TRANSCATHETER PATENT DUCTUS-ARTERIOSUS OCCLUSION - APPLICATION IN THE SMALL CHILD

Objectives. This study intended to evaluate application of transcatheter occlusion of the patent ductus arteriosus in children <10 kg body weight. Background. Transcatheter occlusion of the patent ductus arteriosus in the child weighing >10 kg has been proved safe and effective. Methods. We reviewed 74 consecutive patients weighing <10 kg (median 8.1 kg, range 3.98 to 10) and aged 4 to 30 months (median 13 months) who underwent patent ductus arteriosus occlusion between June 1986 and November 1992. A modification of the delivery system to facilitate application in small children is described. Results. A 12-mm device was implanted in 50 patients and a 17-mm device in 24. Three device embolizations occurred early in the experience, and one required removal because of hemolysis associated with a moderate residual shunt. One 17-mm device was removed at catheterization because of acute compromise to left pulmonary artery Bow after implantation. Prevalence of residual shunting was 33% at 6 months, 20% at 12 to 18 months and 17% at 2-year follow up and was not related to device, age, weight or size of the patent ductus. Altered flow to the left pulmonary artery was noted in seven patients (9.9%), with more significant com promise associated with the 17-mm device. Conclusions. Transcatheter patent ductus arteriosus occlusion is feasible in the small child <10 kg, particularly with the use of a modified delivery system. However, implantation of a 17-mm device in this patient population may impair Bow to the left lung and should be reserved for the symptomatic child.