A fully biodegradable patent ductus arteriosus occlude

The purpose of this study was to develop a fully degradable occluder for the closure of PDA, which can be deployed percutaneously. The blends of biodegradable poly(ε-caprolactone) and poly(L-lactide-co-ε-caprolactone) with various compositions were studied as the potential material. The mechanical properties, i.e. elastic modulus and strain recovery, of the blends could be largely tailored by changing the continuous phase component. Moreover, the suitable blends were selected to fabricate a prototype and its in vitro biodegradation rate and blood compatibility, was evaluated. The current results indicate that no adverse effect on the platelet and leukocyte components of the blood. Biocompatibility implantation studies of the device showed acceptable tissue response. Finally, an artificial PDA conduit was created in a pig, and the device deployment was tested from a sheath: the device recovered within 2-3 min of unsheathing and fully sealed the conduit.

[Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II]

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.

Early postoperative interventional ASD-closure for severe atrial right to left shunt in a neonate with common arterial trunk

Although closure of an atrial septal defect (ASD II) with an occluding device in the first year of life is not a routine procedure, it is a feasible treatment, even in neonates. Case reports on the off-label use of Amplatzer devices have been repeatedly published, but there are no reports on using the Amplatzer Duct Occluder (ADO) to close an atrial septal defect in a neonate. We report on a successful catheter closure of an ASD II with ADO in a severely cyanotic neonate, seven days after surgical repair of common arterial trunk. Due to progressive cyanosis and clinical signs of right ventricular failure, which developed after common arterial trunk repair, the neonate underwent cardiac catheterization. Diastolic filling impairment of the right ventricle (right ventricle hypertrophy, pulmonary regurgitation, and residual right ventricle outflow tract obstruction) was thought to be the cause of impaired right ventricle diastolic filling, resulting in the right-to-left shunt at the atrial level. Under transesophageal echocardiographic guidance, ADO was delivered through a 5 French sheath into the atrial septal defect. Amplatzer duct occluder closed the defect and proved to be stable in position after disconnection. During the procedure, the child was stable and then transferred to the intensive care unit with significantly improved oxygen saturation. This is the first report on placing a duct occluder in the atrial septal position, which is a novel procedure for-small neonates.

Transradial approach for percutaneous closure of patent ductus arteriosus with the Amplatzer duct occluder II: a case report

Percutaneous patent ductus arteriosus (PDA) closure is a safe and feasible treatment, and it is recommended over surgical approach in the majority of cases. Amplatzer duct occluder (ADO-AGA Medical Corporation, Golden Valley, MN) is the preferred device for transcatheter treatment of PDA. Recently, the ADO II (AGA Medical Corporation, Golden Valley, MN), allowing PDA closure through a small delivery catheter from an antegrade or retrograde approach, received the European Community mark approval. Here, we report, for the first time, successful PDA closure in a 66-year-old female with the ADO II device, using a transradial approach.

Pediatric interventional cardiology: 2009

PURPOSE OF REVIEW

Pediatric interventional cardiology has evolved quite dramatically over the past few decades and now, in 2009, the published literature continues to evolve new percutaneous strategies for managing patients with congenital heart disease, both simple and complex. Our goal for this review was to highlight new techniques and the new devices available to the pediatric interventional cardiologist, and to review the outcomes from past endeavors.

RECENT FINDINGS

Manuscripts published in the past year continue to demonstrate innovation; indicating an exciting and increasing experience of transcatheter treatment of septal communications using either new occluder devices or novel techniques. Bioabsorbable devices and percutaneously implanted valves are leading examples of technological improvements and creativity that will ultimately improve patient outcomes while minimizing invasiveness. Reports on procedural outcomes show technically safe early follow-up, with promising mid-term and long-term results for balloon valvuloplasty, balloon atrial septostomy and pulmonary artery stent implantation. As well, fetal and hybrid interventions have become important new arenas for the pediatric interventionist.

SUMMARY

Pediatric interventions have grown far beyond the early stages of the 1980s as mid-term and long-term outcome data are being reported, and many previously insurmountable hurdles have been overcome by developing new strategies and devices.

Failure of the Amplatzer ductal occluder II: kinking of the aortic retention disk at 24 hours

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.

Further experience with catheter closure of patent ductus arteriosus using the new Amplatzer duct occluder in children

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.