Percutaneous closure of persistent ductus arteriosus in low-weight infants

Introduction. The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6 kg. Aim of the study. The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children. Patients and methods. The records of children weighing less than 6 kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed. Results. Fourteen patients (mean weight: 5.7 kg [range: 4.8-6]; mean age: 6.5 months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5 mm (range: 3-6 mm), correlating well with that found on ultrasound (r = 0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46 12 min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6 kg was not retained as a predictor of procedure failure. No late embolization occurred after 11 months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. Conclusion. This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6 kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications. (C) 2016 Elsevier Masson SAS. All rights reserved.