The clinical application of micro-catheter and micro-guidewire rail technique in transcatheter closure for children with very small patent ductus arteriosus

Objective: Percutaneous closure of the small Patent Ductus Arteriosus (PDA) that a conventional 0.035″hydrophilic guide wire cannot pass through was challenging. A new technique of using a coronary guidewire with microcatheter assistance in the closure of the small PDA via AmplatzerDuctOccluderⅡ(ADOⅡ) was developed. Methods This is a single-center, retrospective study from April 2017 to December 2019, including 12 patients. A 0.014″ coronary guidewire (BMW, Abbott, tip load 0.7g) with the assistance of a 1.9F-2.4F catheter was advanced into the PDA. A 4F or 5F delivery system was chosen to deliver the ADOⅡdevice by either an antegrade (venous) or retrograde (arterial) approach with the support of a semi-rail or a full rail: a guidewire-established femoral arteriovenous loop.All patients completed a 6-month follow-up. Results Successful PDA closure via this technique in all patients was achieved (n = 15). The average diameter of the PDAs detected by transthoracic echocardiography (TTE) and aortic angiography were1.61 ± 0.53mm (1.00-2.50mm), 0.76 ± 0.83mm (0.50-0.80mm) respectively. No complications were found during the procedure and the follow-up period. Conclusion Using a coronary guidewirewith the assistance of a microcatheter to close small PDA is safe and effective, and thereby offers a new opportunity to improve the success rate of percutaneous closure of a PDA.