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Perpulmonary Device Closure of Patent Ductus Arteriosus with Minimum Diameter More Than 4 mm in Infants

Shibin Sun1,#, Geoffrey J. Changwe1,2,#, Zeeshan Farhaj1, Hongxin Li1,*, Yuekun Sun1, Zhongzheng Kong1
1 Department of Cardiovascular Surgery, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
2 Department of Cardiovascular and Thoracic Surgery, The National Heart Hospital, Lusaka, Zambia
* Corresponding Author: Hongxin Li. Email:
# The first two authors contributed equally and must be considered as the first author

Congenital Heart Disease 2022, 17(4), 437-445.

Received 22 November 2021; Accepted 13 April 2022; Issue published 04 July 2022


Background: Closure of large patent ductus arteriosus (PDA) in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes. However, outcomes amongst infants have been variable with several drawbacks. Here we describe a novel minimally invasive technique, a product of mini-thoracotomy and traditional percutaneous technique skills, accomplished exclusively under echocardiography guidance. Methods: Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected. The symptoms were varying degrees of tachypnea, tachycardia, heart failure, failure to thrive, recurrent respiratory tract infections, or intensive care unit treatment for a longer duration. Through a left parasternal mini-thoracotomy, two parallel purse-string sutures were placed on the pulmonary trunk. After purse-string circle puncture, under exclusively transesophageal echocardiography guidance, a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set. The safety-suture prevented device migration in case of dislocation. The basic demographics, PDA size, device size and type, intrapulmonary manipulation time, operation time, PDA parameters (length, diameter, type of duct), redeployment of the device, residual shunt, and retention of safety-suture were all recorded and analyzed. The follow-up was done with transthoracic echocardiography on the 2nd postoperative day, 1, 3, 6, and 12 months, and yearly thereafter. Results: Fifty-two infants with a mean age of 8 months ± 2.8 months (Interquartile range = 0) underwent Perpulmonary device closure of PDA. Successful PDA occlusion was accomplished event-free in all subjects. The mean PDA, mean device, and mean operation time were 5.6 mm ± 1.4 mm, 7.9 mm ± 1.7 mm, and 61.2 min ± 12.9 min, respectively. The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up. Eighteen infants had retained safety-suture for added safety. There were no reports of the device or procedure-related complications. Conclusion: Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring > 4 mm among infants. The safety-suture, in case of dislocation, prevents migration and associated complications.


Patent ductus arteriosus; perpulmonary device closure; transesophageal echocardiography; infant; minimally invasive surgery

Cite This Article

Sun, S., Changwe, G. J., Farhaj, Z., Li, H., Sun, Y. et al. (2022). Perpulmonary Device Closure of Patent Ductus Arteriosus with Minimum Diameter More Than 4 mm in Infants. Congenital Heart Disease, 17(4), 437–445.

This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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