New minimally invasive technique of perpulmonary device closure of patent ductus arteriosus through a parasternal approach.

BACKGROUND

Transcatheter closure and previous surgical techniques of patent ductus arteriosus (PDA) have different drawbacks. We describe a new minimally invasive technique of perpulmonary device closure of a PDA and evaluate the feasibility, safety, and advantages of this technique.

METHODS

Seventy-nine patients aged 0.4 to 52 years (mean, 18±15 years) underwent perpulmonary device closure of PDA. A 2- to 3-cm parasternal incision was made in the left second intercostal space. The pericardium was incised. A specially designed delivery sheath loaded with the device was inserted through the pursestring sutures into the pulmonary trunk. Under transesophageal echocardiographic guidance, it was advanced through the PDA into the descending aorta, and the device was subsequently deployed. In patients with a large PDA or significant pulmonary hypertension, a device stay suture was passed through the device and tied down with the pursestring sutures after device release to avoid device dislocation.

RESULTS

The procedure was successful in 78 patients (99%). The device stay suture was used in 21 patients. The mean minimum PDA diameter was 6.0±3.4 mm (range, 1.7 to 18.0 mm). The implanted device size was 9.6±4.1 mm (range, 4 to 24 mm). The mean intrapulmonary manipulation time was 15±13 minutes (range, 2 to 55 minutes). During the follow-up period of 3 to 24 months, a minor residual shunt was found in 2 patients.

CONCLUSIONS

Perpulmonary device closure of a PDA is simple, safe, and efficacious. It has the advantages of more accurate device positioning and reduces the risk of device embolization by using the device stay suture.