@Article{chd.2022.019943,
AUTHOR = {Shibin Sun, Geoffrey J. Changwe, Zeeshan Farhaj, Hongxin Li, Yuekun Sun, Zhongzheng Kong},
TITLE = {Perpulmonary Device Closure of Patent Ductus Arteriosus with Minimum Diameter More Than 4 mm in Infants},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {17},
YEAR = {2022},
NUMBER = {4},
PAGES = {437--445},
URL = {http://www.techscience.com/schd/v17n4/48757},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Closure of large patent ductus arteriosus (PDA) in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes. However, outcomes amongst infants have been variable with several drawbacks. Here we describe a novel minimally invasive technique, a product of mini-thoracotomy
and traditional percutaneous technique skills, accomplished exclusively under echocardiography guidance.
<b>Methods: </b>Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were
selected. The symptoms were varying degrees of tachypnea, tachycardia, heart failure, failure to thrive, recurrent
respiratory tract infections, or intensive care unit treatment for a longer duration. Through a left parasternal
mini-thoracotomy, two parallel purse-string sutures were placed on the pulmonary trunk. After purse-string circle
puncture, under exclusively transesophageal echocardiography guidance, a device secured to the safety-suture was
implanted on the ascending aorta via pulmonary trunk using a specially designed set. The safety-suture prevented
device migration in case of dislocation. The basic demographics, PDA size, device size and type, intrapulmonary
manipulation time, operation time, PDA parameters (length, diameter, type of duct), redeployment of the device, residual shunt, and retention of safety-suture were all recorded and analyzed. The follow-up was done with transthoracic
echocardiography on the 2<sup>nd</sup> postoperative day, 1, 3, 6, and 12 months, and yearly thereafter. <b>Results: </b>Fifty-two infants
with a mean age of 8 months ± 2.8 months (Interquartile range = 0) underwent Perpulmonary device closure of PDA.
Successful PDA occlusion was accomplished event-free in all subjects. The mean PDA, mean device, and mean operation time were 5.6 mm ± 1.4 mm, 7.9 mm ± 1.7 mm, and 61.2 min ± 12.9 min, respectively. The immediate acceptable
residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up. Eighteen infants had retained
safety-suture for added safety. There were no reports of the device or procedure-related complications. <b>Conclusion:</b>
Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring > 4 mm among
infants. The safety-suture, in case of dislocation, prevents migration and associated complications.},
DOI = {10.32604/chd.2022.019943}
}