Challenges in device closure of PDA in adults.

Objective: To describe the challenges and outcomes of per cutaneous closure of PDA in adolescents and adults. Study Design: Cross Sectional, Retrospective Analysis. Setting: Department of Pediatric Cardiology, CPE Institute of Cardiology, Multan. Period: 2017 to 2019. Material & Methods: A total of 111 adolescent and adult patients were included in the study. Patients with irreversible severe pulmonary hypertension were not included. Sampling with consecutive nonprobability was done. Procedure was done according to standard protocols. Different devices were used in different patients according to morphology of defect. Devices included SHSMA and Lifetech duct occluders. In two patients VSD muscular devices were also used. Results: Mean age was 22 + 7.88 years. Out of these 111 subjects, 72 (63%) were female and 39 (37%) were male with a ratio of 1.84:1. Two patients were of moderate size (3-5mm) PDA, 26 (27%) were of moderately large (5-7mm) size and majority of patients had large size (>7mm) PDA (55%). Majority of PDAs were type A (100, 90%), one was type B, 4 were type C and 6 were of type E according to Krichenko classification. No complications occurred except in one patient in which device was embolized. Foaming through the device was noted in 65 patients after 24 hours post procedure echocardiography. Conclusion: It was concluded that PDA device closure has its own challenges in adults but it is safe and effective as well.

Atrial Septal Defect Device Closure in Patients with Metabolic Diseases or Genetic Syndromes

Concomitant metabolic or genetic syndromes can make atrial septal defect device closure difficult. We searched our database and found eight. The cohort consists of patients with different metabolic and genetic disease . Thromboembolic events and device embolization occurred in some patients. Careful attention is recommended in patients with special diseases.

Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants

(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.