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ICVTS on-line discussion A Endovascular closure of PDA with the use of occluders

Bakoulev Scientific Center, Roublevskoye Shosse 135, Moscow 121552, Russia

Surgical removal of an embolised patent ductus arteriosus amplatzer occluding device in a 4-year-old girl

eComment: Endovascular closure of PDA with the use of amplatzer duct occluder proved effective in the clinical practice [1]. The use of this occluder is indicated in patients, in whom the defect is not accompanied by high pulmonary hypertension. In patients with equal (or close to equal) pressure in the aorta and the pulmonary artery, after the determination of indications for the defect correction, PDA must be closed with amplatzer muscular septal ventricular occluder. Despite the use of this type of occluder there is a potential risk of its migration into the pulmonary artery as well as into the aorta. In order to prevent such complications, in our opinion, one has not to be in a hurry to disconnect the occluder from the delivery system. It is necessary to wait a certain amount of time, maybe – up to one day, until there is a significant decrease of the pressure in the pulmonary artery. Besides, before disconnecting the device it is necessary to perform test tractions in order to check the stability of occluder fixation in the duct. With respect to these recommendations the risk of occluder migration can be minimized. Even in cases of occluder migration it can be safely retrieved with a trap.

In our clinical practice we met with occluder migration into the pulmonary artery as well as into the aorta. The occluder migrated into the pulmonary artery in a patient after VSD closure due to aneurysm rupture, and into the aorta – in a patient with PDA and with equal pulmonary arterial and systemic arterial pressures. Initial measurement of the pulmonary arterial pressure in the patient with PDA and pulmonary arterial hypertension revealed pressure decrease. After that we decided to close the duct with amplatzer duct occluder. However immediately after occluder implantation and disconnecting it from the delivery catheter the occluder migrated into the descending aorta. The occluder was successfully retrieved with a snare catheter trap. Then we closed the arterial duct with an occluder destined for the closure of muscular ventricular septal defects; the occluder was not disconnected from the delivery system for 24 hours. After 24 hours the systolic pressure in the pulmonary artery decreased from 120 to 78 mmHg, which allowed disconnecting the occluder from the delivery system.

Thus, we can conclude that in both cases the occluders were safely retrieved with the snare catheter trap. The VSD was closed with a bigger occluder, and the PDA – with amplatzer muscular septal ventricular occluder. As a rule, there are no problems with the retrieval of occluder after its migration into the pulmonary artery. The experience of an interventional cardiologist is of great importance in both cases. The retrieval must be done using the snare catheter trap.

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1. Shahabuddin S, Atiq M, Hamid M, Amanullah MM. Surgical removal of an embolised patent ductus arteriosus amplatzer occluding device in a 4-year-old girl. Interact CardioVasc Thorac Surg 2007; 6:572–574.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Bagrat G. Alekyan Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Grigoryan, A. M. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Grigoryan, A. M. Related Collections Related Article