuded. All other patients were taken for catheter closure. Ducts with roomy ampulla were closed with multiple coils aided by bioptome, and others with Amplatzer duct occluders. Results: Twenty-eight patients aged 2-18 months (median 5.5 months) and weighing 3.8-6 kg (median 4.7 kg) had large PDA (mean diameter 6.3 +/- 2 mm) with hyperkinetic pulmonary hypertension. Four patients had bioptome-aided coil closure. Twenty-two other ducts were closed with devices. Two procedures failed due to sheath kink in one patient and device pulling through a duct in the other patient. Four infants needed blood transfusions. The mean procedural time was 42 +/- 20 minutes. On a mean follow-up of 25.5 +/- 14.8 months, there were no residual flows and no gradients across aorta or pulmonary artery. Conclusions: Transcatheter closure of large ducts >= 4 mm might be considered safe and effective in infants weighing <= 6 kg also. Decision on coils versus devices depends on ductal morphology. On midterm follow-up with somatic growth, there was no occurrence of aortic or PA gradients. (J Interven Cardiol 2008;21:196-203)