Device closure of patent ductus arteriosus (PDA)
Posted by: Johnson Francis on: 14 Oct, 2008
PDA angio prior to device closure
Though small PDAs can be closed by coils, large PDAs require a device to close them. Initially an angiogram is taken to confirm the size of the PDA to choose the size of the device. The angiogram above shows pigtail catheter in the descending aorta and the dye passing from the descending aorta to pulmonary artery through the PDA. The PDA is superimposed on the tracheal air column in this view.
PDA device in position
A guide wire is introduced into the femoral vein and guide through inferior vena cava into right atrium. From right atrium it is passed into the pulmonary artery through the right ventricle. From the pulmonary artery, the guide wire is passed into the descending aorta across the PDA. A long sheath is threaded over the guide wire. Then the PDA device is loaded under water and introduced into the sheath. The device is pushed out of the sheath in the aorta and the assembly is withdrawn so that the device is deployed in the PDA.
PDA angio with device in position
Check angio is taken with the pigtail catheter in the descending aorta. It shows that the device has fully closed the PDA. Residual flow can cause hemolysis as the blood flows at high velocity through a small orifice. This can lead to hemolytic anemia, hemoglobinuria and very rarely renal failure.
PDA device delivered
Once the position of the device is fine, and the shunt obliterated, the delivery cable is unscrewed and the device released. Delivery cable and sheath are withdrawn, as well as the pigtail. Hemostasis is achieved by compression over the puncture site. Follow up echocardiograms are obtained to document the absence of residual flow.
