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Wang Z, Wang Q, Zhu X. Iatrogenic or predetermined aortic dysplasia? Cardiol Young 2023; 33:1456-1458. [PMID: 36805879 DOI: 10.1017/s104795112200419x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Coarctation of aorta post-transcatheter occlusion of patent ductus arteriosus is rare. We report a special case of infant with patent ductus arteriosus complicated by bicuspid aortic valve, who presented severe coarctation of aorta and aortic valve dysfunction post-patent ductus arteriosus occlusion during follow-up, eventually receiving surgical operations. A genetic rather than iatrogenic predisposition towards post-procedural complications has been discussed.
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Affiliation(s)
- Zhongchao Wang
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Qiguang Wang
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Xianyang Zhu
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang 110016, China
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Transcatheter patent ductus arteriosus closure in extremely premature infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Amelia P, Adriansyah R, Lubis B, Akil M. The Outcomes of Transcatheter Closure in Patients with Patent Ductus Arteriosus at Haji Adam Malik General Hospital, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Patent ductus arteriosus (PDA) is one of the most common acyanotic congenital heart diseases. The incidence of PDA is approximately 1 in 500 full-term neonates. The current management of PDA includes pharmacological and surgical treatments. Transcatheter closure is a preferable PDA treatment than pharmacological intervention, for medications have a higher failure rate in premature infants. Several studies have reported the efficacy and safety of transcatheter closure in smaller and lower-weight infants.
AIM: This study aims to describe the outcomes of transcatheter closure of PDA, which are complete closure, migrating device, and residuals, while also investigating factors that might affect these outcomes.
METHODS: A descriptive cross-sectional study was conducted from January to March 2018 in the pediatric cardiology outpatient clinic of Haji Adam Malik Hospital, Medan, Indonesia. All PDA patients who underwent transcatheter closure were included in this study. We collected patients’ demographic data (age and sex), PDA size (categorize into large, moderate, and small), and PDA closure outcomes from medical records. The collected data were then analyzed with SPSS.
RESULTS: One hundred and two children were included in this study, comprised 34 (33.3%) males and 68 (66.7%) females, with a mean age of 4.3 (±4.02) years old and the mean size of the defects 4.4 (±2.25) mm. Transcatheter closure with Lifetech® PDA Occluder was performed in 95 (93.1%) and MFO® in 7 (6.9%) patients. Small residuals were found in three patients, device migration was found in one patient. No relationship was found between the size of PDA and the outcomes measured.
CONCLUSION: We concluded that transcatheter closure remains an effective treatment for PDA, with a considerable success rate.
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Percutaneous Closure of Patent Ductus Arteriosus in Infants 1.5 kg or Less: A Meta-Analysis. J Pediatr 2021; 230:84-92.e14. [PMID: 33098843 DOI: 10.1016/j.jpeds.2020.10.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. STUDY DESIGN A systematic review and meta-analysis was performed. Data sources included Scopus, Web of Science, Embase, CINAHL, Cochrane, and PubMed from inception to April 2020. Publications were included if they had a clear definition of the intervention as percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. Data extraction was independently performed by multiple observers. Primary outcome was technical success and secondary outcomes were adverse events (AEs). Subgroup analysis was performed in infants ≤6.0 kg. Data were pooled by using a random-effects model. RESULTS We included 28 studies, including 373 infants ≤1.5 kg and 69 studies enrolling 1794 infants ≤6.0 kg. In patients ≤1.5 kg, technical success was 96% (95% CI, 93%-98%; P = .16; I2 = 23%). The overall incidence of AE was 27% (95% CI, 17%-38%; P < .001; I2 = 70%) and major AEs was 8% (95% CI, 5%-10%; P = .63; I2 = 0%). There were 5 deaths related to the procedure (2%; 95% CI, 1%-4%; P = .99; I2 = 0%); 4 of these deaths occurred in infants <0.8 kg. The probability of technical failure was inversely related to age at the time of the procedure (OR, 0.9; 95% CI, 0.830-0.974; P = .009). Weight at intervention has decreased over time and procedural success has increased. CONCLUSIONS Percutaneous patent ductus arteriosus closure is feasible in infants ≤1.5 kg with few major AEs. The procedural success rate is high, despite performing the intervention in smaller patients. PROSPERO REGISTRATION CRD42020145230.
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Podnar T, Plank F, Müller S, Mair J. A case report on the successful interventional treatment of a rare cause of left heart failure in a 69-year-old woman. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33628999 PMCID: PMC7891253 DOI: 10.1093/ehjcr/ytaa440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 10/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dyspnoea is very common in elderly patients and can be caused by a variety of different diseases. However, the initial diagnosis of patent ductus arteriosus (PDA) as a cause of left heart failure is very rare in this patient population. CASE SUMMARY A 69-year-old physically active woman with known hypertension presented with worsening exertional dyspnoea. Echocardiography showed a dilated left ventricle with moderately reduced left ventricular ejection fraction, and evidence for PDA. The PDA was confirmed by computed tomography angiography and successfully closed by implantation of an Amplatzer PDA occluder II 06-06 mm. As a result, the heart failure symptoms receded completely. DISCUSSION Congenital heart diseases should be considered as heart failure causes even in older adults. In addition to the standard medical therapy, there may be effective interventional treatment options to reverse the symptoms of heart failure in such patients.
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Affiliation(s)
- Tomaz Podnar
- Department of Child and Adolescent Health, Pediatrics III – Cardiology and Pulmonology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Fabian Plank
- Department of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Johannes Mair
- Department of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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Sheth K, Dalvi B. Left pulmonary artery stenting for relief of left pulmonary artery stenosis following ductal closure using Amplatzer Duct Occluder II. Ann Pediatr Cardiol 2019; 12:172-175. [PMID: 31143050 PMCID: PMC6521675 DOI: 10.4103/apc.apc_101_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 6-month-old infant with moderate-sized patent ductus arteriosus (PDA) and inadequate weight gain underwent closure of the duct using Amplatzer Ductal Occluder II (ADO II). She developed severe progressive left pulmonary artery (LPA) stenosis due to protrusion of the disc at the pulmonary end of the ADO II. She was subjected to balloon angioplasty of the LPA stenosis with suboptimal result. Hence, she was subjected to stenting of the LPA using a Formula stent which could be subsequently postdilated to keep up with the growth of the child. Immediate and short-term results were excellent anatomically as well as physiologically.
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Affiliation(s)
- Kshitij Sheth
- Department of Paediatric Cardiac Science, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Department of Paediatric Cardiac Science, Sir H N Reliance Foundation Hospital and Glenmark Cardiac Centre, Mumbai, Maharashtra, India
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Roushdy A, Abd el razek Y, Mamdouh Tawfik A. Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure. Echocardiography 2018; 35:71-78. [DOI: 10.1111/echo.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Alaa Roushdy
- Cardiology Department; Ain Shams University Hospital; Cairo Egypt
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El-Saiedi SA, El Sisi AM, Mandour RS, Abdel-Aziz DM, Attia WA. Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients. Ann Pediatr Cardiol 2017; 10:144-151. [PMID: 28566822 PMCID: PMC5431026 DOI: 10.4103/0974-2069.205138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims: In this study, we examined the differences in cost and effectiveness of various devices used for the closure of small to medium sized patent ductus arteriosus (PDA). Setting and Design: We retrospectively studied 116 patients who underwent closure of small PDAs between January 2010 and January 2015. Subjects and Methods: Three types of devices were used: the Amplatzer duct occluder (ADO) II, the cook detachable coil and the Nit Occlud coil (NOC). Immediate and late complications were recorded and patients were followed up for 3 months after the procedure. Statistical Methods: All statistical calculations were performed using Statistical Package for the Social Science software. P <0.05 were considered significant. Results: We successfully deployed ADO II devices in 33 out of 35 cases, cook detachable coils in 36 out of 40 cases and NOCs in 38 out of 41 cases. In the remaining nine cases, the first device was unsuitable or embolized and required retrieval and replacement with another device. Eleven patients (9.5%) developed vascular complications and required anticoagulation therapy. Patients who had hemolysis or vascular complications remained longer in the intensive care unit, with consequently higher total cost (P = 0.016). Also, the need for a second device increased the cost per patient. Conclusions: The cook detachable coil is the most cost-effective device for closure of small-to medium-sized PDAs. Calculations of the incremental cost-effectiveness. (ICE) revealed that the Cook detachable coil had less ICE than the ADO II and NOC. The NOC was more effective with fewer complications.
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Affiliation(s)
- Sonia A El-Saiedi
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Amal M El Sisi
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Rodina Sobhy Mandour
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Doaa M Abdel-Aziz
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
| | - Wael A Attia
- Department of Pediatrics, Division of Pediatric Cardiology, Cairo University Children's Hospital, Cairo, Egypt
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9
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Gruenstein DH, Ebeid M, Radtke W, Moore P, Holzer R, Justino H. Transcatheter closure of patent ductus arteriosus using the AMPLATZER™ duct occluder II (ADO II). Catheter Cardiovasc Interv 2017; 89:1118-1128. [DOI: 10.1002/ccd.26968] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Makram Ebeid
- Department of Pediatric Cardiology, University of Mississippi Medical Center; Jackson Mississippi
| | - Wolfgang Radtke
- Department of Pediatric Cardiology, Alfred I. duPont Hospital for Children; Wilmington Delaware
| | - Phillip Moore
- Department of Pediatric Cardiology, University of California San Francisco; San Francisco California
| | - Ralf Holzer
- Department of Pediatric Cardiology, Sidra Medical Center; Doha Qatar
| | - Henri Justino
- Department of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine; Houston Texas
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10
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Góreczny S, Dryżek P, Morgan GJ, Mazurek-Kula A, Moll JJ, Moll JA, Qureshi S, Moszura T. Fenestration closure with Amplatzer Duct Occluder II in patients after total cavo-pulmonary connection. Arch Med Sci 2017; 13:337-345. [PMID: 28261286 PMCID: PMC5332453 DOI: 10.5114/aoms.2016.61836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/16/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Creation of a fenestration during completion of a total cavopulmonary connection (TCPC) has been associated with a reduction in early mortality and morbidity. However, the long-term benefits are negated by an associated limitation in exercise tolerance and the potential risks of thrombo-embolic complications. We sought to describe the safety and efficacy of an Amplatzer Duct Occluder II (ADO II) for transcatheter fenestration closure following TCPC. MATERIAL AND METHODS Between January 2000 and July 2014, 102 patients underwent percutaneous closure of extra-cardiac TCPC fenestrations with a range of devices. Patients in whom fenestration closure was performed with an ADO II and who had at least 6 months of follow-up were included in this study. RESULTS Forty-seven patients had successful fenestration occlusion with an ADO II. The mean oxygen saturation and mean systemic venous pressures increased from 84.8 ±6.1% before to 97.6 ±2.9% (p < 0.001) after and from 14.2 ±2.15 mm Hg before to 15.6 ±2.2 mm Hg after closure (p < 0.001). Eight patients developed heart failure symptoms, managed by optimization of medical therapy, with 1 patient requiring device removal to reopen the fenestration. Color Doppler transthoracic echocardiography demonstrated residual flow across the device in 18 (38%), 10 (22%), 5 (11%) and 4 (9%) patients before discharge, at 1 and 6 months, and at the latest outpatient visit, respectively. CONCLUSIONS The ADO II can be safely and effectively used to close fenestrations in extra-cardiac type Fontan completions. Many of the design features of this device confer potential benefit in this population.
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Affiliation(s)
- Sebastian Góreczny
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Paweł Dryżek
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Gareth J. Morgan
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Anna Mazurek-Kula
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Jacek J. Moll
- Department of Cardiac Surgery, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Jadwiga A. Moll
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
| | - Shakeel Qureshi
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tomasz Moszura
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
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11
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Backes CH, Rivera BK, Bridge JA, Armstrong AK, Boe BA, Berman DP, Fick T, Holzer RJ, Hijazi ZM, Abadir S, Justino H, Bergersen L, Smith CV, Kirpalani H. Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis. Pediatrics 2017; 139:peds.2016-2927. [PMID: 28087683 DOI: 10.1542/peds.2016-2927] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Patent ductus arteriosus (PDA) is a precursor to morbidity and mortality. Percutaneous (catheter-based) closure is the procedure of choice for adults and older children with a PDA, but use during infancy (<1 year) is not well characterized. OBJECTIVE Investigate the technical success and safety of percutaneous PDA closure during infancy. DATA SOURCES Scopus, Web of Science, Embase, PubMed, and Ovid (Medline) were searched through December 2015 with no language restrictions. STUDY SELECTION Publications needed to clearly define the intervention as percutaneous PDA closure during infancy (<1 year of age at intervention) and must have reported adverse events (AEs). DATA EXTRACTION The study was performed according to the Systematic Reviews and Meta-Analysis checklist and registered prospectively. The quality of the selected studies was critically examined. Data extraction and assignment of AE attributability and severity were independently performed by multiple observers. Outcomes were agreed on a priori. Data were pooled by using a random-effects model. RESULTS Thirty-eight studies were included; no randomized controlled trials were found. Technical success of percutaneous PDA closure was 92.2% (95% confidence interval [CI] 88.8-95.0). Overall AE and clinically significant AE incidence was 23.3% (95% CI 16.5-30.8) and 10.1% (95% CI 7.8-12.5), respectively. Significant heterogeneity and publication bias were observed. LIMITATIONS Limitations include lack of comparative studies, lack of standardized AE reporting strategy, and significant heterogeneity in reporting. CONCLUSIONS Percutaneous PDA closure during infancy is feasible and associated with few catastrophic AEs; however, the limitations constrain the interpretability and generalizability of the current findings.
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Affiliation(s)
- Carl H Backes
- Centers for Perinatal Research, .,Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | | | - Jeffrey A Bridge
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Innovation in Pediatric Practice, and
| | - Aimee K Armstrong
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Brian A Boe
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Darren P Berman
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Tyler Fick
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Ralf J Holzer
- Department of Pediatrics, Weill Cornell Medical College, New York, New York.,Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Weill Cornell Medical College, New York, New York.,Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar
| | - Sylvia Abadir
- Department of Pediatric Cardiology, CHU mère-enfant Sainte-Justine, Université de Montréal, Quebec, Canada
| | - Henri Justino
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington; and
| | - Haresh Kirpalani
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Transcatheter closure of ventricular septal defects using the Amplatzer Duct Occluder II device: a single-center experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:340-347. [PMID: 27980548 PMCID: PMC5133323 DOI: 10.5114/aic.2016.63635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/27/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Off-label use of different devices has been described for percutaneous closure of ventricular septal defects (VSD) because of the unacceptable rate of post-procedure heart block associated with special VSD devices. Aim To describe the early single-center clinical experience with closure of a VSD using the Amplatzer Duct Occluder II (ADO II) device in children. Material and methods Between May 2013 and June 2015, 26 patients between 13 days and 16 years of age underwent percutaneous closure of a VSD with an ADO II device at our institute. The decision to use the ADO II device was based primarily on lower risk of total atrioventricular block (TAVB) after VSD closure reported in the literature, reduction of the cost of the procedure and the need to close symptomatic VSDs in young patients. Results The location of the VSD was perimembranous in 21 patients, postsurgical residual in 2, midmuscular in 2 and apical muscular in 1. Complex procedures including newborn, combined procedures and postsurgical residual VSD were performed in 5 (19%) patients. The median duration of follow-up was 12 months. The complete VSD closure rate was 81% immediately after the procedure, 85% at 24 h, and 93% at the last follow-up. There was no device embolization. During the entire follow-up period, TAVB did not develop. Conclusions The ADO II constitutes a safe and effective therapeutic alternative for morphologically varied VSDs in all pediatric age groups. A larger range of sizes and configurations of this occluder may be required to successfully occlude a wider range of VSDs.
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Sathanandam S, Justino H, Waller BR, Radtke W, Qureshi AM. Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants. Catheter Cardiovasc Interv 2016; 89:1051-1058. [DOI: 10.1002/ccd.26878] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/06/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Shyam Sathanandam
- Division of Pediatric Cardiology, Department of Pediatrics; University of Tennessee Health Science Center, LeBonheur Children's Hospital; Memphis Tennessee
| | - Henri Justino
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - B. Rush Waller
- Division of Pediatric Cardiology, Department of Pediatrics; University of Tennessee Health Science Center, LeBonheur Children's Hospital; Memphis Tennessee
| | - Wolfgang Radtke
- Division of Pediatric Cardiology, Department of Pediatrics; A.I. Dupont Hospital For Children; Wilmington Delaware
| | - Athar M. Qureshi
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
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14
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Wang-Giuffre EW, Breinholt JP. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants. Catheter Cardiovasc Interv 2016; 89:1059-1065. [DOI: 10.1002/ccd.26855] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Elizabeth W. Wang-Giuffre
- Division of Pediatric Cardiology, Department of Pediatrics; University of Texas Health Science Center at Houston; Houston Texas
| | - John P. Breinholt
- Division of Pediatric Cardiology, Department of Pediatrics; University of Texas Health Science Center at Houston; Houston Texas
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15
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Pan XB, Ouyang WB, Wang SZ, Liu Y, Zhang DW, Zhang FW, Pang KJ, Zhang Z, Hu SS. Transthoracic Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Occlusion: A New Strategy for Interventional Treatment. Echocardiography 2016; 33:1040-5. [PMID: 27038152 DOI: 10.1111/echo.13207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Percutaneous patent ductus arteriosus (PDA) occlusion has become the preferred therapeutic option, which uses fluoroscopy as the guidance. To reduce the x-ray exposure, PDA occlusion using the Amplatzer Duct Occluder II (ADO II) under guidance of transthoracic echocardiography only was conducted. This single center study aims to access the safety and efficiency of this new strategy. METHODS AND RESULTS From June 2013 to May 2015, 63 consecutive PDA patients underwent transthoracic echocardiography-guided PDA occlusion through the femoral artery. Outpatient follow-up was conducted at 1, 3, and 6 months, and yearly. Sixty-two patients successfully underwent echocardiography-guided percutaneous PDA occlusion. One patient was converted to minimally invasive transthoracic occlusion due to failure of delivery sheath passage through tortuous PDA. Mean procedure duration was 24.3 ± 7.0 minutes; ADO II diameter averaged 4.6 ± 0.9 mm; 8 cases showed traces of residual shunt immediately after operation which resolved after 24 hours; and mean hospital stay was 3.4 ± 0.5 days. There was no occluder migration, hemolysis, pericardial effusion, pulmonary branch or aortic stenosis at mean 13.5 ± 4.8 months follow-up. CONCLUSIONS This study demonstrated that percutaneous PDA occlusion can be successfully performed under guidance of transthoracic echocardiography only and appears safe and effective while avoiding radiation and contrast agent use.
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Affiliation(s)
- Xiang-Bin Pan
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen-Bin Ouyang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shou-Zheng Wang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yao Liu
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Da-Wei Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng-Wen Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kun-Jing Pang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhe Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sheng-Shou Hu
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Abstract
Despite several reports describing echocardiography for the guidance of ductal closure, two-dimensional angiography remains the mainstay imaging tool; three-dimensional rotational angiography has the potential to overcome some of the drawbacks of standard angiography, and reconstructed image overlay provides reliable guidance for device placement. We describe arterial duct closure solely from venous approach guided by live three-dimensional image overlay.
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Masri S, El Rassi I, Arabi M, Tabbakh A, Bitar F. Percutaneous closure of patent ductus arteriosus in children using amplatzer duct occluder II: relationship between PDA type and risk of device protrusion into the descending aorta. Catheter Cardiovasc Interv 2015; 86:E66-72. [PMID: 26032159 DOI: 10.1002/ccd.25940] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/02/2015] [Accepted: 03/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of Amplatzer Duct Occluder II (ADOII) among the various patent ductus arteriosus (PDA) types, and to assess the association between development of aortic obstruction and the PDA type in terms of measurable parameters as the device angulation and distance of upper end protrusion into the aortic lumen. METHODS Retrospective cohort study involving 50 consecutive subjects who underwent ADO II device closure of PDA. RESULTS The median age and weight at intervention were 13 months (5.5 months to 18 years) and 11 (6-67) kg respectively. The median smallest ductal diameter by angiography was 3.2 (1.9-5.4) mm. Thirty two patients had type A PDA, 5 had type C, 5 had type D, and 8 had type E. Residual shunt was seen in only 1 patient who had a tubular PDA and resolved within 2 months of the procedure. No device embolization or pulmonary side protrusion were noted. There was a 16% aortic protrusion rate. The median distance of protrusion of the upper end of the device into the aortic lumen was 3.1 (0-9) mm and the median angle formed between the aortic end of the device and the PDA take-off was 10.4 (0-80.6) degrees. These latter parameters of aortic obstruction were significantly higher in the non-conical PDA group as compared to the conical PDA. Nevertheless, there was no significant coarctation due to aortic retention disc protrusion. CONCLUSION Device closure of PDA using the ADO II is a safe procedure for chosen types of PDA. We demonstrated a novel technique for objective assessment of device protrusion into the descending aorta based on measurable parameters. ADOII device closure of non-conical PDAs warrants closer follow ups.
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Affiliation(s)
- Samer Masri
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Division of Pediatric and Congenital Cardiac Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Anas Tabbakh
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon
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18
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GARAY FRANCISCOJ, AGUIRRE DANIEL, CÁRDENAS LUIS, SPRINGMULLER DANIEL, HEUSSER FELIPE. Use of the Amplatzer Vascular Plug II Device to Occlude Different Types of Patent Ductus Arteriosus in Pediatric Patients. J Interv Cardiol 2015; 28:198-204. [DOI: 10.1111/joic.12188] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - LUIS CÁRDENAS
- Hospital de Niños Dr. Luis Calvo Mackenna; Santiago Chile
| | | | - FELIPE HEUSSER
- Hospital Clínico de la Universidad Católica de Chile; Santiago Chile
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Narayan SA, Elmahdi E, Rosenthal E, Qureshi SA, Krasemann T. Long-term follow-up is not indicated after routine interventional closure of persistent arterial ducts. Catheter Cardiovasc Interv 2015; 86:100-4. [PMID: 25753890 DOI: 10.1002/ccd.25912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 02/26/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known about the necessity for long-term follow-up after interventional closure of persistent arterial duct (PDA). Potential side effects and complications include residual shunts, haemolysis, device embolization, and obstruction to flow in the adjoining vessels. METHODS Single centre retrospective study of paediatric patients undergoing interventional PDA occlusion. RESULTS 315 patients who underwent interventional occlusion of a PDA between November 2002 and September 2013 were included. Of these, eight needed re-intervention (three for device embolization, five for residual shunt). Seven had mild obstruction to flow in the adjoining vessels, but did not require any intervention. All sequelae were found latest at the first follow-up appointment after the procedure (usually within 3 months); whilst none developed during further follow-up. CONCLUSION Complications of interventional closure of PDA were apparent immediately after the procedure or by three months of follow-up. Long-term follow-up is not indicated in cases when no complications are seen early after the procedure.
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Affiliation(s)
- Srinivas A Narayan
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
| | - Elfadil Elmahdi
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
| | - Eric Rosenthal
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
| | - Shakeel A Qureshi
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
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20
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Parra-Bravo JR, Osuna-Izaguirre MA, Beirana-Palencia L, Gálvez-Cancino F, Martínez-Monterrosas C, Lazo-Cárdenas C, Reyes-Vargas C. [Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:171-6. [PMID: 24998666 DOI: 10.1016/j.acmx.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/29/2013] [Accepted: 09/19/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. OBJECTIVE We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. METHODS We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7kg (range 6-16.3kg). The minimal ductus arteriosus diameter was 2.7mm (1-5mm). RESULTS Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4mm (3 patients), in 2 patients were used 3-4mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. CONCLUSIONS The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I.
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Affiliation(s)
- José Rafael Parra-Bravo
- Servicio de Cardiología, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
| | - Manuel Alfredo Osuna-Izaguirre
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Luisa Beirana-Palencia
- Servicio de Cardiología, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Franco Gálvez-Cancino
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Christian Martínez-Monterrosas
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - César Lazo-Cárdenas
- Servicio de Cardiología, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - César Reyes-Vargas
- Servicio de Pediatría, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
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21
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Kang SL, Morgan G, Forsey J, Tometzki A, Martin R. Long-term clinical experience with Amplatzer Ductal Occluder II for closure of the persistent arterial duct in children. Catheter Cardiovasc Interv 2014; 83:1102-8. [PMID: 24403100 DOI: 10.1002/ccd.25393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/09/2013] [Accepted: 12/21/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the long-term clinical experience and follow-up with the Amplatzer Ductal Occluder II (ADO II) in children. METHODS All patients undergoing attempted transcatheter closure of patent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters. RESULTS From March 2008 until March 2013, 62 patients with a median age of 1.2 years (range 0.43-11.1 years) and median weight of 9 kg (range 4.7-31.4 kg) underwent the procedure. The median measurement for minimal ductal diameter was 2.7 mm (range 1.3-5 mm). An ADO II was implanted in 60 patients (96.8%). Two patients had significant residual shunting following deployment of the ADO II and underwent closure with the Amplatzer ductal occluder I (ADO I) during the same procedure. In six patients, the initial ADO II was unsatisfactory, and after recapture a different size ADO II was deployed. Device embolization of the ADO II to the pulmonary artery occurred in 6.7% of patients. Of these, one underwent surgical closure and three were closed with an ADO I. Complete occlusion on echocardiography was noted prior to discharge in 87.5% of the deployed occluders and 100% at first follow-up. Five year follow-up (n = 25) revealed a 100% occlusion rate. There were three cases of persistent mild left pulmonary artery stenosis at long-term follow-up. CONCLUSIONS The ADO II is effective for occlusion of PDA with variable anatomy from either arterial or venous approaches with a low profile delivery system. Stable occluder position is highly dependent on accurate device sizing, good quality imaging to visualize device configuration after deployment and operator experience.
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Affiliation(s)
- Sok-Leng Kang
- Bristol Congenital Heart Centre, Bristol Royal Hospital for Children and Bristol Royal Infirmary, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
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22
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Baykan A, Narin N, Özyurt A, Argun M, Pamukçu Ö, Onan SH, Sezer S, Baykan Z, Üzüm K. Do we need a femoral artery route for transvenous PDA closure in children with ADO-I? Anatol J Cardiol 2014; 15:242-7. [PMID: 25333978 PMCID: PMC5337062 DOI: 10.5152/akd.2014.5269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The standard procedure in percutaneous closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder-I (ADO-I) is transvenous closure guided by aortic access through femoral artery. The current study aims to compare the procedures for PDA closure with ADO-I: only transvenous access with the standard procedure. METHODS This study was designed retrospectively and 101 pediatric patients were included. PDA closure was done by only femoral venous access in 19 of them (group 1), arterial and venous access used in 92 patients (group 2) between 2004 to 2012 years. The position of the device and residual shunt in group1 was evaluated by the guidance of the aortogram obtained during the return phase of the pulmonary artery injection and guidance of transthoracic echocardiography. Shapiro-Wilk's test, Mann-Whitney U, chi-squared tests were used for statistical comparison. RESULTS The procedure was successful in 18 (95%) patients in group 1 and 90 (98%) patients in group 2. Complications including the pulmonary artery embolization (n=1), protrusion to pulmonary artery (n=1), inguinal hematoma (n=3), bleeding (n=2) were only detected in group 2. In other words, while complications were observed in 7 (7.2%) patients in group 2, no minor/major complication was observed in group 1. Complete closure in group 1 was: in catheterization room 14 (77.8%), at 24th hour in 2 (11.1%), at first month in 2 (11.1%). Complete closure in group 2 was: 66 (73.4%) patients in the catheterization room, 21 (23.3%) at 24th hour, 3 (3.3%) at first month, complete closure occurred at the end of first month. CONCLUSION In percutaneouse PDA closure via ADO-I, this technique can be a choice for patients whose femoral artery could not be accessed, or access is impossible/contraindicated. But for the reliability and validity of this method, randomized multicenter clinical studies are necessary.
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Affiliation(s)
- Ali Baykan
- Department of Peadiatric Cardiology, Faculty of Medicine, Erciyes University; Kayseri-Turkey.
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23
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Huang Y, Kong JF, Venkatraman SS. Biomaterials and design in occlusion devices for cardiac defects: a review. Acta Biomater 2014; 10:1088-101. [PMID: 24334144 DOI: 10.1016/j.actbio.2013.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/14/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
This review examines the biomaterials used in occlusion devices for cardiac defects, and how the choice of these materials is dictated by design. Specifically, the devices used in three major applications, the atrial septal defect, the ventricular septal defect and the patent ductus arteriosus, are examined critically. A number of different devices are available, with varied performance in deployment and sealing. There is no device in any of the three categories that satisfies fully the range of requirements, and all have associated complications. The type and rate of complications are different among different devices. The short-term (immediate) complications are addressed by immediate retrieval. For longer-term complications, most of which can be fatal, currently only surgical retrieval and replacement are possible. Most of these longer-term complications can be alleviated by the use of fully degradable devices, which will eliminate concerns regarding the use of metals inside the heart, and if fully endothelialized, also minimize migration concerns. On the other hand, the lower moduli of currently available biodegradable materials need to be augmented. Improvements in the stiffness required for deployment can be accomplished with the use of fillers, nano- or micro-sized, and an example of this are radiopaque fillers.
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24
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Tang L, Zhou S, Shen X. Severe spinal cord ischemic injury secondary to device embolization after transcatheter closure of a patent arterial duct. Tex Heart Inst J 2014; 41:83-6. [PMID: 24512410 DOI: 10.14503/thij-12-2927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous closure of patent arterial ducts with the Amplatzer Ductal Occluder has become an effective and widely accepted alternative to surgical management. Although rarely, the occluder can be dislodged after an initially successful deployment, and with catastrophic consequences. We describe such a case in a 12-month-old girl who underwent transcatheter closure of a patent arterial duct. After device deployment, the occluder embolized in the patient's descending thoracic aorta, and severe spinal cord ischemic injury resulted. To our knowledge, ours is the first report of this complication after the deployment of an Amplatzer Ductal Occluder. We discuss pathophysiologic mechanisms that could expose patients to the risk of device dislodgment, and we review the relevant medical literature.
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Affiliation(s)
- Liang Tang
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha 410011, People's Republic of China
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25
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Liem NT, Tung CV, Van Linh N, Tuan TM, Quang LH, Tu TT. Outcomes of thoracoscopic clipping versus transcatheter occlusion of patent ductus arteriosus: randomized clinical trial. J Pediatr Surg 2014; 49:363-6. [PMID: 24528987 DOI: 10.1016/j.jpedsurg.2013.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 11/18/2022]
Abstract
AIM To compare outcomes of thoracoscopic clipping (TC) versus transcatheter occlusion (TO) for patent ductus arteriosus (PDA). PATIENTS AND METHODS One hundred patients were enrolled in the study from May 2010 to December 2011. Those patients were randomized into 2 groups: group one received TC, group two received TO. RESULT There were no significant differences concerning width or length of the ductus (P>0.05). However the median age and median weight of patients in the TO group were greater than in the TC group (P<0.05). Mean operative time was 32 ± 12 min in the TC group versus 20 ± 3 min in the TO group (P<0.05). There were no deaths in either group. There were no complications in the TC group whereas three patients in the TO group had complications and required subsequent operation. Median postoperative stay was 3.5 days (IQR: 3.0-4.3) in the TC group versus 3 days (IQR: 2.0-4.0) in the TO group (P<0.05). There was no residual shunting in either group. Average cost for one patient was $645 ± 232 in the TC group versus $1,260 ± 204 in the TO group (P<0.001). CONCLUSION Thoracoscopic clipping is safer than transcatheter occlusion for PDA repair, with the same effectiveness and lower cost.
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Affiliation(s)
| | - Cao Viet Tung
- Cardiology Department, National Hospital of Pediatrics, Hanoi, Vietnam, Hanoi, Vietnam
| | - Nguyen Van Linh
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - To Manh Tuan
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Le Hong Quang
- Cardiology Department, National Hospital of Pediatrics, Hanoi, Vietnam, Hanoi, Vietnam
| | - Tran Thanh Tu
- Research Institute for Child Health, National Hospital of Pediatrics, Hanoi, Vietnam
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Cubeddu RJ, Babin I, Inglessis I. The off-label use of the Amplatzer muscular VSD occluder for large patent ductus arteriosus: a case report and review. Cardiovasc Interv Ther 2013; 29:256-60. [DOI: 10.1007/s12928-013-0223-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/20/2013] [Indexed: 11/28/2022]
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Kumar SM, Subramanian V, Bijulal S, Krishnamoorthy KM, Sivasankaran S, Tharakan JA. Percutaneous closure of a moderate to large tubular or elongated patent ductus arteriosus in children younger than 3 years: is the ADO II appropriate? Pediatr Cardiol 2013; 34:1661-7. [PMID: 23591801 DOI: 10.1007/s00246-013-0700-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
Protrusion of the Amplatzer duct occluder (ADO) II device into the aortic isthmus or the pulmonary artery causing obstruction and residual flow has been reported, but the same has not been widely studied in small children with a patent ductus arteriosus (PDA) anatomy not considered suitable for closure with the ADO I device. This study aimed to report the safety and efficacy of the ADO II device in children younger than 3 years with a tubular or elongated PDA and to analyze the possible reasons for residual flow in children with such a PDA. In this study, 17 children younger than 3 years (mean age, 10.3 ± 7 months; mean weight, 6 ± 3.6 kg) underwent attempted closure of a tubular or elongated PDA (mean diameter at the narrowest point, 4.1 ± 1.1 mm) with the ADO II device between July 2010 and July 2012. Of the 17 patients, 16 (2 boys and 14 girls) completed the follow-up evaluation. A complete echocardiographic evaluation was performed on all the patients before PDA closure and at the follow-up visit, and the results were compared with those of previous published studies. Of the 16 patients, the 15 who completed the follow-up evaluation had successful device closure (1 device embolization). Residual flow was present in six patients immediately after deployment, which was reduced to three patients at the last follow-up visit. Five of nine patients closed with a 6-mm-long device had residual flow compared with only one of seven patients closed with a 4-mm-long device. After device closure, significant elevations of the left and right pulmonary artery velocities occurred in three and two patients, respectively; in 12 patients, descending thoracic aortic (DTA) velocities increased mildly. There was trend toward a fall in the elevated pressures at the last follow-up visit, although one patient had an elevation in right pulmonary artery velocity at last the follow-up echocardiogram compared with the echocardiogram immediately after closure. Hence, in children younger than 3 years with or without pulmonary arterial hypertension, closure of a PDA not amenable to closure with the ADO I device is feasible using the ADO II device, with an increased incidence of clinically nonsignificant complications. Selection of device dimensions according to the manufacturer's recommendation may not be the optimal strategy.
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Affiliation(s)
- Saktheeswaran Mahesh Kumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India,
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28
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Kenny D, Morgan GJ, Bentham JR, Wilson N, Martin R, Tometzki A, Oslizlok P, Walsh KP. Early clinical experience with a modified amplatzer ductal occluder for transcatheter arterial duct occlusion in infants and small children. Catheter Cardiovasc Interv 2013; 82:534-40. [DOI: 10.1002/ccd.24522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 04/13/2012] [Accepted: 06/12/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Damien Kenny
- Rush Center for Congenital and Structural Heart Disease Rush University Medical Center; Chicago, IL; USA
| | | | | | | | | | | | - Paul Oslizlok
- Our Lady's Hospital for Sick Children; Dublin; Ireland
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29
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Sungur M, Karakurt C, Ozbarlas N, Baspinar O. Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer duct occluder II additional sizes: Multicenter study. Catheter Cardiovasc Interv 2013; 82:245-52. [DOI: 10.1002/ccd.24905] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/19/2013] [Accepted: 02/26/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Metin Sungur
- Department of Pediatric Cardiology; Ondokuz Mayis University; Samsun Turkey
| | - Cemsit Karakurt
- Department of Pediatric Cardiology; İnönü University; Malatya Turkey
| | - Nazan Ozbarlas
- Department of Pediatric Cardiology; Cukurova University; Adana Turkey
| | - Osman Baspinar
- Department of Pediatric Cardiology; Gaziantep University; Gaziantep Turkey
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30
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Liddy S, Oslizlok P, Walsh KP. Comparison of the results of transcatheter closure of patent ductus arteriosus with newer amplatzer devices. Catheter Cardiovasc Interv 2013; 82:253-9. [DOI: 10.1002/ccd.24768] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 11/13/2012] [Accepted: 11/25/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Stephen Liddy
- Department of Cardiology; St Vincent's University Hospital; Dublin 4 Ireland
| | - Paul Oslizlok
- Cardiac Department; Our Lady's Hospital for Sick Children; Crumlin Dublin Ireland
| | - Kevin P. Walsh
- Cardiac Department; Our Lady's Hospital for Sick Children; Crumlin Dublin Ireland
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31
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Morgan GJ, Yim DLS, Hayes AM, Martin RP, Hamilton MCK, Stuart G. Imaging and percutaneous occlusion of a large aneurysm of the ductus arteriosus in an infant with Loeys-Dietz syndrome. CONGENIT HEART DIS 2013; 8:E192-5. [PMID: 23350955 DOI: 10.1111/chd.12041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 11/28/2022]
Abstract
Loeys-Dietz is a multisystem congenital syndrome that comprises craniofacial and cutaneous abnormalities as well as structural cardiac defects. One of its key pathological features is an aggressive widespread vasculopathy that can manifest as aortic or cerebral aneurysms, which is prone to dissection and rupture. We report a case of a large aneurysm of the ductus arteriosus in a patient with Loeys-Dietz syndrome, successfully occluded by interventional catheterization.
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Affiliation(s)
- Gareth J Morgan
- Department of Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
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32
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Baspinar O, Irdem A, Sivasli E, Sahin DA, Kilinc M. Comparison of the efficacy of different-sized Amplatzer duct occluders (I, II, and II AS) in children weighing less than 10 kg. Pediatr Cardiol 2013; 34:88-94. [PMID: 22648339 DOI: 10.1007/s00246-012-0393-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
The transcatheter closure of patent ductus arteriosus (PDA) may cause more complications in small children. Amplatzer (St. Jude Medical, Plymouth, MN) has produces three types of devices for ductal occlusion: the Amplatzer duct occluder I (ADO I) and II (ADO II) and the recently introduced ADO II additional sizes (ADO II AS). We performed this study to determine the efficacy and complication rates in children who weigh <10 kg for the three types of devices used in our clinic. Between February 2007 and March 2012, 77 patients weighing <10 kg had their PDAs occluded with ADOs. The mean age of the patients was 0.76 ± 0.44 years (range 17 days-2 years), and their mean weight was 6.73 ± 2.05 (range 1.2-9.9) kg. In total, 54 girls (70.1 %) and 23 boys (29.9 %) with a mean pulmonary ductus diameter of 2.55 ± 1.0 (1.08-5.94) mm were included in the study. The ADO I was used in 26 patients (33.8 %); the ADO II was used in 43 patients (55.8 %); and the ADO II AS was used in 8 patients (10.4 %). The mean ages of patients with the ADO I, ADO II, and ADO II AS were 1.07 ± 0.48, 0.66 ± 0.31, and 0.28 ± 0.17 years (p < 0.05), respectively. Their mean weights were 7.86 ± 1.45, 6.50 ± 1.85, and 4.36 ± 2.49 kg (p < 0.05), respectively. Their mean narrowest ductal diameters were 3.11 ± 0.96, 2.25 ± 1.06, and 2.33 ± 1.01 mm (p < 0.05), respectively. The use of the ADO II and ADO II AS was found to be more common in type C defects. One patient with the ADO I and 5 patients with the ADO II (7.8 %) developed varying degrees of left pulmonary artery stenosis or iatrogenic aortic coarctation. In 1 patient, the ADO II AS was replaced with the ADO II due to a significant residual shunt observed during the procedure. Each of the ADOs has its own advantages and disadvantages. Although the ADO I is convenient for medium- and large-sized defects, the ADO II and ADO II AS can be used both anterogradely and retrogradely. The ADO II AS is safe and efficient to use in small infants.
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Affiliation(s)
- Osman Baspinar
- Pediatric Cardiology Department, Gaziantep University Medical Faculty, 27310 Gaziantep, Turkey.
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Delaney JW, Fletcher SE. Patent ductus arteriosus closure using the Amplatzer® vascular plug II for all anatomic variants. Catheter Cardiovasc Interv 2012; 81:820-4. [PMID: 23074167 DOI: 10.1002/ccd.24707] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 10/07/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the Amplatzer® Vascular Plug II (AVPII) for closure of the patent ductus arteriosus (PDA). BACKGROUND The PDA has significant anatomic variation. No device has proven applicable to all PDAs. Previous case reports and small series have documented limited use of the AVPII for some PDA types. We describe the largest and most diverse experience using the AVPII. METHODS A retrospective analysis of patients undergoing percutaneous PDA closure between 01/01/2009 and 05/01/2012 was performed. The PDA was characterized, measured, and the device chosen was listed. Deployment technique, complications and procedural results were recorded. RESULTS Sixty-seven procedures were performed. The AVPII was utilized for 43 (64.2%), 15 (20.9%) had coils, 7 (10.4%) had the AGA duct occluder, and 3 (4.5%) were referred for surgery. The AVPII was placed in infants as young as 2 months and 4.2 kg. AVPII size ranged from 4 to 10 mm. All PDA types were closed. Retrograde and antegrade deployments were performed, using the outer disc as a "retention skirt" to secure the device and improve occlusion. Three patients were up-sized prior to release. All deployments were successful; 89% "in-lab" and 100% closure on postprocedural echocardiogram. There were no complications. CONCLUSIONS We report the largest experience with the AVPII for PDA closure. The device was used in all morphologic types and small patients. It is low profile, easily repositioned, and had excellent results without complications. We contend that this is the most versatile device currently available.
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Affiliation(s)
- Jeffrey W Delaney
- Children's Hospital and Medical Center, Department of Pediatrics, Division of Pediatric Cardiology, University of Nebraska, Omaha, Nebraska 68114, USA.
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Abstract
OBJECTIVES To determine the safety and efficacy of the Amplatzer duct occluder and the Amplatzer duct occluder II in different types of arterial ducts, and to determine in which types of ducts the use of this new device can be advantageous. METHODS All children with a device-based ductal closure between September, 2005 and February, 2010 were included. We retrospectively analysed the catheterisation and follow-up data. RESULTS Between September, 2005 and February, 2010, 44 ducts were closed with the Amplatzer duct occluder - group Amplatzer duct occluder - and 52 ducts were closed with the Amplatzer duct occluder II - group Amplatzer duct occluder II. In the Amplatzer duct occluder group, the mean age was 3 years and 4 months, and the mean weight was 14.7 kilograms. Closure was successfully performed in all children. Complete closure at 24 hours was attained in 42 of 44 children (95.45%). No major complications occurred. In the Amplatzer duct occluder II group, the mean age was 6 years and 2 months, and the mean weight was 25.4 kilograms. Closure was successfully performed in all children, except in two children in whom the occluder protruded into the aortic isthmus and was replaced by the Amplatzer duct occluder. Complete closure at 24 hours was attained in 51 of 52 children (98.08%). No major complications occurred. CONCLUSION In our experience, duct closure with the Amplatzer duct occluder II is a safe and effective method. The advantages of using it are the smaller sheath sizes and softer shape.
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Koh GT, Ai Mokthar S, Hamzah A, Kaur J. Transcatheter closure of patent ductus arteriosus and interruption of inferior vena cava with azygous continuation using an Amplatzer duct occluder II. Ann Pediatr Cardiol 2011; 2:159-61. [PMID: 20808631 PMCID: PMC2922666 DOI: 10.4103/0974-2069.58320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of transcatheter closure of patent ductus arteriosus using the new Amplatzer duct occluder II in an adult patient with interrupted inferior vena cava with azygous continuation via the femoral artery approach.
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Affiliation(s)
- Ghee Tiong Koh
- Department of Cardiology, Pediatric Cardiology Unit, Penang General Hospital, Penang, Malaysia
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 492] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Tahlawi ME, Kammache I, Fraisse A. Ventricular septal defect closure in a small children with the Amplatzer Duct Occluder II. Catheter Cardiovasc Interv 2011; 77:268-71. [DOI: 10.1002/ccd.22723] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bentham J, Meur S, Hudsmith L, Archer N, Wilson N. Echocardiographically guided catheter closure of arterial ducts in small preterm infants on the neonatal intensive care unit. Catheter Cardiovasc Interv 2010; 77:409-15. [DOI: 10.1002/ccd.22637] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 04/23/2010] [Indexed: 11/05/2022]
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Spies C, Cao QL, Hijazi ZM. Transcatheter closure of congenital and acquired septal defects. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beck C, Laser KT, Haas NA. Failure of the Amplatzer ductal occluder II: kinking of the aortic retention disk at 24 hours. Catheter Cardiovasc Interv 2010; 75:1100-3. [PMID: 20310021 DOI: 10.1002/ccd.22467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since March 2008, the new Amplatzer duct occluder II (ADO II) has been used clinically for PDA closure in Europe. We report an interesting case of a 2(1/2)-year-old girl with a 3-mm conical shape PDA (type A PDA) who underwent uneventful implantation of 3/4 ADO II with complete closure by angiography and echocardiographic control at the end of the procedure. To our surprise, echocardiography 24 hr later revealed a moderate secondary shunt due to kinking of the aortic retention disk of the device with the central waist and the pulmonary retention disk still in correct position. The persistent shunt was closed 1 year later in the cath lab with a 9/6 Nit-Occlud device. To our knowledge, this is the first reported late complication directly related to the device.
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Affiliation(s)
- Carsten Beck
- Department for Congenital Heart Defects, Ruhr University Bochum, Bad Oeynhausen, Germany.
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Further experience with catheter closure of patent ductus arteriosus using the new Amplatzer duct occluder in children. Am J Cardiol 2010; 105:1005-9. [PMID: 20346321 DOI: 10.1016/j.amjcard.2009.11.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to report our additional experience with transcatheter closure of the patent ductus arteriosus in 65 consecutive patients using the new Amplatzer duct occluder. The median patient age was 3.6 years (range 0.2to 12), and the median weight was 10.5 kg (range 4 to 38). The device was a modified Amplatzer duct occluder made of fabric-free fine Nitinol wire net in to 2 very low profile disks with an articulated connecting waist. It is delivered through a 4Fr to 5Fr delivery sheath. The device was permanently implanted in 62 of 65 patients. The mean patent ductus arteriosus diameter (at the pulmonary end) was 3.6 +/- 1.3 mm (range 0.5 to 5.5). The mean device diameter (waist diameter) was 4.2 +/- 1.5 mm (range 3 to 6). Complete echocardiographic closure of the PDA at 1 month follow-up was observed in 61 (98%) of 62 patients. Immediately after the procedure, mild left pulmonary stenosis (peak pressure gradient of 8, 10, and 12 mm Hg) in 3 of 63 patients. Device embolization in 1 patient was the main complication of the procedure. No other complications were observed. In conclusion, catheter closure using the Amplatzer duct occluder II is an effective and safe therapy for most patients with patent ductus arteriosus. Additional studies are required to document its efficacy, safety, and long-term results in a larger patient population.
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Saliba Z, El-Rassi I, Abi-Warde MT, Chehab G, Daou L, Khater D, Gerbaka B, Jebara V. The Amplatzer Duct Occluder II: a new device for percutaneous ductus arteriosus closure. J Interv Cardiol 2009; 22:496-502. [PMID: 19780890 DOI: 10.1111/j.1540-8183.2009.00504.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Study the new Amplatzer Duct Occluder II (ADO II). Limitations were encountered with the preexisting devices in nonconical ducts, large ducts, or in small infants. These include failure, residual shunts, protrusion, migration, and vascular damage. METHODS Between June 2008 and March 2009, 20 consecutive patients were enrolled. In cases where different devices were applicable, we favored the use of the ADO II to maximize our experience with this device and prove its superiority. No coils were required in these 20 patients. RESULTS There were 15 females and 5 males (median age 2 years). ADO II group (n = 16): Immediate complete closure in 75% of the patients, rising to 93.7% at 24 hours. A residual shunt persisted at 3 months in one child. Aortic narrowing from device protrusion was noted in two type E ducts, without any significant gradient, however. ADO I group (n = 4): In two adolescents and in one adult patient, the duct was successfully closed. In a 2-year-old patient with a 6.6 mm type B duct, the ADO I totally obstructed the aortic flow and was retrieved before releasing. The child was sent for surgery. CONCLUSION Even though we did not compare the ADO II to other devices, we feel that it has the capacity to substitute most of the coils, and some of the original ADO I indications. Arterial access was sufficient in most patients, but venous delivery is advised in small infants with large or long ducts, to avoid aortic protrusion and residual shunts.
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Affiliation(s)
- Zakhia Saliba
- From the Saint Joseph University, Hotel-Dieu de France Hospital, Pediatric Cardiology & Cardiac Surgery, Beirut, Lebanon
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