Gianturco Coil Occlusion of Patent Ductus Arteriosus

Gianturco coils (Cook Cardiology, Bloomington, IN) are commonly employed to occlude restrictive patent ductus arteriosus. The clinical experience of the 1990s demonstrated efficacy and safety. This article reviews the current status of Gianturco coil occlusion of the patent ductus arteriosus. It covers the design of the available coils, patient selection for the procedure, coil selection and delivery methods, results and complications of occlusion, and financial considerations.     

0.052吋Gianturco coil弹簧栓子经导管封堵动脉导管未闭

目的 :评价 0 0 5 2Gianturcocoil弹簧栓子经导管封堵动脉导管未闭 (PDA)的疗效及安全性。方法 :10例PDA患者在基础和骶管麻醉下 ,用心内膜心肌活检钳控制和传递 0 0 5 2Gianturcocoil弹簧栓子 ,顺行经导管封堵PDA。结果 :8例 1枚Gianturcocoil弹簧栓子、1例 3枚Gianturcocoil弹簧栓子完全封堵成功 ,1例因Gianturcocoil弹簧栓子未能回收至传递鞘内改行手术结扎。结论 :用 0 0 5 2Gianturcocoil弹簧栓子经导管封堵 3 0～ 4 0mm直径的PDA ,是安全、可靠的非手术方法     

N-Butyl Cyanoacrylate Embolization of a Peripheral Pulmonary Artery Aneurysm in a Patient with Patent Ductus Arteriosus

N-Butyl cyanoacrylate embolization of peripheral pulmonary artery aneurysms has rarely been performed. This report presents a young woman with a history of patent ductus arteriosus and massive hemoptysis secondary to pulmonary artery aneurysm, successfully managed by embolotherapy using n-Butyl cyanoacrylate. This is the first report of n-Butyl cyanoacrylate embolization treatment of a bleeding pulmonary artery aneurysm in the setting of patent ductus arteriosus. The pertinent literature has been reviewed and the clinical background and the procedure have been explained.     

Double-Helix Coil for Occlusion of Large Patent Ductus Arteriosus: Evaluation in a Chronic Lamb Model

Objectives. We sought to evaluate the efficacy and tissue reaction of a new miniature interventional device for occlusion of large patent ductus arteriosus (PDA) in a neonatal lamb model.Background. A variety of devices are used to close PDAs by interventional measures. Spring coils found to have a high cumulative occlusion rate have thus far been limited to smaller PDAs because of the physical limitation of grip forces.Methods. Memory-shaped double-cone stainless steel coils with enhanced stiffness of the outer rings by a double-helix configuration were mounted on a titanium/nickel core wire. A snap-in mechanism attaches the coil to the delivery wire, allowing intravascular coil retrieval and repositioning. The system was placed through a 4F or 5F Teflon catheter. A chronic lamb model (n = 8) of PDA (>5 mm) was used in which ductus patency was secured by a protocol of repetitive angioplasty procedures. The animals were killed after 1 to 181 days, and the ductal region was examined by inspection as well as by light and electron microscopy.Results. Placement of the coils within the PDA was possible in all lambs. Before final detachment, the coils were retrieved or repositioned, or both, up to 12 times. In all but one animal the ductus was closed within 6 days after the procedure. The coils caused no infections or aortic and pulmonary artery obstruction. Histologic and electron microscopic studies revealed endothelial coverage of the implants but no foreign body reaction or local or systemic inflammation or erosion of the implant.Conclusions. The device effectively closed large PDAs in our model and may overcome the previous limitations of coils. Clinical trials are indicated.     

经导管弹簧圈堵闭小儿动脉导管未闭结扎术后残余分流

目的　评价经导管弹簧圈堵闭小儿动脉导管未闭 (PDA)结扎术后残余分流的应用价值。方法　 10例小儿PDA结扎术后残余分流的病人 ,男 3例 ,女 7例 ,平均年龄6 6± 2 9岁 (2～ 11岁 ) ,平均体重 18 6± 5 9公斤 (10～ 30公斤 ) ,均应用Cook可控弹簧圈经动脉途径进行堵闭。结果　残余分流PDA最小直径平均为 1 75± 0 6 2mm (0 8～ 3 0mm) ,漏斗形 8例 ,管形 2例 ;10例均用单个Cook可控弹簧圈一次堵闭成功 ,术后即刻造影仅 1例极少量残余分流 ;平均手术时间为 47 0± 3 5分钟 (40～ 5 0分钟 ) ,平均X线透视时间为 6 1± 1 8分钟 (4～ 10分钟 ) ;平均 32 2月随访残余分流均完全堵闭 ,无并发症出现。结论　经导管弹簧圈法是关闭小儿PDA结扎术后残余分流适宜 ,有效的方法。     

Transcatheter Closure of Patent Ductus Arteriosus in Under 6 kg and Premature Infants

Background

Transcatheter closure of a patent ductus arteriosus (PDA) has always been considered risky for infants weighing <6 kg and preterms. We present our findings regarding transcatheter closures of PDA.

Methods

The inclusion criteria were a weight of <6 kg and the presence of PDA symptoms. The study subjects were divided into two groups: <6 kg and premature infants.

Results

A total of 69 infants were included. The mean ages and weights of the <6 kg and the preterms were 5.4 ± 2.7 months and 30.3 ± 19.9 days, and 4.6 ± 0.8 and 1.7 ± 0.3 kg, respectively. Type C PDAs were most frequently observed in the premature group, and type A was in <6 kg. Sixteen of the patients were premature infants, and 81.2% of them had an extremely low birth weight. All of the premature infants had comorbidities, and had been receiving respiratory support therapy. Transcatheter closure was successfully completed in 81.2% of the premature infants and 94.3% of the <6‐kg infants. Major complications occurred in 4 patients (one death and three device embolizations). The patient's age was found to be the main risk factor. The most frequently used device was the Amplatzer duct occluder II in additional sizes (84.6%) in the preterms and the Amplatzer duct occluder I (34%) and II (34%) in the <6‐kg group.

Conclusion

The transcatheter closure of PDA is relatively safe and effective in preterms and in infants <6 kg. The selection of a suitable device based on the type of PDA is critical to the success of the procedure.

     

Incremental Value of Three‐Dimensional Transesophageal Echocardiography over the Two‐Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale

We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three‐dimensional transesophageal echocardiography provided considerable incremental value over two‐dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three‐dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden.     

Midterm Outcome of Stent Dilatation of Patent Ductus Arteriosus in Ductal‐dependent Pulmonary Circulation

Objective. We sought to assess the outcome of transcatheter ductus arteriosus stenting in newborns with ductal‐dependent pulmonary circulation. Background. Better results of ductal stenting have been reported using stents with better scaffolding and ensuring stenting of the entire length of the ductus arteriosus. Methods. Twenty‐one patients with ductal‐dependent pulmonary circulation were brought to the catheterization laboratory for ductal stenting. Five patients did not qualify because of a complex tortuous ductus arteriosus or branch pulmonary artery stenosis. Stent implantation was successful in 14 patients. The duct was accessed with a 0.014‐inch guidewire. A low profile premounted coronary stent was implanted in the duct without using a long delivery sheath. Attempts were made to cover the entire length of the ductus arteriosus. Results. The mean age of the patients at the time of stent implantation was 24 ± 17.5 days. The mean body weight was 2.9 ± 0.35 kg. The ductus was mildly tortuous in four, moderately tortuous in four, conical in four, and vertical in four patients. Ductal stenting was successful in 14 patients. The mean ductal diameter was 3.9 ± 0.5 mm. The mean diameter and the length of the stent implanted were 3.9 ± 0.72 and 15.4 ± 3.16 mm, respectively. Mean fluoroscopy and procedure times were 22.16 ± 12.5 and 107.9 ± 34.5 minutes, respectively. Out of the 14 successful stent implantations, the ductus arteriosus was not completely covered with the stent in five patients at the time of primary procedure, four of them required re‐stenting for significant desaturation. One of these patients died despite successful re‐stenting. Another patient died due to aspiration pneumonia. Of the 12 survivors, five underwent Glenn shunt (two deaths related to pulmonary hypertension), two underwent biventricular repair, one patient was lost to follow‐up, and the remaining four are doing well with a mean oxygen saturation of 85% at a mean follow‐up of 13 ± 6 months. Conclusion. Stenting of ductus arteriosus, including moderately tortuous ducts, is a safe palliation for patients with ductal‐dependent pulmonary circulation. Incomplete stenting of the duct invariably results in ductal stenosis and compromised pulmonary flow.     

Impact of Transcatheter Occlusion of a Patent Ductus Arteriosus on Atrial Septal Defect Diameter in Children

Background. A persistent patent ductus arteriosus (PDA) may delay closure of a coexisting atrial septal defect (ASD) due to volume loading and enlargement of the left atrium. The purpose of this study was to investigate the natural history of ASD size in patients with a PDA following transcatheter PDA occlusion. Methods. All patients with an ASD and a PDA who underwent transcatheter PDA occlusion at Texas Children’s Hospital were identified. Patients with ASD diameter <3 mm, or additional cardiac defects were excluded. Eight patients (7 females) with small‐ to moderate‐sized ASDs and a PDA were identified. Patient demographics, echocardiographic data, and cardiac catheterization data were recorded. Data were analyzed by 1‐tailed t‐test. Results. Following PDA occlusion, ASD diameter decreased in 6 of 8 patients by a mean of 3.8 mm (±2.3 mm), including 2 that closed. The median duration of follow‐up was 689 days. One ASD remained unchanged and 1 increased in size. The mean maximum ASD diameter decreased from 6.4 mm (±2.2 mm) to 3.9 mm (±3.4 mm) (P = .03). Two patients underwent subsequent transcatheter ASD occlusion. Conclusion. Following transcatheter PDA occlusion, small‐ to moderate‐sized ASDs have significant probability to decrease in size, and possibly close. In infants and children, we recommend transcatheter PDA occlusion, and serial follow‐up of the size of the ASD. This will allow many small‐ to moderate‐sized ASDs to either close, or become smaller, obviating the need for future intervention.     

Short‐Term Outcomes of Patent Ductus Arteriosus Closure With New Occlutech® Duct Occluder: A Multicenter Study

Aim

Over the past 2 decades, transcatheter occlusion of patent ductus arteriosus (PDA) with coils and the duct occluders evolved to be the procedure of choice. A new device, the Occlutech PDA® occluder (ODO) device has been designed. Herein, we aimed to evaluate the characteristics and short‐term results of patients who underwent transcatheter closure of PDA using the ODO.

Methods

We reviewed the clinical records of 60 patients from different centers in Turkey between December 2013 and January 2016. The medical records were reviewed for demographic characteristics and echocardiographic findings. Device size was selected on the narrowest diameter of PDA.

Results

The median patient age was 2.5 years (6 months–35 years), and median PDA diameter was 2.5 mm (1.2–11 mm). Fifty‐eight of 60 patients (96.6%) had successful ODO implantation. The occlusion rates were 37/58 (63.7%) at the end of the procedure, 51/58 (87.9%) at 24–48 hours post‐procedure, and 57/58 (98.2%) on echocardiography at a median follow‐up of 7.6 months.

Conclusion

Our results indicate that transcatheter closure of PDA using the ODO is effective. Larger studies and longer follow‐up are required to assess whether its shape and longer length make it superior to other duct occluders in large, tubular, or window‐type ducts. (J Interven Cardiol 2016;29:325–331)

     

Challenges in Device Closure of a Large Patent Ductus Arteriosus in Infants Weighing Less Than 6 Kg

Introduction

Transcatheter closure of patent ductus arteriosus (PDA) has replaced surgery in most institutions. Despite improvements in techniques and the devices available, closure of large PDA in very small infants remains a challenge.

Aim

To assess the challenges, feasibility, and efficacy of device closure of large PDA, in infants weighing ≤6 kg.

Materials and Methods

Analysis of device closure of a PDA was done in 61 infants ≤6 kg. Their ages, ranged from 9 days–12 months (mean 8.9 months), weight ranged from 2.2 to 6 kg (mean 5.3 kg), and PDA measured 3.2–8.7 mm (mean 4.8 mm). The fluoroscopy time was 3–18 minutes. The largest device used was 12 × 10 mm.

Results

Successful device placement was achieved in 60/61 infants (98.4%). Mild aortic obstruction occurred in 2 cases (3.3%), as the device got displaced towards the aorta after release. The device embolized in 2 cases (3.3%). In one it was retrieved by a novel method like fastening the screw in the aorta and was closed with a 4 × 6 ADO II. In the other infant, with a single kidney, died of uremia after device retrieval. Mild left pulmonary artery (LPA) obstruction occurred in one case (1.6%). Four cases (6.6%) had minor vascular complications. The postprocedure weight gain after 3 months was between 2.5 kg ± 250 mg.

Conclusions

Device closure of large PDA in infants weighing ≤6 kg with left ventricular failure is challenging but possible, safe and effective. Retrieval of embolized device could be tricky. (J Interven Cardiol 2013;26:69–76)