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Bruckheimer E, Steiner K, Barak-Corren Y, Slanovic L, Levinzon M, Lowenthal A, Amir G, Dagan T, Birk E. The Amplatzer duct occluder (ADOII) and Piccolo devices for patent ductus arteriosus closure: a large single institution series. Front Cardiovasc Med 2023; 10:1158227. [PMID: 37215550 PMCID: PMC10193946 DOI: 10.3389/fcvm.2023.1158227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose Evaluate Piccolo and ADOII devices for transcatheter patent ductus arteriosus (PDA) closure. Piccolo has smaller retention discs reducing risk of flow disturbance but residual leak and embolization risk may increase. Methods Retrospective review of all patients undergoing PDA closure with an Amplatzer device between January 2008 and April 2022 in our institution. Data from the procedure and 6 months follow-up were collected. Results 762 patients, median age 2.6 years (range 0-46.7) years and median weight 13 kg (range 3.5-92) were referred for PDA closure. Overall, 758 (99.5%) had successful implantation: 296 (38.8%) with ADOII, 418 (54.8%) with Piccolo, and 44 (5.8%) with AVPII. The ADOII patients were smaller than the Piccolo patients (15.8 vs. 20.5 kg, p < 0.001) and with larger PDA diameters (2.3 vs. 1.9 mm, p < 0.001). Mean device diameter was similar for both groups. Closure rate at follow-up was similar for all devices ADOII 295/296 (99.6%), Piccolo 417/418 (99.7%), and AVPII 44/44 (100%). Four intraprocedural embolizations occurred during the study time period: two ADOII and two Piccolo. Following retrieval the PDA was closed with an AVPII in two cases, ADOI in one case and with surgery in the fourth case. Mild stenosis of the left pulmonary artery (LPA) occurred in three patients with ADOII devices (1%) and one patient with Piccolo device (0.2%). Severe LPA stenosis occurred in one patient with ADOII (0.3%) and one with AVPII device (2.2%). Conclusions ADOII and Piccolo are safe and effective for PDA closure with a tendency to less LPA stenosis with Piccolo. There were no cases of aortic coarctation related to a PDA device in this study.
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Affiliation(s)
- Elchanan Bruckheimer
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Kristoffer Steiner
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Yuval Barak-Corren
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Leonel Slanovic
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Michael Levinzon
- Section of Pediatric Anesthesiology, Schneider Children’s, Medical Center of Israel, Petach Tikva, Israel
| | - Alexander Lowenthal
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Gabriel Amir
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Tamir Dagan
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Einat Birk
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
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Abstract
Stroke from cardiac sources is a major cause of cerebral infarctions and ischemia. Cardiac sources of stroke include intracardiac thrombus, right-to-left shunts, tumors, and slow-flow states resulting from hemodynamic compromise. Computed tomography angiography of the neck is currently used for the evaluation of a suspected stroke. The availability of longer multidetector computed tomography detector arrays and prospective echocardiography triggering techniques could permit evaluation of the chest, head, and neck during the same examination, streamlining patient evaluation and management.
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Campbell F, Thomas W, Miller S, Berger D, Kittleson M. Immediate and Late Outcomes of Transarterial Coil Occlusion of Patent Ductus Arteriosus in Dogs. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02827.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sun F, Usón J, Crisóstomo V, Maynar M. Interventional cardiovascular techniques in small animal practice--embolotherapy and chemoembolization. J Am Vet Med Assoc 2005; 227:402-9. [PMID: 16121606 DOI: 10.2460/javma.2005.227.402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Fei Sun
- Endoluminal Therapy and Diagnosis Department, Minimally Invasive Surgery Centre, Cáceres, Spain
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Kónya A, Wright KC. New retrievable coil anchors: preliminary in vivo experiences in swine. Cardiovasc Intervent Radiol 2005; 28:228-41. [PMID: 15696355 DOI: 10.1007/s00270-003-0242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To design and test retrievable coil anchors to improve the safety and efficacy of coil embolization. METHODS Fifty-two 0.038-inch homemade retrievable stainless steel coils were equipped with one of four different pre-shaped nitinol anchors and tested in 38 pigs. All coils with the anchor were completely retrieved and redeployed 3-18 times (median 7 times) prior to release. Types 1 and 2 anchored coils were acutely deployed in the external iliac arteries (n = 10 each), and chronically tested (1 week) in the common carotid arteries (n = 6 each). Larger type 1 (n = 4), type 3 (n = 6), and type 4 (n = 4) anchored coils were acutely deployed in the abdominal aorta. The largest type 1 anchors (n = 6) were acutely tested in the inferior vena cava. RESULTS All anchored coils were successfully retrieved and repositioned several times. All but two coils formed a compact plug and there was no coil migration except with two mechanically defective type 3 anchors. CONCLUSION The use of retrievable anchors allowed the coils to be retrieved and repositioned, prevented coil migration, and enabled compact coil configuration.
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Affiliation(s)
- A Kónya
- Section of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Penny DJ, Taib R. What's Happening in Paediatric Cardiology? Heart Lung Circ 2004; 13 Suppl 3:S24-30. [PMID: 16352235 DOI: 10.1016/j.hlc.2004.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent decades have witnessed dramatic advances in the care of adults with heart disease. However, equally significant advances have occurred in the care of children. In this review we describe some of the advances, which have been made in the care of children with heart disease, focusing not only on technological advances, but also on developments in team-based care, which together have resulted in significant improvements in outcomes.
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Affiliation(s)
- Daniel J Penny
- Department of Cardiology, The Royal Children's Hospital, Australia.
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Saunders AB, Miller MW, Gordon SG, Bahr A. Pulmonary Embolization of Vascular Occlusion Coils in Dogs with Patent Ductus Arteriosus. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb02603.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Beck A, Birk E, Blieden LC, Bruckheimer E. Stent implantation for coarctation of aorta caused by a Rashkind patent ductus arteriosus umbrella. Catheter Cardiovasc Interv 2004; 63:80-2. [PMID: 15343573 DOI: 10.1002/ccd.20128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This case demonstrates a novel use of stent implantation for relief of coarctation of the aorta caused by protrusion of a Rashkind patent ductus arteriosus umbrella. Follow-up 3 years after stent implantation shows complete relief of obstruction.
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Affiliation(s)
- Avi Beck
- Department of Pediatric Cardiology, Schneider Children's Medical Center-Israel, Beilinson Campus, Tel Aviv University, Petach Tikva, Israel
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Fox JM, Bjornsen KD, Mahoney LT, Fagan TE, Skorton DJ. Congenital heart disease in adults: catheterization laboratory considerations. Catheter Cardiovasc Interv 2003; 58:219-31. [PMID: 12552548 DOI: 10.1002/ccd.10433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital heart defects are the most common birth defects and represent an increasing proportion of adolescent and adult patients followed by cardiologists. While many of these patients have undergone successful palliative or corrective surgery with excellent functional results, most of them still require careful follow-up. Further, even complex lesions may first be diagnosed in adolescence and adulthood. Therefore, cardiologists caring for adults need to become more familiar with these defects. Assessment of the patient with known or suspected congenital heart defects requires a careful history, physical examination, and noninvasive assessment. In addition, the catheterization laboratory remains a critical venue for diagnosis and, increasingly, therapy. Pressure measurements, oximetry, and angiography remain cornerstones of diagnosis in selected patients and a variety of interventional procedures have become viable therapeutic alternatives in both pre- and postoperative patients.
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MESH Headings
- Adult
- Aortic Coarctation/diagnosis
- Aortic Coarctation/physiopathology
- Aortic Valve Stenosis/diagnosis
- Aortic Valve Stenosis/physiopathology
- Cardiac Catheterization
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/surgery
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/physiopathology
- Heart Septal Defects, Ventricular/surgery
- Hemodynamics
- Humans
- Pulmonary Valve Stenosis/diagnosis
- Pulmonary Valve Stenosis/physiopathology
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/physiopathology
- Transposition of Great Vessels/diagnosis
- Transposition of Great Vessels/physiopathology
- Tricuspid Atresia/diagnosis
- Tricuspid Atresia/physiopathology
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Affiliation(s)
- James M Fox
- Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, USA
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El Mallah MK, Sands AJ, Casey FA, Craig BG, Mulholland HC. Transcatheter occlusion of the patent ductus arteriosus: a comparison of two devices. Ir J Med Sci 2002; 171:151-4. [PMID: 15736355 DOI: 10.1007/bf03170504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transcatheter occlusion of the arterial duct is a safe and effective alternative to surgical closure. The Rashkind umbrella occluder and the Cook coil are two established devices, although the former is no longer manufactured. AIMS To assess any difference in outcomes between the use of the Cook detachable coil and the Rashkind double umbrella in patent ductus arteriosus (PDA) occlusion. METHODS A retrospective study of 77 patients in whom PDA occlusion was attempted using the Cook detachable PDA coil from March 1996 to March 2000. A comparison was carried out with patients in whom occlusion was attempted using the Rashkind double umbrella between 1989 and 1996. RESULTS The rate of immediate complete occlusion was 24% compared with 29.9% for the Rashkind device. The figure for complete occlusion after 24 hours with the PDA coil was 63% compared with 61.5% in the Rashkind group (p > 0.1). The overall closure rate in the coil group was 72% versus 74.6% for umbrellas. CONCLUSION The outcome in terms of complete duct closure using the Cook coil is comparable with figures obtained using the Rashkind umbrella. Both devices have a good safety profile in the short and medium-terms.
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Affiliation(s)
- M K El Mallah
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Northern Ireland
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Cohen AJ, Tamir A. Invited Commentary. Asian Cardiovasc Thorac Ann 2002. [DOI: 10.1177/021849230201000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Akiva Tamir
- Department of Pediatric Cardiology The Edith Wolfson Medical Center P.O. Box 5 Holon 58100, Israel
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O'Donnell C, Neutze JM, Skinner JR, Wilson NJ. Transcatheter patent ductus arteriosus occlusion: evolution of techniques and results from the 1990s. J Paediatr Child Health 2001; 37:451-5. [PMID: 11885708 DOI: 10.1046/j.1440-1754.2001.00689.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the evolution of transcatheter patent ductus arteriosus (PDA) occlusion techniques and results. METHODS A single institution, retrospective review including all patients with intention to close a PDA from 1991 to 1998, with no exclusions. RESULTS Rashkind occluder (n = 65), sideris double-button (n = 6), Cook detachable coil (n = 28) and Amplatzer ductal occluder (n = 4) were used. Successful implantation occurred in 99 of 103 patients. There was a need for a second transcatheter procedure to close residual ductal shunting in 12% of patients: Rashkind umbrellas (n = 8), double-button (n = 1), coils (n = 3). Eight patients (8%) required surgery, including 4 of 6 patients with the double-button occluder. CONCLUSIONS The Rashkind occluder and the Sideris double-button device both had an unacceptably high rate of residual shunts requiring a second transcatheter procedure or surgical closure. Detachable coils and the Amplatzer ductal occluder have become the current technology of choice for transcatheter PDA closure with high success rates.
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Affiliation(s)
- C O'Donnell
- Department of Paediatric Cardiology, Green Lane Hospital, Auckland, New Zealand
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Kónya A, Maxin M, Wright KC. New embolization coil containing a nitinol wire core: preliminary in vitro and in vivo experiences. J Vasc Interv Radiol 2001; 12:869-77. [PMID: 11435544 DOI: 10.1016/s1051-0443(07)61513-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To improve the stability of the standard stainless steel embolization coil by adding a nitinol wire core. MATERIALS AND METHODS With use of one coil with a nitinol wire core and one without one, stability and resistance to elongation were measured in vitro. Thirty-one factory-made stainless-steel macrocoils equipped with preshaped nitinol wire cores were acutely deployed into branches of the superior mesenteric artery (SMA) in five pigs (part I of the study). Fifteen homemade retrievable coils with thermal shape memory (TSM) nitinol wire cores were acutely deployed in the abdominal aortae or inferior venae cavae of four pigs (part II). Coils with a superelastic (SE) nitinol wire core (n = 9), a TSM nitinel wire core (n = 5), and without a core (n = 5) were compared in carotid embolization (part III). RESULTS In vitro, the expansile strength of the reinforced coils was significantly greater and elongation was significantly less than the standard coils (P <.01). In part I, coils were easily deployed via diagnostic catheters. In part II, ability to reposition the coils facilitated optimal coil configuration, which resulted in effective self-anchoring and occlusion. In part III, no coils with a SE core migrated, whereas one of five with a TSM core and three of five without reinforcement migrated immediately. The core significantly increased coil stability and postplacement configuration (P <.01). CONCLUSIONS Addition of a nitinol wire core increases the intravascular stability of the standard embolization coil by significantly enhancing expansile force and postplacement configuration. The wire core does not adversely affect the handling of the coil. The ability to reposition/retrieve the coil is a desirable feature.
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Affiliation(s)
- A Kónya
- Department of Diagnostic Radiology, the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 057, Houston, Texas 77030, USA.
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Jaeggi ET, Fasnacht M, Arbenz U, Beghetti M, Bauersfeld U, Friedli B. Transcatheter occlusion of the patent ductus arteriosus with a single device technique: comparison between the Cook detachable coil and the Rashkind umbrella device. Int J Cardiol 2001; 79:71-6. [PMID: 11399343 DOI: 10.1016/s0167-5273(01)00406-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED Transcatheter coil occlusion of the patent ductus arteriosus (PDA) has become the interventional treatment option of choice. Immediate occlusion of any residual shunting results in excellent closure rates, but frequently requires multiple coil deployment. AIMS To assess the efficacy and limitations of single Cook detachable coil PDA closure compared to a preceding series of Rashkind umbrella procedures. METHODS AND RESULTS Between 1990 and 1999, transcatheter occlusion of a small (<2 mm; n=45) or moderate-sized (2-4 mm; n=47) PDA was successfully attempted in 90/92 consecutive patients (mean age 6+/-4.8 years) with a coil (39/41) or Rashkind device (51/51). Immediate angiographic closure rates for both devices were low, although better for small (54-68%) than moderate ducts (7-22%, P<0.01). A 2-year echocardiographic closure rate of small ducts increased to 92% for the coil group versus 95% for the Rashkind group. By that time, moderate-sized ducts were only occluded in 64% with the coil and 54% with the Rashkind device. A visible residual shunt at post-implant angiography in moderate ducts was associated with a high incidence (59%) of long-term echocardiographic shunt patency and a need for repeat interventions for audible residual shunts (32%). CONCLUSIONS Single coil transcatheter occlusion is the treatment of choice for the small duct as most residual shunts will resolve spontaneously. However, long-term shunt persistence after single coil deployment in moderate sized ducts is as frequent as with the Rashkind device. A primary multiple coil approach is advocated if the postcoil aortogram shows residual ductal shunting and if there is persistence of a ductal murmur on auscultation.
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Affiliation(s)
- E T Jaeggi
- Paediatric Cardiology, University Children's Hospital of Geneva, 6 Rue Willy-Donzé, 1211, Geneva, Switzerland.
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Justino H, Justo RN, Ovaert C, Magee A, Lee KJ, Hashmi A, Nykanen DG, McCrindle BW, Freedom RM, Benson LN. Comparison of two transcatheter closure methods of persistently patent arterial duct. Am J Cardiol 2001; 87:76-81. [PMID: 11137838 DOI: 10.1016/s0002-9149(00)01276-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomized trial of arterial duct occlusion with a double umbrella (DU) or wire coil (WC) was undertaken for patients <18 years of age, weighing >10 kg with isolated ducts < or = 3 mm in diameter. Baseline, procedural, and outcome characteristics were compared in an intention-to-treat analysis according to randomization group. From 40 consecutively screened patients, 2 were not enrolled due to a ductal diameter of >3 mm on initial aortography, 38 patients were randomized to either the DU (n = 20) or WC (n = 18) groups. The groups did not differ significantly with respect to age, weight, gender, duct size, type, or branch pulmonary artery diameters. Crossover occurred only in the DU group, where 4 patients (20%) had a ductal diameter of < or = 1 mm and could not be entered for umbrella placement. All remaining DU group patients had ductal diameters of > or = 1.3 mm (p <0.0001). There were no embolizations or secondary implants in the DU group, but in the WC group there was 1 early and 1 late embolization, with 6 patients (33%) with > or = 2 coils. Mean times for the procedure (DU 68+/-19 minutes; WC 65+/-27 minutes; p = 0.70) and fluoroscopy (DU 14+/-4 minutes; WC 11+/-6 minutes; p = 0.22) did not differ significantly. Angiographic duct closure was documented in 4 of 13 patients (31%) of the DU group and 4 of 18 patients (22%) of the WC group (p = 0.69). Combined with an echocardiogram, closure in 11 of 17 patients with DU (65%) and 13 of 18 patients with WC (72%) (p = 0.64) was documented before hospital discharge. One WC group patient received thrombolytic therapy for a femoral artery thrombus. Follow-up at a median of 6.5 months (range 3.2 to 37) showed closure by Doppler echocardiography in 15 of 19 patients with DU (79%) versus 14 of 18 patients with WC (78%) (p = 1.0). Thus, with a tendency toward similar procedural characteristics and outcomes, the higher cost of the DU system compared with coil implants favors the use of coils for closure of the small arterial duct.
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Affiliation(s)
- H Justino
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada
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Abstract
Several investigations have been performed to evaluate the mid-term results of coil embolization for patent ductus arteriosus. Excellent results were obtained with coils if the minimum diameter of the ductus was less than 4 mm. Balloon dilation of native coarctation and recoarctation may be associated with complications such as aneurysm formation. Stent placement may solve some of the problems of balloon dilation, but the stents currently available are not perfect. Results of transcatheter closure of atrial septal defect using new devices have been were reported. The self-expanding nitinol double-disk device (Amplatzer septal occluder) (AGA Medical Corporation, Golden Valley, Minnesota) is becoming popular because it is easy to implant, is easy to retrieve before its release, can occlude a relatively large defect, and has a low rate of residual leak. Although the immediate results with this device were excellent, surgical closure is still the standard treatment and we need to see the long-term results of transcatheter closure.
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Affiliation(s)
- T Nakanishi
- Heart Institute of Japan, Tokyo Women's Medical University.
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