Transvenous occlusion of patent ductus arteriosus in 56 consecutive dogs
Julie E. Blossom, DVM a, Janice M. Bright, BSN, MS, DVM a, Leigh G. Grifﬁths, MA, VetMB, MRCVS, PhD a,b,*
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 WestDrake Rd, Fort Collins, CO 80526, USA b College of Veterinary Medicine, University of California, One Shields Avenue, 2108 Tupper Hall, Davis, CA 95616, USA
Received 11 August 2009; received in revised form 29 March 2010; accepted 14 April 2010
PDA; Transvenous; Congenital heart disease; Catheter; Occlusion
Abstract Objective: Document safety and efﬁcacy of transvenous catheterocclusion of patent ductus arteriosus (PDA) over a wide range of ductal and patient sizes. Animals, materials and methods: Retrospective study of ﬁfty-six consecutive dogs referred to Colorado State University with diagnosis of PDA. All cases utilized the transvenous approach, via the femoral vein. Occlusion was achieved using a coil (Flipperä) in dogs with PDA minimal dimension of 4 mm. AmplatzerÒ ductoccluder or AmplatzerÒ vascular plugs were used in dogs with PDA minimal dimension >4 mm, or if a coil was unstable following deployment. Results: Ductal occlusion was achieved using the transvenous route alone in 54/56 dogs (96.4%). Occlusion was achieved using detachable Flipperä coils in 39/42 dogs (92.9%) in which coil occlusion was attempted, with 38/39 dogs (97.4%) requiring only a singlecoil. In 16 dogs, occlusion was achieved using an AmplatzerÒ duct occluder or vascular plug. Post-procedure residual ductal ﬂow was absent or only mild in 36/39 (92.3%) dogs in which it was assessed. Procedural mortality rate was 1.7%, and major complication rate 7.0%. Conclusion: Transcatheter occlusion via a transvenous approach is a safe and effective method for treating PDA in dogs and isuseful for small dogs (5 kg body weight), a 4 or 5 Fr introducer sheath was also placed in the right femoral artery. Once introducer sheath placement was complete, heparin was administered IV (150 IU/kg). If femoral arterial access was achieved, a 4 or 5 Fr pig tail angiographic catheterd was advanced through the arterial sheath to the proximal descending aorta and an angiogram was performed bypressure injection of iohexol (1.5 ml/kg over 1 s; pressure limit 800 psi). In those patients in which percutaneous femoral arterial catheterization was not achieved, a ﬂow directed balloon wedge cathetere (4, 5 or 6 Fr) was introduced through the introducer sheath into the right femoral vein and advanced with ﬂuoroscopic guidance through the right atrium and right ventricle into the main pulmonaryartery. A ﬂexible, straight tipped, guide wire with hydrophilic coatingf (0.018”, 0.025” or 0.035” by 180 cm depending on catheter size) was then passed through the wedge catheter and directed across the ductus into the descending aorta. The wedge catheter was then advanced over the wire into the descending aorta. The hydrophilic wire was replaced with a standard exchange guide wireg and the wedgecatheter exchanged over the wire for a 4 or 5 Fr angiographic catheterh The angiographic catheter was positioned with the tip in the aorta just beyond the ductal oriﬁce so that the catheter side holes were located within the ductal lumen. An angiogram was performed by pressure injection of iohexol (1.5 ml/kg over 1 s; pressure limit 800 psi). The minimal ductal dimension and the ductal ampulladimension were measured from either the transvenous or transarterial angiograms and measurements were corrected for magniﬁcation.
77 4 mm or less (measured from angiogram) received a detachable coil (Flipperä),i, with coil loop diameter at least twice the minimal ductal dimension.16,20 Those with ductal dimension >4 mm received a self-expanding nitinol occlusion device which was either an AmplatzerÒ...