Risks Associated With Transcatheter Closure Of Patent Ductus Arteriosus

There are two primary approaches for treating patent ductus arteriosus (PDA): open surgical ligation and minimally invasive transcatheter closure. Today, the catheter-based closure method is widely preferred due to its less invasive nature and favorable safety profile. However, like any medical procedure, it carries certain risks and potential complications that patients and physicians should be aware of.

Main Risks And Complications

1. Device Embolization

One of the more serious, albeit rare, complications is the dislodgement of the occlusion device. If this occurs, the device may travel into the pulmonary or systemic circulation, potentially causing an embolic event. In such cases, further intervention—either through catheter retrieval or surgical removal—is typically required. Fortunately, the likelihood of this complication is quite low due to advancements in device design and placement techniques.

2. Residual Shunting

Residual shunting refers to incomplete closure of the ductus arteriosus following the procedure. This issue is more commonly seen with coil occlusion methods, although modern practice typically employs occlusion devices such as septal occluders, which significantly reduce the risk. In most cases where minor residual flow persists, spontaneous closure is often observed within a year post-procedure, eliminating the need for additional interventions.

3. Hemolysis

Hemolysis can occur when red blood cells are damaged as they pass through small openings around the occlusion device, particularly in cases of residual shunting. Mild hemolysis usually resolves with conservative management, but more severe cases may require replacement of the device or surgical ligation of the ductus arteriosus to fully correct the issue.

4. Other Potential Complications

Transient hypertension is a relatively common but short-lived side effect that typically does not require specific treatment. Additionally, vascular injury at the access site—usually the femoral artery—is a possible complication, especially in younger children with smaller blood vessels. These injuries are generally minor, though they may occasionally require further medical or surgical attention.

Conclusion

While transcatheter closure of PDA is considered a safe and effective treatment option, understanding the potential risks and complications is essential for informed decision-making. Most complications are rare and can be effectively managed with timely intervention. Patients are encouraged to discuss these risks with their cardiologist to determine the most appropriate treatment plan based on individual health status and anatomical considerations.