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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020
AFRICA
33
Ductal closure in infants under 6 kg including premature
infants using Amplatzer
TM
duct occluder type two
additional sizes: a single-centre experience in South
Africa
Lungile Pepeta, Adele Greyling, Mahlubandile Fintan Nxele, Zongezile Makrexeni, Samkelo Jiyana
Abstract
Background:
This is a report on percutaneous closure of patent
ductus arteriosus (PDA) using Amplatzer Duct Occluder type
two additional sizes (ADO II AS) in patients under 6 kg.
Methods:
Prospective data were collected and a review of
patients’ records was conducted. Demographics, and angio-
graphic and clinical outcomes are reported in this article.
Results:
During the period June 2011 to June 2017, of the 92
patients who underwent closure of the PDA using the ADO
II AS device, 59 were under 6 kg. The median weight of the
cohort at closure was 3.6 kg (range: 900 g – 5.8 kg). The medi-
an ductal diameter was 1.9 mm (range: 1.0–3.4 mm). Three
embolisations in the cohort were all retrieved percutaneously.
Two PDAs were closed percutaneously and one surgically.
Four premature infants required blood transfusions. The
closure rate was 96.6% before discharge.
Conclusion:
PDA closure using ADO II AS in small infants is
feasible, effective and has few complications.
Keywords:
congenital heart disease, paediatric intervention,
percutaneous closure
Submitted 24/10/18, accepted 17/7/19
Published online 30/8/19
Cardiovasc J Afr
2020;
31
: 33–39
www.cvja.co.zaDOI: 10.5830/CVJA-2019-044
In the term newborn, patent ductus arteriosus (PDA) accounts
for about 5–10% of all congenital heart lesions.
1,2
This incidence
is higher in the preterm infant and may be as high as 70% in
infants less than 28 weeks’ gestation, which could be due to
the untoward effect of prematurity on the regulators of ductal
tone.
3-5
Ductal patency in the preterm infant is associated with heart
failure and pulmonary oedema, bronchopulmonary dysplasia
(BPD) and necrotising enterocolitis (NEC). In addition, ductal
patency may lead to intraventricular haemorrhage (IVH),
prolonged ventilator or oxygen support, a long stay in hospital
and increased mortality rates.
6,7
Established PDA management methods in small infants
include conservative management with supportive therapy,
pharmacological therapy with anti-prostaglandins, such as
ibuprofen or indomethacin, and surgical ligation.
8-10
Percutaneous
closure of a PDA has become standard treatment in older
children and adults. Various reports note successful ductal
closure using a wide range of available devices on the market,
which include the Amplatzer
TM
duct occluders.
11
However, the
Rashkind device is no longer used for PDA closure, and coils are
used in appropriately selected patients.
11,12
There are a growing number of publications on percutaneous
ductal closure in small infants, including premature infants.
13-18
The
introduction of Amplatzer
TM
Duct Occluder type two additional
sizes (ADO II AS) (Abbott Laboratories, St Jude Medical,
St Marks, Minnesota) has revolutionised the management of
ducts in the lower-weight infant.
19-22
Routine percutaneous PDA
closure in infants under 6 kg using the Amplatzer
TM
device as
standard management is however currently not FDA approved.
23
Challenges facing a low- and middle-income country (LMIC)
such as South Africa include a shortage of congenital heart
surgeons and the protracted hospital stay of patients awaiting
surgery. These result in increased patient mortality and morbidity
rates as well as high hospital costs.
23-26
Therefore the aim of this
study was to report on the experience of closing a PDA in infants
under 6 kg at a single centre in a LMIC (which is usually faced
with the above-mentioned challenges).
Methods
This study reports on percutaneous PDA closure using the ADO
II AS device in infants less than 6 kg, including preterm infants,
at the Port Elizabeth hospital complex in South Africa. This is
a coastal tertiary healthcare centre offering general paediatrics,
paediatric cardiology and neonatal healthcare services with fully
qualified paediatric cardiologists and neonatologists. As our
centre is the only referral site for the diagnosis and management
Faculty of Health Sciences, Nelson Mandela University,
Port Elizabeth, South Africa
Lungile Pepeta, MB ChB, DCH (SA), FC Paed (SA), Cert Cardiology
(SA), MMed (Wits), FSCAI,
Lungile.Pepeta@mandela.ac.zaDivision of Paediatric Cardiology, Department of Paediatrics
and Child Health, Dora Nginza Hospital, Faculty of Health
Sciences, Nelson Mandela University, Port Elizabeth, South
Africa
Adele Greyling, MB ChB (UP), MRCPCH (UK), FC Paed (SA), Cert
Cardiology (SA), ECDS (EHRA Cardiac Device Specialist), ECES
(EHRA Electrophysiology Specialist)
Mahlubandile Fintan Nxele, BSc, MB ChB, FC Paed (SA), Cert
Cardiology (SA)
Samkelo Jiyana, MB ChB, DCH (SA), Dip HIV Man (SA), FC Paed (SA)
Division of Paediatric Cardiology, Department of
Paediatrics and Child Health, Nelson Mandela Academic
Hospital, Mthatha, South Africa
Zongezile Makrexeni, MB ChB, FC Paed (SA), MMed, Cert
Cardiology (SA)