PDA Device Closure

Device Closure of a Large Patent Ductus Arteriosus with Severe Pulmonary Hypertension Using Amplatzer Device

Indication

Large / Huge tubular PDA with severe pulmonary hypertension.

Equipment

  1. Amplatzer duct occluder (ADO)) 14 x 12mm.
  2. Amplatzer PDA device delivery system 8Fr.
  3. Torcon catheter 5 french.
  4. 038 Exchange wire 260 mm.
  5. 5 Fr venous sheath.
  6. 4 Fr arterial sheath.
  7. 4 Fr Pigtail catheter.
  8. 5 Fr MPA end and side hole catheter.
  9. 5 Fr Bherman Balloon Angiographic catheter.

Sedation:

Inj Ketamine, Midazolum, Phenobarbitone.

Procedure:

A 5 Fr sheath should be inserted to right femoral vein and 4 Fr sheath to right femoral artery. A 5 Fr MPA catheter then introduced through femoral vein to record pressure and saturation of right heart chambers and aorta. These are recorded in two conditions, once in room air and a second time with 100% oxygen. Pulmonary artery pressure and aortic pressure in room air should be measured. Pulmonary vascular resistance should be reduced significantly with 100% oxygen. PDA I be occluded with a Berman balloon catheter for 5 minutes and pulmonary artery pressure reduction can be observed. This is done to exclude any chance of pulmonary hypertensive crisis after device implantation. An aortogram is done and PDA size measured in the narrowest part. A Torcon catheter is then placed in aorta through femoral venous approach by crossing PDA. Catheter is exchanged with PDA delivery sheath. An Amplatzer device size is selected and loaded in loader screwing with delivery cable. The loader is then connected to the delivery sheath and device with cable forwarded to the aorta. Aortic end of the device is released first. The whole system is then pulled back until aortic end gets fixed with ampulla at the aortic side. A pigtail aortogram is performed to check complete occlusion. A delivery system is then pulled further backward to release pulmonary end of the device. A pressure of aorta above and below the device level is recorded with the help of pigtail to exclude any chance of coarctation from the big sized device before final deployment. Device is then deployed by reverse screwing of the delivery cable. An aortogram is repeated after 5 minutes and complete occlusion is recorded. Injectable antibiotic (e.g Cefuroxime 15-mg/kg body weight 8 hourly) is given IV and continued for 24 hours. Echocardiography should be performed in the next morning to see residual shunt and pulmonary pressure. A patient is usually discharged after 24 hours observation period. Follow up appointment is given at 1, 3, 6, 9, 12, 18, 24 months and yearly thereafter.

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