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Follow-up results of transvenous occlusion of patent ductus arteriosus with the buttoned device¹

P. Syamasundar Rao, MD, FACC^* , Seong Ho Kim, MD, Jae-Young Choi, MD, Christian Rey, MD^||, Jorge Haddad, MD^¶, Francois Marcon, MD^#, Kevin Walsh, MD^** and Eleftherios B. Sideris, MD

^* Division of Pediatric Cardiology, University of Wisconsin Medical School, Madison, Wisconsin, USA
Saint Louis University School of Medicine, St. Louis, Missouri, USA
Sejong General Hospital, Puchon, South Korea
Yonsei University, Seoul, South Korea
^|| Université de Lille, Lille, France
^¶ Hospital do Coracão de Ribeirão Preto, Ribeirão Preto, Brazil
^# Centre Hospitallier Université, Nancy, France
^** Royal Liverpool Children’s NHS Trust, Alder Hey, Liverpool, England, United Kingdom
Athenian Institute of Pediatric Cardiology, Athens, Greece

View larger version (118K): [in a new window]   Figure 1 Photograph of the modified buttoned device showing the occluder (Occ), counter-occluder (COc) and polyurethane folding plug (FP) covering (arrows) the button loop (BL). LW = loading wire.

View larger version (45K): [in a new window]   Figure 2 (A) Relationship of residual shunt (by echo-Doppler within 24 hours of device implantation) with shape of the ductus; note that there is no significant (p > 0.1) relationship. (B) Relationship of residual shunt (within 24 hours of procedure by echo-Doppler) to the size of ductus is shown; note higher incidence of residual shunts with larger ducts.

View larger version (16K): [in a new window]   Figure 3 Transcatheter closure of PDA. Graph showing actuarial event-free rates after transvenous buttoned device occlusion of patent ductus arteriosus.

View larger version (29K): [in a new window]   Figure 4 Prevalence of residual shunts following buttoned device occlusion of patent ductus arteriosus. Note that there was gradual increase in the number of subjects without residual shunts while the number of patients with residual shunt decreased gradually. McNemar’s pairwise comparison of data was used and Bonferroni correction was applied. The rate of change is statistically significant (p < 0.05 to <0.01). NS = no residual shunt; SS = small residual shunt; TS = trivial residual shunt.

View larger version (15K): [in a new window]   Figure 5 Actuarial resolution (p < 0.01) of residual shunts following buttoned device closure of patent ductus arteriosus. Reinterventions are not included in the calculation of resolution of residual shunts.

View larger version (88K): [in a new window]   Figure 6 Selected cineangiographic frames from aortograms in right anterior oblique view prior to (a) and 15 minutes following (b) transvenous implantation of buttoned device with a folding plug demonstrating a large patent ductus arteriosus (PDA) in a, which is completely occluded following device (D) implantation (b). Ao = aorta; PA = pulmonary artery.