Mumtaz ZA, Sagar P, Sivakumar K, Mohakud AR, Rajendran M, Pavithran S.Cardiol Young. 2023 Oct;33(10):2041-2048. doi: 10.1017/S1047951122003973. Epub 2022 Dec 14.PMID: 36515000
Take home points:
- Device embolization occurs in 4% of transcatheter patent ductus arteriosus closures and may lead to significant morbidity.
- Significant risk factors for device embolization are age ≤ 6 months, large tubular duct, and closure with vascular plugs or undersized devices.
Commentary from Dr. Milan Prsa (Switzerland, Europe), section editor of Congenital Heart Disease Interventions Journal Watch:
Transcatheter patent ductus arteriosus (PDA) closure is currently routinely performed across the globe. Device embolization, however, remains a major and occasional complication. The authors of this retrospective study sought to identify risk factors for device embolization and report its intermediate term outcomes.
They analyzed data from 376 procedures performed at a tertiary center over an 8-year period. Notably, they used almost exclusively a venous approach and chose the device solely based on an echocardiographic evaluation of the PDA. An undersized device was clearly defined as a conical occluder <2 mm larger than narrowest duct diameter or a vascular plug <150% of the duct diameter. Outcomes were detailed according to the various types of ductal occluders.
The results mirror what has been previously reported in the literature. The incidence of embolization was relatively low at 4% but had significant implications for those affected, including the necessity of surgical intervention in 20% of embolization cases. Most embolizations occurred in infants ≤ 6 months (73%), weighing < 6 kg (87%), with tubular ducts (80%) and higher pulmonary artery pressures (93%). The use of vascular plugs and the intentional undersizing of devices to avoid vascular obstruction were also identified as significant risk factors (Table 1). Most devices embolized to the branch pulmonary arteries, including two into distal lobar branches that could not be retrieved and were left in place. The PDA was ultimately successfully closed in 60% of embolization cases.
Despite its retrospective design and being limited to a single center’s experience, the study provides a meaningful contribution to the existing literature by clarifying risk factors associated with device embolization during transcatheter PDA closure. It offers actionable insights for clinicians to refine their procedural strategies, particularly in high-risk groups, thereby potentially reducing the incidence of these serious complications. The detailed discussion of device types and their specific risks provides a useful guide for device selection in clinical practice.
Table 1. Risk factors predisposing to embolization.
| Parameter | P value | Odds ratio | 95% Confidence Interval for Odds ratio | |
| Lower | Upper | |||
| Morphology of duct Conical Tubular Others | 0.003 0.264 | Reference 13.9 4.5 | 2.4 0.3 | 81.0 64.1 |
| Pulmonary arterial hypertension | 0.06 | 9.3 | 0.9 | 96.5 |
| Undersizing of the device | 0.001 | 24.6 | 3.8 | 160 |
| Device type Duct occluder Vascular plugs others | 0.05 0.6 | Reference 4.0 0.4 | 0.96 0.02 | 16.8 11.5 |
| Body surface area | 0.2 | 0.2 | 0.02 | 2.6 |
| Age group(months) >12 6-12 0-6 | 0.2 0.002 | Reference 4.67 27.7 | 0.42 3.55 | 52.3 216.6 |
