At BirthPVR/SVR from 10 to 1/3 in few s.In the preterm infant:osystolic steal, reversed flow, pulmonarycongestionIn the newborn:ospontaneous constriction, due to increased PaO2,then fibrous occlusionPDA if the arterial duct is still patent after 1 month
What ONLY matters for clinicalimplications of ISOLATED DBP is its sizeWhat matters for percutaneous closure arepatient age and weight, PDA size, PDAshape (size of the aortic isthmus, size of theampulla, lenght of the PDA, size of LPA...)
PDASmall: no symptoms, sometimes systolicmurmur, low risk of endocarditisAttitude: varies in accordance with theinstitution policyLarge: ventricular overload, pulmonaryhypertension, congestive heart failureAttitude: percutaneous closure
Stenting the duct with an occlusivedeviceThe AGA systemADO I ADO II
AGA system : ADO IAdvantages• From the venous side• Retrievable• Repositionable• High rate immediateocclusion• Occlusion of large PDADisadvantages• Iatrogenic coarctation• Absence of pulmonary disc• Migration (aorta or PA)• Difficult retrivability aftermigration• Residual shunt andhaemolysis• Bleeding !
Peculiar cases…Spasm of the arterial ductHeart 2005Rev Esp Cardiol. 2012
The ADO II deviceADO II:fabric-free fine nitinol wire, 2 very low profiledisks, articulated connecting waist. Antegrade orretrograde approach.Advantages: reduced sheath sizes and softer shapeReports: protrusion into the aortic isthmus or pulmonaryartery
ADO II AS•Few preliminary reports•Good results•Easy, premounted (generally..), navigability +++•No obstruction, no migration, no residual shunt,variety of different anatomies …Early clinical experience with a modified Amplatzer ductal Occluder for transcatheter arterial ductocclusion in infants and small children. Kenny D et al, Catheter Cardiovasc Interv 2012Closure of the patent ductus arteriosus with the new duct occluder II addotional sizes device.Agnoletti G et al Catheter Cardiovasc Interv 2012Closure of a large ductus arteriosus in a preterm infant using the ADO II AS device. Agnoletti G et al.Heart 2012
Conclusions•All PDAs can be closed percutaneously ?•All PDAs should be closed percutaneously ?•Almost always feasible•Almost always successful…•Different devices for different patients…•Complications can occur
ConclusionsGood new: you recover from DA patency!