Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 246 AFRICA
Transcatheter closure of the patent ductus arteriosus at
a public sector hospital in Soweto, South Africa: a review
of patient outcomes over 15 years
Paul Ernest Adams, Matthew Francis Chersich, Antoinette Cilliers
Abstract
Background: Methods of closing patent ductus arteriosus
(PDA) have evolved over time. We review this development
in our setting.
Methods: This was a retrospective analysis of children who
had transcatheter PDA closure at Chris Hani Baragwanath
Hospital between 1993 and 2008.
Results: Over 15 years, 1 254 PDAs were diagnosed, of which
293 required intervention; 139 patients had transcatheter
closure, the median age was 1.8 years (interquartile range
= 1–4.5 years) and 66% were female (92/139). Mean PDA
diameter was 3.2 mm (standard deviation = 1.6 mm), with an
average 2:1 shunt. Transcatheter closure was performed using
COOK ® Flipper coils (n = 93) or Amplatzer™ devices (n =
46). Early occlusion rates for coils were 52% (39/75) and late
occlusion occurred in 91% (68/75) of patients. For Amplatzer
devices, early occlusion rates were 94% (33/35) and late occlu-
sion was 100%. Amplatzer™ devices, available since 2003,
were overwhelmingly used in the later years.
Conclusion: Transcatheter PDA closure was safe and effective
in this setting, with outcomes similar to reports elsewhere.
Keywords: patent ductus arteriosus (PDA), intervention, percu-
taneous, transcatheter
Submitted 15/2/18, accepted 4/4/18
Published online x/x/18
Cardiovasc J Afr 2018; 29: 246–251
DOI: 10.5830/CVJA-2018-028
The patent ductus arteriosus (PDA) is a common congenital
heart lesion, with isolated PDAs accounting for six to 11% of all
congenital heart defects.1 Surgical closure of the PDA was the
standard management of PDAs for many years,2 with the first
report of surgical ligation by Gross and Hubbard in 1939.3 In the
last few decades only, has this been challenged by transcatheter
options, which are now the preferred alternatives.4,5
With the development of new devices, the majority of
PDAs can be effectively and safely closed without surgery. This
prevents not only complications of the PDA itself, but also the
morbidity associated with surgery in general.1 The spectrum of
PDAs amenable to transcatheter closure continues to increase.
With advances in closure technologies, only very small infants
with large, symptomatic PDAs, and PDAs with unfavourable
anatomy or failed device closure are now candidates for surgical
closure.5,6
The first transcatheter options for closure of the PDA were
described by Porstmann and co-workers in 1967.7 Since then,
the number of available devices has expanded rapidly, most
especially in recent years. They range from close copies of
the Amplatzer™ design to devices with different shapes and
release mechanisms (for example, Ceraflex and Occlutec). The
Amplatzer™ devices were first implanted in 19968 and have since
been shown to be safe, effective and relatively easy to use. 5,9-11 The
Amplatzer™ range has increased steadily over time, offering
devices with different shapes and even a range to close very small
PDAs.12
In many settings, the detachable COOK® PDA coils were
widely used in small PDAs (< 2.5 mm). 4,5,8,13 The Amplatzer™
devices, conversely, became increasingly popular for moderate to
large PDAs (> 2.5 mm).4,5
In this study, we review outcomes of transcatheter closure
of PDAs at a large tertiary-level facility in South Africa over
a 15-year period, which included the introduction of the
Amplatzer™ range of devices. We also document differences
between PDAs closed with coils or Amplatzer™ devices, and the
shifts in closure methods that occurred over time.
Methods
A retrospective analysis was conducted of patient records and
the Paediatric Cardiology database (Microsoft Access 2003) at
the Chris Hani Baragwanath Academic Hospital, Johannesburg,
South Africa. All children who had transcatheter or surgical
PDA closure at the facility between January 1993 and July 2008
were included in this analysis. A brief update on more recent
figures is also provided (January 2009 – August 2017).
After explaining the procedure to the parent or legal guardian,
informed consent was obtained. The child was sedated and
femoral arterial and venous access was obtained. During the
period under study, two groups of transcatheter devices were
available, COOK ® coils and Amplatzer™ devices. Specifically,
the coils used were the detachable MReye® Flipper® PDA coils,
and the Amplatzer™ devices encompassed the Amplatzer™ duct
occluders (ADO) and the Amplatzer™ vascular plugs (AVP).
Division of Paediatric Cardiology, Department of
Paediatrics, Chris Hani Baragwanath Academic Hospital,
Soweto, and School of Clinical Medicine, University of the
Witwatersrand, Johannesburg, South Africa
Paul Ernest Adams, FCPaed (SA),
Antoinette Cilliers, FCPaed (SA)
Wits Reproductive Health and HIV Institute, Faculty
of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
Matthew Francis Chersich, PHD,