Patent ductus arteriosus spasm during percutaneous device occlusion in infants and children

Background: Spasm of ductus arteriosus is an uncommon but significant phenomenon associated with transcatheter patent ductus arteriosus (PDA) occlusion. It can lead to procedural failure, improper device sizing, or even embolization of the occluder device as the spasm subsides post-procedure. Aim of this study is to report the frequency, features, management and outcome of PDA spasm during device closure in a single Egyptian center. Patients and methods: Over about 3 years, 200 infants and children underwent percutaneous device occlusion. The echocardiographic and catheterization data of patients who developed spasm of PDA before or during or shortly after anesthesia induction or upon catheter entry into PDA were recorded and analyzed. Upon detecting the spasm, the anesthetist managed it by increasing the depth of anesthesia through a higher minimum alveolar concentration of inhaled sevoflurane and administering a secondary opioid dose (fentanyl 0.5 mcg/kg) to reduce stress level. The outcome of this treatment protocol was recorded. Results:PDA spasm occurred in 8(4%) of the patients between 8 months and 7 years. Complete resolution of spasm was attained after 10–45 minutes of anesthesia management. All 8 ducts were successfully occluded but one of them had significant residual shunt after device deployment, so larger device was used instead. No cases were referred for surgery. Conclusions: Ductal spasm at the start of anesthesia induction can be effectively managed, allowing the procedure to be safely completed, by following a straightforward anesthetic protocol.