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.     

The snare-assisted technique for transcatheter coil occlusion of moderate to large patent ductus arteriosus: immediate and intermediate results.

OBJECTIVES: The purpose of this study was to evaluate the feasibility, safety and efficacy of using a snare-assisted technique to coil occlude the moderate to large size patent ductus arteriosus (PDA). BACKGROUND: Transcatheter occlusion of small PDAs using Gianturco coils is safe and effective. However, in larger size PDAs and/or those with short PDA length, the procedure still carries risks of coil embolization, incomplete occlusion and failure to implant the coil. METHODS: From January 1994 to June 1997, the records of 104 consecutive snare-assisted coil occlusions of moderate to large PDAs (minimum diameter >2.0 mm) were reviewed. Immediate and intermediate outcomes including complete and partial occlusion, failure to implant and complications were analyzed with respect to ductal type and size. RESULTS: Patient age ranged from 0.1 to 70.1 years (median 3.3 years). Minimum PDA diameter ranged from 2.1 to 6.8 mm (mean 3.0 +/- 0.9 mm). Angiographic types were A-62, B-13, C-6, D-14 and E-9. Using the snare-assisted technique, coil placement was successful in 104/104 patients (100%), irrespective of size or angiographic type. Immediate complete closure was observed in 73/104 (70.2%) and was related to smaller PDA size, but not to angiographic type. Complete closure was documented in 102/104 (98.1%) at 2- to 16-month follow-up. Successful closure was unrelated to PDA size or type. Coil embolization to the pulmonary artery occurred in 3/104 (2.9%) patients and was not related to PDA size or type. The need for multiple coils was found in 28/104 patients (26.9%), and was related to larger PDA size, but not to angiographic type. CONCLUSIONS: The snare-assisted delivery technique allows successful occlusion of moderate to large PDAs up to 6.8 mm, irrespective of angiographic type. This technique permits improved control and accuracy of coil placement, and facilitates delivery of multiple coils.     

Effect of intracoronary stenting on intimal dissection after balloon angioplasty: results of quantitative and qualitative coronary analysis

The effect of the Palmaz-Schatz stent on the angiographic appearance and residual luminal stenosis in patients with intimal dissection after balloon angioplasty was evaluated in 84 consecutive patients (90 lesions). Coronary angiography was performed before angioplasty, after conventional angioplasty and after stent implantation. The degree of intimal disruption was assessed as follows: grade 0, no dissection; grade 1, simple dissection (intraluminal linear defect or extraluminal cap extravasation); or grade 2, complex dissection (nonlinear spiral defect or luminal defect with multiple irregular borders). Quantitative coronary analysis of digitized cineangiograms was performed with use of a computerized automatic edge detection algorithm. After balloon angioplasty, 31 (34%) of 90 lesions demonstrated intimal dissection (18 simple, 13 complex). After stent implantation, intimal dissection improved by greater than or equal to 1 grade in 29 (94%) of the 31 lesions with 27 (87%) reduced to grade 0 (that is, no dissection). Dissection grade improved after stenting in 16 (89%) of 18 simple dissections and in all 13 complex dissections. Mean diameter stenosis was 77 +/- 17% before angioplasty, 47 +/- 17% after angioplasty and 14 +/- 10% after stenting (before angioplasty vs. after angioplasty and after angioplasty vs. after stenting, p less than 0.0001). In conclusion, intracoronary stenting is effective in reducing the residual luminal stenosis and in improving the angiographic appearance of intimal dissections after conventional balloon angioplasty.     

Transcatheter closure of large patent ductus arteriosus (> or = 4 mm) with multiple Gianturco coils: immediate and mid-term results.

OBJECTIVE: To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus (PDA) > or = 4 mm with multiple Gianturco coils. (Transcatheter closure of large PDAs using the Rashkind occluder or the buttoned device is associated with a 7-38% incidence of residual shunt.) METHODS: 19 patients (7 male, 12 female) underwent an attempt at anterograde transcatheter closure with multiple Gianturco coils of a large PDA at a median age of 3.8 yr (range 2 weeks-34 yr) and median weight of 14 kg (range 2.3-80 kg). RESULTS: The median PDA diameter at the narrowest segment was 4.3 mm (range 4-7 mm) and the mean (SD) Qp/Qs was 1.9 (0.8). Each patient had left atrial and left ventricular volume overload. A 4F catheter was used to deliver the coils in all patients. There was immediate and complete closure in 16/18; one patient had residual shunt that was closed at a second procedure and the other had spontaneous disappearance of the residual shunt at the six week visit. A short ductus (angiographic type B) in one patient could not be closed. The median number of coils placed at the first attempt to close the ductus was 4 (range 2-6 coils) and the median fluoroscopy time was 40 minutes (range 13-152 minutes). Mild left pulmonary artery stenosis occurred in the two smallest patients. Coil migration to the lung occurred in 3 patients with retrieval of coils in two patients. All procedures but one were done on an outpatient basis. At a median follow up of 1.6 yr (range 2 weeks-2.2 yr) all patients had complete closure with no new complications. CONCLUSIONS: Anterograde transcatheter closure with multiple Gianturco coils is an effective treatment for most patients with large PDA of diameters up to 7 mm. This technique can be performed in small infants on an outpatient basis without the need for general endotracheal anaesthesia.     

Clinical efficiency and safety analysis of transcatheter interventional therapy for compound congenital cardiovascular abnormalities

OBJECTIVE: To investigate the efficiency and safety of transcatheter interventional therapy for compound congenital cardiovascular abnormalities. METHODS: From Nov 2001 to Jun 2006, a total of 36 patients (17 male, 19 female), aged 17.20 +/- 10.52, with compound congenital cardiovascular abnormalities underwent transcatheter interventional procedure. These patients included 11 with perimembranous ventricular septal defect (PVSD) and patent ductus arteriosus (PDA), 8 patients with PVSD and atrial septal defect (ASD), 8 patients with ASD and PDA, 7 patients with ASD and pulmonary stenosis (PS), 1 patient with ASD and mitral stenosis(MS), 1 patient with coarctation of aorta (COA) and PDA. According to the principle of "easy first, hard second," balloon valvuloplasties of PS or MS were performed before the closure of PVSD, and of PDA and ASD. Electrocardiogram and transthoracic echocardiogram were examined at 4 days, 1, 2, 6 and 12 months, respectively, after each procedure. RESULTS: Transcatheter interventional therapy for compound congenital cardiovascular abnormalities was successful in all patients. Among these, 2 occluders were planted in each of 27 patients, 7 patients with ASD combined with PS and 1 patient with ASD combined with MS underwent successfully performed balloon valvuloplasty and ASD closure, 1 patient with COA combined with PDA underwent successfully performed balloon valvuloplasty and subsequent covered stent implantation. No patient encountered serious adverse events during the (30.5 +/- 14.6) months of follow-up. CONCLUSIONS: Transcatheter interventional therapy for compound congenital cardiovascular abnormalities could obtain satisfactory results with technical feasibility.     

Patent ductus arteriosus balloon sizing: A new technique to evaluate the size in complex cases

Patent ductus arteriosus (PDA) transcatheter closure is a widespread procedure. However in some cases PDA measurements may be unclear and choice of the proper device could be quite difficult. This may happen in large PDA and in particular in adults. We have developed a new technique using an ASD sizing balloon to measure the PDA in order to better understand PDA anatomy and size. The first step is to create an artero‐venous circuit across the PDA. A 24 or a 34 mm Amplatzer balloon sizing for ASD closure is placed over the wire from the venous access in the descending aorta. Then, the balloon is inflated and gently pulled back across the PDA toward the pulmonary artery. The frame where the balloon is exactly across the PDA is chosen and measurements performed. In conclusion, a new method for PDA measurement in large PDA is reported. The procedure is safe and reliable. © 2015 Wiley Periodicals, Inc.     

Major dissection during coronary angioplasty: outcome using prolonged balloon inflation versus coronary stenting

BACKGROUND: Abrupt or threatened closure is the major acute complication following conventional coronary angioplasty with a persistent incidence of 2% to 10%. OBJECTIVES: In order to evaluate the safety and efficacy of endoluminal stenting and autoperfusion balloon angioplasty in the setting of abrupt or threatened closure following coronary angioplasty, the short- and long-term clinical and angiographic follow-up of respectively 45 and 51 patients treated by either method were compared. METHODS: From August 1986 through August 1992, consecutive patients treated by either endoluminal stenting or autoperfusion balloon angioplasty for abrupt closure following coronary angioplasty, were entered into an observational trial that requested clinical follow-up and repeat angiography at 6 months. RESULTS: Except for vessel localization, baseline clinical, angiographic and procedural characteristics were comparable. The in-hospital clinical and angiographic outcome was similar (p = 0.85) with 69% event-free patients in both treatment groups. The postprocedural minimal luminal diameter was larger following stenting: 2.67 +/- 0.76mm versus 2.07 +/- 0.70mm (autoperfusion balloon) (p = 0.0002). At follow-up, there were less events in the stent group: 11% versus 34% for the autoperfusion balloon angioplasty group, (p = 0.03). Restenosis rates were 5% (2/37 patients, stent) versus 27% (11/41 patients, autoperfusion balloon) (p = 0.02). CONCLUSIONS: Autoperfusion balloon angioplasty and endoluminal stenting are effective and safe therapeutic options for abrupt or threatened closure following coronary angioplasty with a comparable short-term clinical and angiographic outcome. However, during follow-up, more complications occur following autoperfusion balloon angioplasty. This is explained by a higher restenosis rate in this treatment group.     

Successful placement and re-expansion of a new balloon expandable stent to maintain patency of the ductus arteriosus in a newborn animal model

Objective: We performed this study in order to evaluate the usefulness of a new balloon expandable stent for maintaining ductal patency in a neonatal piglet model and to evaluate the ability to re-expand the stent weeks following initial implantation. Background: Maintaining patency of the ductus arteriosus without administration of Prostaglandin E has been reported previously using balloon dilation and stent implantation techniques. However, the experience is limited and the currently available stents are not modified for neonates. Methods: 14 newborn piglets all at age 12 days and median weight 3.6 Kg (range 2.7-4.3 Kg), underwent initial balloon dilation of the ductus arteriosus. Angiography after dilation demonstrated no significant left to right shunt. All piglets underwent successful stent (3.5 mm x 17 mm) placement in the ductus arteriosus. Results: Percutaneous ductal stent implantation via the arterial route was successful in all piglets with angiographic demonstration of a significant left to right shunt. Follow-up studies at weekly intervals with color flow Doppler were used to confirm patency of the stents. In 3 piglets the stent was not patent at initial follow-up and autopsy revealed sub-optimal stent placement. In two animals the stent was later re-expanded to 4 mm at 22 days, in one to 4 mm at 30 days and in one to 6 mm at 15 days, maintaining flow for an additional period of 15 to 34 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Patent ductus arteriosus closure using the new Amplatzer Duct Occluder. Preliminary results and review of the literature.

BACKGROUND: Patent ductus arteriosus (PDA) is the second most common congenital heart disease. A large number of surgical and transcatheter techniques for the interruption or closure of PDA has been reported. The aim of this study was to assess the immediate and short-term results of transcatheter closure of PDA using the new, self-expandable, self-centering, and repositionable Amplatzer Duct Occluder device. METHODS: We attempted occlusion of PDA with the Amplatzer Duct Occluder in seven consecutive patients, one child and six adults, four females and three males, between September 1999 and January 30th 2000. All PDAs but one were approached from the femoral venous site; the Amplatzer Duct Occluder size was selected in order to be 2 mm larger than the duct's diameter at its narrowest site and the mean PDA diameter was 5.4+/-2.5 mm (range 3-9). All patients underwent physical examination, chest X-ray and echocardiography within 48 hours and on first and third month after PDA occlusion. RESULTS: Four patients had a megaphone type (type A), and three had an elongated, conical type (type E) PDA. Four patients had immediate, complete angiographic closure of the ductus 10 minutes after the procedure, one had a trace shunt and two had small shunts which all disappeared within 48 hours. The average fluoroscopy time and procedural time were 34.4+/-10.6 min (range 21-50) and 105+/-38.9 min (range 75-190) respectively. There were no complications at follow-up. CONCLUSIONS: Transcatheter closure of PDA using the new Amplatzer Duct Occluder is an easy and effective technique. Moreover it is safe even in the presence of wide PDAs.     

应用Amplatzer房缺封堵伞堵塞成人特殊动脉导管未闭

目的:评价Amplatzer房缺封堵伞(AASO)堵塞特殊类型动脉导管未闭(PDA)的可行性及近期效果。方法:采用经导管Amplatzer AASO堵闭特殊类型巨大PDA并重度肺动脉高压5例。术后24 h、60 d、180 d进行经胸超声心动图及X线胸片、心电图复查随访。结果:5例均堵闭成功;2例术后完全无分流,2例术后残余2mm左向右分流,1例残余明显穿伞分流,分别在60 d、180d随访中分流完全消失;血流动力学和心脏解剖在术后及随访期间有显著改善。结论:Amplatzer AASO可用于堵闭形态特殊、管径较大的PDA,即时残余穿伞分流率高,近期效果好。     

Intravascular ultrasonographic evaluation of direct stents, implanted without predilatation. Comparison of results according to lesion types

INTRODUCTION AND OBJECTIVES: Direct stenting is a safe and feasible technique in selected lesions yielding excellent angiographic results. However, there are no studies providing intravascular ultrasonographic examination after direct stenting. The aim of this study was to evaluate direct stent expansion with ultrasonography and to know whether there are differences in the results based on lesion types. METHODS: Patients with amenable lesions for direct stenting were enrolled; including patients with no occlusion, no calcification, no significant tortuosity or angulation, a length 15 mm and a reference lumen diameter 2.5 mm. Intravascular ultrasonography was performed after stent implantation. The ultrasonographic criteria for optimal expansion were: complete apposition and a minimal intrastent lumen area > 80% of the average reference luminal area and 90% of the distal reference lumen area. RESULTS: We included 40 patients (50 lesions). The final angiographic result was good in all the patients but in one case an additional stent was used due to dissection. The ultrasonographic examination did not show significant differences between type A and B lesions. Optimal expansion was achieved in 14/21 (66%) of type A lesions and 17/29 (58%) of type B lesions (p = 0.5). The balloon/artery ratio was the only factor significantly related to ultrasonographic results. When this ratio was 1.1-1.2 (25 cases), 76% of the stents were optimally expanded and when the ratio was < 1. 1 (25 cases) only in a 48% an optimal result was achieved (p < 0.05). CONCLUSIONS: Direct stenting in selected lesions provides ultrasonographic results comparable to those expected with conventional stenting and these results could be even improved if a balloon artery ratio 1.1-1.2 is used. Taking into consideration the selection criteria the differences observed between lesion types A and B are not significant.     

动脉导管未闭分型及其在介入封堵术中的价值评价

目的:研究动脉导管未闭(PDA)的血管造影分型,探讨其在介入治疗中的价值.方法:2002-01-2008-03期间120例PDA患者于封堵术前施行了主动脉弓降部造影术,年龄2～70 (16±2.5)岁,120例患者采用左侧位造影,其中9例患者加摄右前斜20°～50°体位,2例患者加摄左前斜70°～85°体位.将造影结果根据PDA形态及其与主动脉弓降部的夹角进行分型.结果:①根据PDA形态将PDA分为5种类型,漏斗型92例, 最窄直径2～13.9 mm,平均最窄直径(4.0±3.0)mm; 管型16例,平均直径为(6.1±1.3)mm;哑铃型2例,最窄直径分别为2.4、8.0 mm;指型5例,最窄直径为(2.4～5.8) mm ,平均最窄直径为(3.2±1.1)mm;半漏斗型5例最窄直径2.1～5.6 cm,平均最窄直径为(3.5±0.8) mm.②根据PDA与降主动脉的夹角将PDA分为成角型PDA15例及非成角型PDA105例.③封堵器选择:其中98例患者选择标准型Amplatzer导管封堵器、15例患者选择成角型Amplatze导管封堵器、5例选择偏心型导管封堵器.2例选择肌部室间隔缺损Amplatze导管封堵器.④手术成功率及随访结果:手术成功率100%,术后随访6个月无残余分流、封堵器移位及脱落.结论:PDA形态变化多端,PDA长轴与降主动脉夹角不一,认识PDA类型有助于指导介入封堵治疗.     

房间隔缺损并发畸形的介入治疗

目的 :评价同期应用介入治疗房间隔缺损 （ASD）及其并发心脏其它畸形的可行性和治疗效果。方法 :全组 7例 ,年龄 2～ 6 5 （34± 2 8）岁。经临床、心电图、X线及超声心动图诊断为 ASD并发其他心脏畸形 ,其中 3例为肺动脉瓣狭窄 ,2例为二尖瓣狭窄 （L utembacher综合征 ） ,2例为动脉导管未闭 （PDA ）。应用 Amplatzer封堵器经导管关闭ASD前 ,先纠正其它畸形 （包括瓣膜成形术及 PDA封堵术 ）。术后 3d,1～ 6月分别行经胸超声心动图 （TTE）、心电图、X线检查评价治疗效果。结果 :7例同期介入治疗均获得成功 ,术中未发生任何重要并发症。术后 3d,1～ 6月TTE显示房间隔无残余分流。并发肺动脉瓣狭窄患者 ,术后即刻跨肺动脉瓣压差得到满意的下降 ;L utembacher综合征患者 ,二尖瓣瓣口面积分别由术前 1.0 ,1.2 cm2增加到术后 1.9,2 .0 cm2 ,左房平均压分别由 2 9,2 6 m m Hg（1mm Hg=0 .133k Pa）降至 8,7m m Hg;并发 PDA患者 ,应用 Amplatzer封堵器 PDA关闭术后 10 min降主动脉侧位造影 ,无残余分流。术后 6月 X线检查显示肺血减少 ,心脏房、室缩小。结论 :同期介入治疗 ASD并发某些心脏畸形是一种有效、安全、简便可行的方法。     

经特殊途径封堵动脉导管未闭3例的临床分析

目的:通过特殊途径放置封堵器治疗动脉导管未闭（PDA）。方法:3例PDA患者,均并发下腔静脉肝下段缺如、奇静脉开放,1例同时并发镜像右位心,经股静脉不能直接到达右心房而采用颈内静脉、锁骨下静脉和降主动脉3种不同的途径封堵PDA。结果:3例均封堵成功,术后5min主动脉弓降部造影显示封堵完全,术后1d、3个月、6个月复查超声心动图无残余分流。结论:可通过特殊途径经心导管封堵并发下腔静脉肝下段缺如的PDA患者。     

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.     

A comparison of the clinical and angiographic evolution of diabetic and nondiabetic patients treated by conventional angioplasty versus stent implantation in native coronary arteries

INTRODUCTION AND OBJECTIVES: Diabetic patients have a high restenosis risk after balloon coronary angioplasty. Stent implantation in these patients appears to be a potential beneficial therapeutic option. The aim of this study was to compare the clinical and angiographic outcome of diabetic patients vs non-diabetic patients, treated with conventional angioplasty vs stent implantation in lesions located in native coronary arteries. MATERIAL AND METHODS: A total of 302 patients (58 diabetics and 244 non-diabetics) underwent a coronary angioplasty of one vessel in native coronary arteries with initial success and after at least six months clinical and angiographic follow-up were included in the study. Of the total number of patients, 100 were treated with conventional balloon angioplasty and 202 with stent implantation. Major adverse clinical events and angiographic restenosis rate were evaluated at follow-up. RESULTS: Mean age of patients was 65 years and 74% were male. Angiographic restenosis rate was similar in diabetic vs non-diabetic patients with stent implantation (24% vs 23% respectively). Nevertheless, diabetic patients treated with balloon angioplasty compared to diabetic patients treated with stenting, evolved with a higher restenosis rate (64% vs 24%; p < 0.05), and at the end of follow-up diabetics had need a higher rate of target vessel revascularization (40% vs 24%; p < 0.05), a lower major event free survival (56% vs 70%; p < 0.05) and worse symptomatic status (72% vs 36%; p < 0.05). CONCLUSIONS: Diabetic patients treated with conventional one vessel coronary balloon angioplasty evolved with a high restenosis rate and a bad mid-term clinical outcome. Stent implantation was able reduce to the restenosis rate and improve the mid-term clinical outcome, in a comparable population of diabetic patients.     

Percutaneous treatment of multiple heart defects

We describe our experience in 6 cases with multiple congenital heart defects treated by percutaneous intervention. Their age ranged from 2.3 to 10 years (mean 6.1), with follow-up from 1 to 84 months (mean 28.8). Two cases had coarctation of the aorta (AC) and persistent ductus arteriosus (PDA). Two patients had pulmonary valve stenosis (PVS) and PDA, one case with aortic stenosis (AE) and PDA and one case with AC, mitral stenosis and subaortic stenosis (Shone's Syndrome). Ductus arteriosus was occluded in all patients with Gianturco coils or Rashkind occluder. The valvular gradient post balloon decreased in cases with AC from 46 to 9 mmHg, with PVS from 110 to 10 mmHg and with AE from 40 to 14 mmHg. In a 8 year old boy with Shone's syndrome, we performed angioplasty of aortic coarctation, mitral valvuloplasty with Inoue catheter. He was referred to surgery for subaortic repair stenosis. All are asymptomatic at follow-up. In conclusion; percutaneous intervention is possible in patients with multiple congenital heart defects.     

Patent ductal arteriosus occlusion by Rashkind umbrella and by detachable coil

The objective of this study is to report all of our experience of patent ductus arteriosus closure by interventional catheterisation, comparing two systems used successively: Rashkind umbrella and detachable coil. METHOD: Between January 1991 and July 2001, 72 patients underwent cardiac catheterisation in order to occlude patent ductus arteriosus (PDA). In 3 patients closure was not attempted (n = 1) or aborted (n = 2). The 69 patients in whom one or several prostheses were implanted are the object of this retrospective study. The patients were between 10 months and 18 years old (median 4 years), weighing between 6.7 and 54 kg (median 17 kg). The narrowest average angiographic diameter of the PDA was 2.2 mm (1 to 4 mm), type A in the Krichenko classification in 59 cases. The PDA was occluded by an umbrella in 29 patients (group 1), and from 1997 coils were used in 40 patients (group II). The medium term results were evaluated clinically and by colour doppler echocardiography. RESULTS: The age, weight, size and type of PDA were similar in the 2 groups. Group 1: 28 patients were treated with a single umbrella and one patient received 2 umbrellas. Systemic embolisation occurred in one case. The average period of follow-up was from 4 years to 10 years (average 6.5 years). The rate of residual shunt at 24 h, 6 months, and 12 months was 43%, 43%, and 39% respectively. A second implant was necessary in 2 children after 7 months and 30 months. The spontaneous disappearance of residual shunt was observed in 8 patients after between 1 month and 54 months (average 33.5 months). A slight residual shunt persisted in 4 patients (13.7%), 4.5 to 8.5 years after placing one or two umbrellas. The patients with a residual shunt were younger: 37 months versus 73 months (p < 0.05). Group II: 34 patients received a single coil and 6 patients several coils. Two cases of embolic migration and two cases of haemolysis were observed. The follow-up extended from 4 months to 4.5 years (average 2.2 years). The rate of residual shunt at 24 h, 6 months, and 1 year respectively was 35%, 10.5%, and 3.3%. At 6 and 12 months this rate was significantly less in group I (p < 0.01). Implantation of supplementary coils was necessary in 2 children at 24 h and at 9 months. Spontaneous disappearance of residual shunt occurred in 10 children out of 14 with an average interval of 5.5 months. A weak residual shunt remained detectable in 2 patients (5%) at 6 months and 36 months. CONCLUSION: The rate of initial residual shunt is comparable using both techniques. Spontaneous disappearance of residual shunts was observed in the majority of cases, but with the detachable coils this outcome is faster and the final rate for residual shunt is very low.     

Transcatheter closure of patent ductus arteriosus in Chinese adults: immediate and long-term results

BACKGROUND: Transcatheter closure of patent ductus arteriosus (PDA) has been established as a safe and effective treatment for pediatric patients. However, long-term experience in adults remains limited. Therefore, our purpose is to report our experience with this approach in Chinese adults. METHODS: Twenty-five patients (mean age, 34 years) who underwent transcatheter closure of PDA in a tertiary cardiology center in Hong Kong were recruited. RESULTS: The mean PDA diameter measured by angiogram was 3.1 mm (range, 1.3 6.6 mm) and the mean pulmonary-to-systemic shunt was 1.65 (range, 1.3 1.8). All procedures were performed under local anesthesia. The average procedure and fluoroscopy times were 54 14 minutes and 14 4 minutes, respectively. The mean period of hospitalization was 4 days (range, 3 5 days). Immediate, one-month and late success rates were 96%, 92% and 84%, respectively. CONCLUSIONS: Percutaneous closure of PDA in adults is a safe and feasible procedure. It should be a reasonable alternative for adult patients who are either not fit for open-chest surgery or who prefer a less invasive approach.     

A comparative study of Rashkind, Grifka and coil devices in percutaneous closing of patent ductus arteriosus

This study was performed to evaluate the efficacy of transcatheter Coil and Grifka closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Ninety seven patients (36 male and 61 females) underwent occlusion of the PDA. The following variables were compared: age, sex, ductus diameter, morphology, device, occlusion time, residual shunt, multiple device and complications. Data obtained were compared using the Student's test and Chi 2. Median patient age was 7.82 +/- 6.89, forty five patients underwent transcatheter Rashkind-17 closure, 19 patients with Rashkind-12, 18 patients with Coil and 13 patients with Grifka device, in two patients the closure could not be performed. There were differences between the morphology and device used (p = 0.008), between the ductus diameter and device used (p < 0.001). There was immediate closure in 26.7% in the Rashkind-17 group compared with, 57.9% for the Rashkind-12 group, 83.3% for Coil group and of 91.7% for Grifka group. The occlusion within 24 hrs of implantation was 60% with Rashkind-17, 78.9% with Rashkind-12, 94.4% with Coil and 100% with Grifka. Residual shunt persisted for more than a year in 7 patients with Rashkind-17 and 1 with Rashkind 12, (p = 0.001), in 4 patients two devices wore placed. The complications were, 15.5% for Rashkind-17, 26.3% for Rashkind-12, 5.2% for Coil and 30% for Grifka, (p = 0.004), one coil and one Grifka embolized. Transcatheter Coil and Grifka occlusion are more effective in achieving immediate closure than the Rashkind device. The indication to use each device is made according to the morphology and size of the ductus.