Challenges in device closure of a large patent ductus arteriosus in infants weighing less than 6 kg.

INTRODUCTION: Transcatheter closure of patent ductus arteriosus (PDA) has replaced surgery in most institutions. Despite improvements in techniques and the devices available, closure of large PDA in very small infants remains a challenge. AIM: To assess the challenges, feasibility, and efficacy of device closure of large PDA, in infants weighing ≤6 kg. MATERIALS AND METHODS: Analysis of device closure of a PDA was done in 61 infants ≤6 kg. Their ages, ranged from 9 days-12 months (mean 8.9 months), weight ranged from 2.2 to 6 kg (mean 5.3 kg), and PDA measured 3.2-8.7 mm (mean 4.8 mm). The fluoroscopy time was 3-18 minutes. The largest device used was 12 × 10 mm. RESULTS: Successful device placement was achieved in 60/61 infants (98.4%). Mild aortic obstruction occurred in 2 cases (3.3%), as the device got displaced towards the aorta after release. The device embolized in 2 cases (3.3%). In one it was retrieved by a novel method like fastening the screw in the aorta and was closed with a 4 × 6 ADO II. In the other infant, with a single kidney, died of uremia after device retrieval. Mild left pulmonary artery (LPA) obstruction occurred in one case (1.6%). Four cases (6.6%) had minor vascular complications. The postprocedure weight gain after 3 months was between 2.5 kg ± 250 mg. CONCLUSIONS: Device closure of large PDA in infants weighing ≤6 kg with left ventricular failure is challenging but possible, safe and effective. Retrieval of embolized device could be tricky.

Superior vena caval stenting for idiopathic mediastinal fibrosis.

Relief of superior vena caval (SVC) syndrome due to non-neoplastic mediastinal disease is a challenge. Surgically created bypass grafts have poor long term patency with significant procedural morbidity. We report a case of SVC syndrome, caused by Idiopathic mediastinal fibrosis, treated percutaneously by balloon angioplasty with nitinol self expanding stent.