Introduction: The ductus arteriosus is a fetal vascular connection between the main pulmonary artery and the aorta that during the fetal life diverts blood away from the pulmonary bed. After birth, the ductus arteriosus undergoes active constriction and eventual obliteration. Patant ductus arteriosus in post-neonatal period accounts for 10% of all congenital heart disease and may cause left to right shunt with slowly development of congestive heart failure and pulmonary hypertension. Trans-catheter closure using occlusive devices has become the treatment of choice for most patients. We describe our experience in 230 patients who underwent trans-catheter closure using the NitOcclud coil in the trans-pulmonary and trans-aortic approach.
Objectives: To compare the success rates, residual shunt, and impact of independent parameters, such as age, weight, gender and device size in patients who underwent trans catheter closure in both trans aortic and trans pulmonary approach.
Patients and methods: The data of two hundred and thirty patients who underwent this procedure between 2005-2013 at the Rambam Medical Center were reviewed.
Results: The overall success rates was 98.2%. There was no significant influence of age, body weight, gender and selection of device size on the success rates. There was a significant difference in failure rates between trans aortic (0/112, 0%) and trans pulmonary (4/118, 3.4%) approach.
Conclusions: trans catheter closure of patent ductus arteriosus is an effective and safe method. While the trans aortic approach shows higher rates of success, it may impose technical difficulties in certain cases. The inaccuracy of coil deployment in the trans-aortic approach and the fact that it was chosen for the smaller ducts may account for the better results as compared with the trans-pulmonary approach, which may have stented the duct, resulting in a small central shunt and some residual flow through the windings of the coil. A second go with an additional coil improved the final result.
