CLOSING A DIFFICULT PDA

Dr Barend Fourie
Tygerberg Hospital
 WHAT IS THE DEFINITION OF A
DIFFICULT PDA

• SIZE
• SHAPE and ANATOMY
• PHT
 SIZE

TYPE Description
Silent Less than 1.5mm and no murmur
Very small ≤ 1.5mm with audible murmur
Small 1.5 – 3mm and murmur
Moderate 3 – 5mm and murmur
Large > 5mm and murmur
ANATOMY
 CLASSIFICATION OF PDA

Philip et al. Catheterization and Cardiovascular Interventions 87:310–317 (2016)

 IMAGING

• ECHOCARDIOGRAPHY
• ANGIOGRAPHY
• CT/MRI
ECHOCARDIOGRAPHY
 ANGIOGRAPHY

• USUALLY PERFORMED IN 2 VIEWS

• RAO 30
• LATERAL
• MIGHT HAVE TO ADJUST VIEWS IF NOT CLEARLY SEEN
RAO
LATERAL
 BUT WHY NOT JUST ECHO?

• Premature babies ductus closed in ICU under echo guidance

• Some centers now closing PDA’s under echo guidance
 CT/MRI

• Why would you want to use CT/MRI

• Roadmap for access
• Awareness of surrounding structures
• Planning of projections
• Can be done without anesthesia
CHALLENGING DUCTS
 PHT

Is it safe?
 PERSISTENT PHT AFTER PDA CLOSURE

• Trial occlusion to assess the risk of persistent pulmonary arterial hypertension

after closure of a large patent ductus arteriosus in adolescents and adults with
elevated pulmonary artery pressures
• 137 patients mPAP > 45 Qp:Qs > 1.5
• Test occlusion with devise

Zhang et al Circ Cardiovasc Interv August 2014

 CLOSING A PULMONARY HYPERTENSIVE
DUCT

Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017

Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017
 CLOSING A TUBULAR DUCT

• Are there appropriate devises to close these defects

 CLOSING A LARGE DUCT

Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017)

Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017)
Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017)
Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017)
Lehner et al. Catheterization and Cardiovascular Interventions 89:718–725 (2017)
WHAT ABOUT OTHER DEVICES

International Journal of Cardiology 117 (2007) e40–e42

A. Eicken et al. / International Journal of Cardiology 117 (2007) e40–e42
Cubeddu et al
BUT BE AWARE

Li et al (Int Heart J 2017; 58: 1017-1019)

BUT EVERY NOW AND AGAIN
THANK YOU