Challenges of Percutaneous Closure of PDA in Adolescents and Adults: Single Center Experience

Aim: To evaluate the challenges, feasibility, and efficacy of device closure of PDA in adolescents and adults by different types of occluder devices in Sohag University Hospital.

Methods: Between 03/2012 to 06/2017, 33 adolescents and adults were chosen from 174 patients with PDA underwent transcatheter closure in our institute. The diameter of the device was chosen 4 mm larger than the narrowest pulmonary end. A balloon-sizing assisted PDA strategy was used in two patients in whom size of PDA could not accurately delineate. A retrospective review of the procedure, results and adverse events was performed.

Results: Successful device placement was achieved in all patients (100%). The median minimum PDA diameter was 5.5 (2.5-9 mm), median weight 45 (35-80 kg), and median age 16 (13-35 years). Median of mean pulmonary pressure was 29 (9-55) mmHg. Median of fluoroscopy time was 11 min. Most of PDAs were closed by ADO I (79%). Four different devices were deployed; muscular VSD, Amplatzer Plug II, ADO II AS and Occlutech® PDA .30 patients had type A PDA. Nineteen out of 33 (81.5%) patients had completed 12-month follow-up.No adverse events encountered in all patients.

Conclusions: Transcatheter closure of PDA is considered safe and efficacious in adolescents and adults. A balloon-sizing assisted PDA and oversizing of occluder strategies should be used to increase safety and feasibility of procedure in the poor delineation of sized of large PDA in this age group.