The New Occlutech Duct Occluder

Dear Editor:

I read with great interest and attention the paper published recently in the Journal of Invasive Cardiology by Kudumula et al.¹ The authors reported a new occluder device for patent ductus arteriosus (PDA) that is manufactured by Occlutech (with manufacturing facilities in Germany, Sweden, and Turkey), the Occlutech Duct Occluder (ODO), which has a form reminiscent of a “cork champagne.” This report is very interesting not only because it is the first paper with in-depth analysis of the performance of this device, although there is a previous report about ODO,² but also because although one of the authors participated in the design of this device, the report conveys much impartiality.

The young catheterization laboratory of the pediatric hospital where we work now has professionals with experience in PDA occlusion in pediatric and adult populations with different devices.^3,4 At present, we are developing an experience with the ODO device (case series not yet published). The ODO is accompanied by a dedicated charger and sheath; according to the manufacturer’s specifications, devices are designed to occlude PDAs ≥2 mm and can be delivered by sheaths from 6-9 Fr. I agree with several of the authors’ comments about the device: implantation is relatively easy, but the shape of the device does not allow us to see the waist clearly when implanted as with other plug-type devices that have been manufactured for PDA occlusion, such as Amplatzer (St. Jude Medical), MemoPart (Lepu Medical), and Nit-Occlud PDA-R (pfm Medical). Also, like the authors, we have also had problems with the ODO delivery cable in some cases (reported to the supplier agent).

In our series, we had a PDA with a minimum diameter of 1.7 mm, and it was impossible to cross the PDA with a 6 Fr sheath to implant a 3.5/5 ODO device, which is the smallest device available. We therefore had to close the PDA with another type of device through a 5 Fr sheath; for this reason, it is noteworthy that the authors have closed PDAs with a minimum diameter of 1 mm without predilation, since a 6 Fr sheath could hardly cross through a hole with a very narrow diameter. Although dilation of the small PDA in preparation for transcatheter occlusion has been described,⁵ the closure of such a very small defect is controversial.⁶

To conclude, I want to congratulate the authors for the excellent report in which impartiality is notorious and relevant. This report also gives us details of this new device that increases the therapeutic arsenal for the treatment of this pathology. I also believe that we must have more experience reported about its usefulness in patients with larger PDAs and at high altitude, with hypertensive ducts, and with different morphology than the conical or Krichenko type-A, as well as longer follow-up to validate its safety, effectiveness, and advantages over other devices.

References

1. Kudumula V, Taliotis D, Duke C. The new Occlutech duct occluder: immediate results, procedural challenges, and short-term follow-up. J Invasive Cardiol. 2015;27:250-257.
2. Abdelbasit MA, Alwi M, Kandavello G, Che Mood M, Samion H, Hijazi ZM. The new Occlutech PDA occluder: initial human experience. Catheter Cardiovasc Interv. 2015;86:94-99.
3. Gamboa R, Mollón FP, Ríos-Méndez RE, Arroyo GM, Fogel A, Villa DM. Patent ductus arteriosus closure using a new device: the Nit-Occlud device. Rev Esp Cardiol. 2007;60:445-458.
4. Gamboa R, Ríos-Méndez RE, Mollón FP, Arroyo GM, Gutiérrez DF. Percutaneous closure of patent ductus arteriosus in adults using different devices. Rev Esp Cardiol. 2010;63:726-729.
5. Benson LN, Freedom RM. Balloon dilatation of the very small patent ductus arteriosus in preparation for transcatheter occlusion. Cathet Cardiovasc Diagn. 1989;18:48-49.
6. Cantinotti M, Assanta N, Murzi B, Lopez L. Controversies in the definition and management of insignificant left-to-right shunts. Heart. 2014;100:200-205.

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From the Department of Cardiology. Baca Ortiz Children’s Hospital, Quito, Ecuador.

Disclosure: The author has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The author reports no conflicts of interest regarding the content herein.

Address for correspondence: Raúl Enrique Ríos-Méndez, MD, Department of Cardiology, Baca Ortiz Children’s Hospital, Quito, Ecuador. Email: riosmendez@intramed.net.ar