IS Case 365: PDA closure devices

Daniel Ginat, MD, MS


2009 URMC Imaging Sciences
Publication Date: 2010-03-02

History

Two patients with history of patent ductus arteriosus.

Findings

Each patient has a ductus arteriosus closure device in satisfactory position.

Diagnosis

PDA closure devices

Discussion

Patent ductus arteriosus (PDA) allows postnatal left to right shunting of blood from the aortic arch to the pulmonary artery. This shunt is of the acynotic type initially. However, as pulmonary artery hypertension ensues, the shunt can reverse into a right to left type and produce cyanosis. This is known as Eisenmenger’s syndrome. Early treatment of PDA can prevent this complication.

A variety of percutaneous implantable occlusion devices have been developed for treatment of PDA. These include the Rashkind device and the Cook PDA coil have been used for the closure of patent ductus arteriosus. The Rashkind device system has a double umbrella configuration and incorporates Dacron fibers that promote thrombosis. In addition, the Amplatzer duct occluder is also relatively frequently used for larger ducts. This device conforms to the vessels contour and is initially retrievable.

On frontal chest radiographs, the occluders project along the superior aspect of the pulmonary artery and over the trachea on lateral chest radiographs, when correctly positioned. Therefore, a potential pitfall of PDA occluders on chest x-rays is confounding their appearance with swallowed or aspirated foreign bodies. Therefore, familiarity with the normal radiographic appearance of the various types of PDA devices is helpful.

Potential complications of PDA occlusion include embolization of the occlusion material either to the pulmonary arteries or to the aorta.

References

  1. Burney K, Thayur N, Husain SA, Martin RP, Wilde P. Imaging of implants on chest radiographs: a radiological perspective. Clin Radiol. 2007 Mar;62(3):204-12. PMID: 17293212

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