Visualization of the Patent Ductus by Means of a New Low Pressure Balloon Catheter

A new angiographic method of determining the anatomy of a patent ductus arteriosus (PDA) preparatory to its surgical or nonsurgical closure has been developed and compared to conventional angiographic techniques in 17 patients using a new low pressure balloon catheter (Edwards). The balloon, 5 cm long, is filled with contrast material and expanded to any diameter up to 20 mm. It may be passed into the ductus from either the arterial (14 patients) or venous (3 patients) side. The balloon is expanded by radiopaque material adjacent to the aortic orifice of the PDA and advanced (or pulled) through the ductus. Deformation of the balloon identified the length and caliber of the PDA providing virtually identical estimates thereof in all 17 patients when compared to conventional angiography. On the other hand, visualization of the PDA was good in only 41 (62%) or tolerable in 14 (21%) of 66 conventionally studied patients. (J In-terven Cardiol 1988:1:2)     

Use of Amplatzer duct occluder to close severely hypertensive ducts: utility of transient balloon occlusion

BACKGROUND: The dividing line between a patent ductus arteriosus with severe but reversible pulmonary artery hypertension and an Eisenmenger duct remains elusive. Increasing experience with the Amplatzer duct occluder has made non-surgical closure of even large patent ductus arteriosus simple and safe. However, data on the use of this device in severly hypertensive ducti is sparse. METHODS AND RESULTS: There were six patients (2 males, 4 females), wherein transient ductal occlusion was done with an embolectomy balloon catheter. The post-occlusion hemodynamics along with overall clinical and hemodynamic assessment was used to decide the likelihood of benefit of closure and the choice of the device. In four of six patients of patent ductus arteriosus with severe pulmonary artery hypertension (pulmonary vascular resistance index> 8.0 U/m2) the duct was successfully closed using the Amplatzer duct occluder, while in two an Amplatzer ventricular septal defect occluder was used. CONCLUSIONS: Transient balloon occlusion is quite helpful for assessing patients with patent ductus arteriosus with severe pulmonary hypertension, and short-term non-invasive follow-up has shown this strategy to be safe and useful.     

Endoluminal occlusion, using a catheter, of patent ductus arteriosus in an adult

The risk of surgical closure of the ductus arteriosus in the adult is greater than in children. The ductus arteriosus can now be occluded by venous catheterisation using a Rashkind umbrella. This procedure vas performed in a 63 year old woman. The diagnosis was confirmed and the anatomy of the lesion defined by catheterisation with aortography. The patent ductus was then occluded with a balloon catheter to assess the reversibility of the pulmonary hypertension. A 17 mm Rashkind umbrella was then used to completely occlude the ductus. The advantages of the method over surgical closure are: absence of morbidity related to thoracotomy, to general anaesthesia, to blood transfusion and the reduction of hospital stay to 3 days.     

Transcatheter closure of a large patent ductus arteriosus with the clamshell septal umbrella

In 14 patients undergoing transcatheter closure of a large (greater than 4 mm diameter) patent ductus arteriosus, occlusion was attempted with use of the Bard Clamshell septal umbrella. Patient age ranged from 0.7 to 30.4 years. Isolated patent ductus arteriosus was present in 11 patients; 3 had additional congenital heart lesions. Moderate or severe pulmonary hypertension was present in four patients. The diameter of the patent ductus arteriosus ranged from 4.5 to 14 mm, as determined by contrast injection through an 11F sheath or by balloon sizing; it appeared larger by this method than by the standard angiographic method. All 14 patent ductus arteriosi were successfully closed. Prior embolization of a Rashkind umbrella was the reason for using a Clamshell device in three patients; one additional embolization of a Clamshell device occurred. All errant devices were retrieved at cardiac catheterization, without associated hemodynamic instability. No other complications occurred. Among the 14 patients, 11 had complete ductal closure by Doppler color flow mapping at last follow-up and 3 had trivial residual flow. All four patients having associated complex lesions or pulmonary hypertension, or both, had symptomatic improvement after the procedure, although one child (with Shone's anomaly) died 3 months later. The Clamshell device provides stable and effective closure of a large patent ductus arteriosus, and allows transcatheter closure to be offered to some patients who were previously considered unsuitable for this procedure.     

Interventional catheterization

Several investigations have been performed to evaluate the mid-term results of coil embolization for patent ductus arteriosus. Excellent results were obtained with coils if the minimum diameter of the ductus was less than 4 mm. Balloon dilation of native coarctation and recoarctation may be associated with complications such as aneurysm formation. Stent placement may solve some of the problems of balloon dilation, but the stents currently available are not perfect. Results of transcatheter closure of atrial septal defect using new devices have been were reported. The self-expanding nitinol double-disk device (Amplatzer septal occluder) (AGA Medical Corporation, Golden Valley, Minnesota) is becoming popular because it is easy to implant, is easy to retrieve before its release, can occlude a relatively large defect, and has a low rate of residual leak. Although the immediate results with this device were excellent, surgical closure is still the standard treatment and we need to see the long-term results of transcatheter closure.     

Right patent ductus arteriosus with an ipsilateral aortic arch: percutaneous closure with amplatzer devices

The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon. An Amplatzer duct occluder was used in two patients and an Amplatzer muscular ventricular septal defect occluder, in the other. In all patients, full closure was confirmed in the catheterization laboratory and the patients were discharged on the same day with no complications. Percutaneous closure of a right patent ductus arteriosus associated with a right aortic arch is feasible, safe and effective.     

PDA: To treat or not to treat

Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta‐analyses of trials using nonsteroidal anti‐inflammatory drugs have shown effectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administration. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure after discharge. Careful postdischarge follow‐up is important, however, because potential adverse effects of long‐standing aortopulmonary shunts may be an indication for catheter‐based ductal closure. Identification of extremely preterm infants at greatest risk of potential harm from a persistently patent ductus, who may benefit most from treatment are urgently needed.     

经胸超声心动图在心血管病介入性治疗的应用

目的：探讨超声心动图引导介入性治疗心血管病的可行性。方法：在彩色超声心动图仪和大型Ｘ线心血管造影仪同时监测下，摸索超声心动图监测引导动脉导管栓堵、二尖瓣和肺动脉瓣狭窄球囊扩张术的最佳观察方法。结果：引导介入性治疗患者５１例。结果表明在二尖瓣狭窄患者中，可正确引导心房间隔穿刺，在二尖瓣及肺动脉瓣狭窄球囊扩张术中，可引导球囊导管的走向、所在部位、扩张程度。在动脉导管栓堵术中，可监测引导栓堵物置入部位，确定其嵌顿的牢固性。术中可对治疗效果进行即时判定。结论：经胸超声心动图引导介入性治疗心血管病具有Ｘ线所不能起到的作用，并且术中可即时判定治疗效果，有其独特优点。     

New technique using temporary balloon occlusion for transcatheter closure of patent ductus arteriosus with Gianturco coils

We describe our early experience with a new technique involving temporary balloon occlusion for transcathether closure of patent ductus arteriosus (PDA) using single or multiple Gianturco coils. Coil occlusion was attempted in 21 patients of median age 3 (range 1–11) years, and angiographic PDA diameter 3.0 mm ± 0.87 mm. The inflated balloon of a pulmonary wedge pressure catheter over a transductal wire was used to mechanically hold the first extruded loop of the coil at the pulmonary end of the duct. If a residual shunt persisted after the delivery of the first coil, additional coils were delivered with or without the balloon support. One to nine coils (median 2) of different sizes varying between 3–12 mm diameter and 4–15 cm length were used. Immediate angiographic occlusion rate was 47.6%. However, color Doppler (CD) at 24 hours and at 6 weeks revealed complete closure in 66.6% and 80.9%, respectively. Blood transfusion was required in 2 (9.5%) patients. Three out of 56 coils (5.4%) embolized during deployment. The use of balloon occlusion is effective and safe in the treatment of ducti up to 4.7 mm. Residual shunts tend to occlude with time. Cathet. Cardiovasc. Diagn. 41:62–70, 1997. © 1997 Wiley-Liss, Inc.     

Amplatzer Muscular VSD Occluder for catheter closure of a 20 mm hypertensive patent ductus arteriosus. A case report and literature review

The treatment of very large patent ductus arteriosus (PDA) was thought to be solely surgical. There is not enough experience in transcatheter closure of large hypertensive PDA. In this report, successful catheter closure of a large and hypertensive ductus using the Amplatzer Muscular VSD Occluder and a literature review are presented.     

Percutaneous closure of patent ductus arteriosus with the Amplatzer duct occluder. Results of 29 patients]

The authors report their experience of percutaneous closure of large patent ductus arteriosus with the Amplatzer duct occluder. The age of the patients ranged from 3 months to 72 years (average 24 months) with body weights of 3.9 to 74 Kg (average 16 Kg). The smallest angiographic diameter of the ductus was 4.0 +/- 1.3 mm at angiography (range 1.8 to 6 mm). The occluder was inserted under local anaesthetic with control aortography in all but one case who required general anaesthesia. In two small babies, the implantation was performed after venous puncture alone with transthoracic echocardiographic monitoring. The implantation was successful in all but one case in which there was a distensible duct. Early angiographic control showed suppression of the shunt in 61% of patients. Secondary haemolysis was observed in one case and was corrected by a second catheterisation 4 days later, with occlusion of the duct with a balloon catheter. The patients were followed up clinically, radiologically and echocardiographically. Doppler echocardiography showed absence of a residual shunt in 24 patients (86%) one month after the procedure, in 25 patients (89%) 3 months after the procedure and in 26 patients (93%) one year after the procedure. Two patients were left with mild or moderate shunts 12 and 16 months after the attempted occlusion. No cases of aortic or pulmonary obstruction were observed. The authors conclude that the Amplatzer duct occluder is a reliable device for closing large patent ductus arteriosus. It may be proposed in young symptomatic children over 4 Kg in body weight. A high rate of occlusion is obtained with a minimal risk of complications.     

Technique for closure of the small patent ductus arteriosus using the Rashkind occluder

Percutaneous transcatheter closure of the patent ductus arteriosus has become a clinically viable procedure in childhood due to the pioneering work of Rashkind and Mullins. Presented is a modification of the technique to accomplish catheter closure in the small ductus arteriosus.     

Different transcatheter strategies for aortic coarctation associated with patent ductus arteriosus

BackgroundOlder patients with combination of aortic coarctation and large patent ductus arteriosus can be managed with transcatheter interventions. The strategies depend on anatomy of coarctation and size of ductus arteriosus.MethodsWe present three different patients with this combination. The anatomic factors like isthmic hypoplasia, dilatation of post coarctation descending aorta and size of ductus arteriosus were noted.ResultsPatients with isthmic hypoplasia needed stent angioplasty of the coarctation. If there is no dilatation of post coarctation aorta, a single covered stent excluded the ductus arteriosus and relieved the coarctation gradients. Dilated post coarctation aorta precluded a covered stent and warranted closure of duct with occluder device and stent angioplasty of coarctation. When there is a good sized aortic isthmus in a discrete membranous coarctation, device closure of the duct and balloon aortoplasty was successful.ConclusionsIn coarctation with patent ductus arteriosus associated with good sized aortic isthmus, closure of duct with duct occluder device and balloon aortoplasty would correct the lesions. If there is isthmic hypoplasia, device closure of the duct and stenting of the coarctation is needed. Covered stent is a reasonable alternative only in presence of non dilated descending aorta.     

Transpulmonary surgical closure of patent ductus arteriosus with hypothermic circulatory arrest in an adult patient

Untreated patent ductus arteriosus carries a higher risk in adults than in children, especially when the defect is large (>4.0 mm in diameter), short, or friable. Therefore, various technical precautions have been suggested for application during surgical closure of a patent ductus arteriosus in an adult. We report the case of a 47-year-old woman with a patent ductus arteriosus who underwent transpulmonary surgical closure of the ductus under hypothermic total circulatory arrest. We discuss the technique in light of the current English-language medical literature.     

带瓣膜心血管内支架封堵动脉导管未闭的可行性研究

目的 探讨带瓣膜心血管内支架在动脉导管封堵中应用的可行性及其体内特性,以期研制一种用于封堵合并严重肺动脉高压动脉导管未闭的新的治疗系统.方法 小型猪8头,采用聚四氟乙烯人工血管建立降主动脉起始部和肺总动脉之间的动脉导管未闭模型,术中采用带瓣膜心血管内支架行直视下封堵术.术后2 h行超声心动图检查,术后30 d行主动脉逆行造影观察动脉导管未闭的封堵情况.术后30 d处死、解削实验动物,并以电镜检查人工动脉导管主动脉端和肺动脉端的新生内膜组织.结果 1头小型猪在术后6 h因支架移位导致肺动脉栓塞而死亡,另外1头小型猪在术后2 h因呼吸衰竭死亡,其余6头小型猪饲养30 d后处死.术后2 h超声心动图和术后30 d主动脉逆行造影均未见残余分流.术后30 d动脉导管均完全封闭,4例动脉导管的肺动脉端和3例动脉导管的主动脉端被新生内膜完整覆盖.电镜检查显示动脉导管主动脉端和肺动脉端的新生组织均有血管内皮细胞生长.结论 采用带瓣膜心血管内支架能有效封堵动脉导管未闭动物模型,残余分流及支架移位发生率低.新生内膜能够覆盖动脉导管的主动脉端和肺动脉端.     

带瓣膜心血管内支架封堵动脉导管未闭的可行性研究

目的 探讨带瓣膜心血管内支架在动脉导管封堵中应用的可行性及其体内特性,以期研制一种用于封堵合并严重肺动脉高压动脉导管未闭的新的治疗系统.方法 小型猪8头,采用聚四氟乙烯人工血管建立降主动脉起始部和肺总动脉之间的动脉导管未闭模型,术中采用带瓣膜心血管内支架行直视下封堵术.术后2 h行超声心动图检查,术后30 d行主动脉逆行造影观察动脉导管未闭的封堵情况.术后30 d处死、解削实验动物,并以电镜检查人工动脉导管主动脉端和肺动脉端的新生内膜组织.结果 1头小型猪在术后6 h因支架移位导致肺动脉栓塞而死亡,另外1头小型猪在术后2 h因呼吸衰竭死亡,其余6头小型猪饲养30 d后处死.术后2 h超声心动图和术后30 d主动脉逆行造影均未见残余分流.术后30 d动脉导管均完全封闭,4例动脉导管的肺动脉端和3例动脉导管的主动脉端被新生内膜完整覆盖.电镜检查显示动脉导管主动脉端和肺动脉端的新生组织均有血管内皮细胞生长.结论 采用带瓣膜心血管内支架能有效封堵动脉导管未闭动物模型,残余分流及支架移位发生率低.新生内膜能够覆盖动脉导管的主动脉端和肺动脉端.     

带瓣膜心血管内支架封堵动脉导管未闭的可行性研究

目的 探讨带瓣膜心血管内支架在动脉导管封堵中应用的可行性及其体内特性,以期研制一种用于封堵合并严重肺动脉高压动脉导管未闭的新的治疗系统.方法 小型猪8头,采用聚四氟乙烯人工血管建立降主动脉起始部和肺总动脉之间的动脉导管未闭模型,术中采用带瓣膜心血管内支架行直视下封堵术.术后2 h行超声心动图检查,术后30 d行主动脉逆行造影观察动脉导管未闭的封堵情况.术后30 d处死、解削实验动物,并以电镜检查人工动脉导管主动脉端和肺动脉端的新生内膜组织.结果 1头小型猪在术后6 h因支架移位导致肺动脉栓塞而死亡,另外1头小型猪在术后2 h因呼吸衰竭死亡,其余6头小型猪饲养30 d后处死.术后2 h超声心动图和术后30 d主动脉逆行造影均未见残余分流.术后30 d动脉导管均完全封闭,4例动脉导管的肺动脉端和3例动脉导管的主动脉端被新生内膜完整覆盖.电镜检查显示动脉导管主动脉端和肺动脉端的新生组织均有血管内皮细胞生长.结论 采用带瓣膜心血管内支架能有效封堵动脉导管未闭动物模型,残余分流及支架移位发生率低.新生内膜能够覆盖动脉导管的主动脉端和肺动脉端.     

Transcatheter closure of a calcified patent ductus arteriosus in an elderly man

Successful transcatheter closure of a calcified patent ductus arteriosus was performed in a symptomatic 78 year old man. Cardiac catheterization revealed a left to right shunt across the patent ductus arteriosus with a pulmonary to systemic flow ratio of 2.8:1. Calcification of the ductus and severe lung disease increased the risk of surgical patent ductus arteriosus closure. A 17 mm Rashkind double umbrella was positioned in the ductus percutaneously by way of the femoral vein. After closure of the ductus there was marked hemodynamic improvement and the patient was discharged with improved exercise tolerance. Transcatheter closure of patent ductus arteriosus may be a viable option for the elderly patient too sick to withstand cardiovascular surgery.     

Transcatheter closure of patent ductus arteriosus with the Amplatzer duct occluder: short-term follow-up

BACKGROUND: Transcatheter closure of the patent ductus arteriosus is a well established procedure. The objective of this study was to assess the effectiveness and the safety of the Amplatzer duct occluder. METHODS AND RESULTS: Occlusion of the patent ductus arteriosus was attempted in 23 patients. The median weight was 11.7 Kg (range, 5 kg - 42.4 kg) with a mean ductus diameter of 3.7 mm (range, 1.6 - 7.2 mm). The immediate closure rate was 86% with a closure rate of 100% at 6 months, 1 year and 2 years following device placement. There was one device embolization that occurred immediately following device placement. No patient had aortic narrowing or pulmonary artery stenosis following the procedure. CONCLUSIONS: The Amplatzer duct occluder is safe and effective in the closure of a patent ductus arteriosus up to 7.2 mm in diameter. Selecting a device at least 12 mm larger than the minimal ductal diameter can minimize embolization.     

带瓣膜心血管内支架封堵动脉导管未闭的可行性研究

目的 探讨带瓣膜心血管内支架在动脉导管封堵中应用的可行性及其体内特性,以期研制一种用于封堵合并严重肺动脉高压动脉导管未闭的新的治疗系统.方法 小型猪8头,采用聚四氟乙烯人工血管建立降主动脉起始部和肺总动脉之间的动脉导管未闭模型,术中采用带瓣膜心血管内支架行直视下封堵术.术后2 h行超声心动图检查,术后30 d行主动脉逆行造影观察动脉导管未闭的封堵情况.术后30 d处死、解削实验动物,并以电镜检查人工动脉导管主动脉端和肺动脉端的新生内膜组织.结果 1头小型猪在术后6 h因支架移位导致肺动脉栓塞而死亡,另外1头小型猪在术后2 h因呼吸衰竭死亡,其余6头小型猪饲养30 d后处死.术后2 h超声心动图和术后30 d主动脉逆行造影均未见残余分流.术后30 d动脉导管均完全封闭,4例动脉导管的肺动脉端和3例动脉导管的主动脉端被新生内膜完整覆盖.电镜检查显示动脉导管主动脉端和肺动脉端的新生组织均有血管内皮细胞生长.结论 采用带瓣膜心血管内支架能有效封堵动脉导管未闭动物模型,残余分流及支架移位发生率低.新生内膜能够覆盖动脉导管的主动脉端和肺动脉端.