Closure of a Very Large Patent Ductus Arteriosus Using the Amplatzer Duct Occluder

Mark H. Hoyer, MD

Closure of the small to moderate sized patent ductus arteriosus (PDA) is accomplished at most large pediatric heart centers by transcatheter techniques, most often by inserting thrombogenic fabric-stranded Gianturco coils. However, closure of the large PDA is more challenging, especially when the morphology provides little substrate to anchor the initial coil. Even if the coils do remain stable, many are required to effectively plug the defect. As a result, the Amplatzer Duct Occluder (AGA Medical Corporation, Golden Valley, Minnesota) was manufactured in different sizes to allow implantation ...

A Novel Technique to Prevent Displacement of Inferior Vena Cava Filter During Cardiac Catheterization with Subsequent Transcathe

Michael R. Recto, MD and Walter L. Sobczyk, MD

Transcatheter closure of patent foramen ovale (PFO) has recently gained acceptance as a form of therapy for patients with cryptogenic stroke.1–3 The standard approach involves passage of a large delivery sheath from the femoral vein into the inferior vena cava and right atrium. The delivery sheath is then positioned across the PFO, and the septal occlusion device is deployed under both fluoroscopic and transesophageal echo (TEE) guidance. The approach as previously described is often straightforward; however, previous placement of an inferior vena cava (IVC) filter can preclude the performan...

Transcatheter Closure of Congenital and Acquired Muscular Ventricular Septal Defects Using the Amplatzer® Device

Massimo Chessa, MD, Mario Carminati, MD, *Qi-Ling Cao, MD, Gianfranco Butera, MD, Sandra Giusti, MD, Roberta Margherita Bini, MD, *Ziyad M. Hijazi, MD, MPH

Surgical closure of congenital or acquired [post-myocardial infarction (MI)] muscular ventricular septal defects (MVSD) is still associated with significant mortality and long-term morbidity.1,2 Different surgical approaches have been suggested, requiring either a right or left ventriculotomy.3,4 Over the past few years, devices designed originally for percutaneous closure of atrial septal defects or patent ductus arteriosus have been used to close MVSDs with variable degrees of successful closure and residual shunts.5–10 Lock et al.5 first reported the transcatheter occlusion of a VSD using...

Late Superior Vena Cava Perforation and Aortic Laceration After Stent Placement for Treatment of Superior Vena Cava Syndrome Sec

Michael R. Recto, MD, *Michael Bousamra, MD, *Thomas Yeh, Jr., MD, PhD

Stent implantation has long been used to treat many types of vascular stenoses. Stents were initially used in the late 1980’s to treat patients with branch pulmonary artery stenoses.1–3 In the 1990’s, stents were used to relieve right ventricular outflow tract obstruction, systemic/pulmonary venous obstruction, systemic venous baffle obstruction and coarctation of the aorta.4–8 Follow-up studies have demonstrated good results following stent implantation.9,10 Stents have also been used for the treatment of superior vena cava (SVC) stenosis and SVC syndrome with good results.11–13 The...

Obliteration of a Competitive Forward Flow from the Ventricle After a Bidirectional Cavopulmonary Shunt with an Amplatzer Duct O

Carlo B. Pilla, MD, Valmir F. Fontes, MD, Carlos A.C. Pedra, MD

The early and mid-term results of the Amplatzer Duct Occluder (ADO) (AGA Medical Corporation, Golden Valley, Minnesota) for obliterating flow through a patent arterial duct are highly encouraging.1,2 High occlusion rates, low complication rates and application even in small children have made the percutaneous occlusion of arterial ducts with this device an attractive alternative to surgery.
The ADO has also been used in other clinical situations, such as closure of coronary artery fistula,3 surgical conduit,4 left ventricle to aorta tunnel5 and muscular apical ventricular septal defect.6 All ...

Transcatheter Closure of Patent Ductus Arteriosus in Chinese Adults: Immediate and Long-term Results

Chi-hang Lee, MBBS, MRCP, *Yim-lung Leung, MBChB, MSc, †Nim-pong Kwong, MBChB, MRCP, On-hing Kwok, MBBS, MRCP, Alex S. B. Yip, MBBS, FRCP, Wing-hing Chow, MBBS, FRCP

Patent ductus arteriosus (PDA) is a common congenital cardiac anomaly. Depending on the size of the PDA, patients may be asymptomatic or in heart failure. Treatment is recommended because of the risk of infective endocarditis and congestive heart failure in the long term. The traditional treatment approach is surgical ligation under direct vision. However, surgical approach is invasive and associated with morbidity. In the past decade, transcatheter closure of PDA has been established as a safe and effective treatment alternative.1–5 The transcatheter approach is less invasive, associated wi...

Severe Aortic Coarctation in Infants Less Than 3 Months: Successful Palliation by Balloon Angioplasty

*†P. Syamasundar Rao, MD, *Saadeh B. Jureidini, MD, *Ian C. Balfour, MD,
*Gautam K. Singh, MD, *Su-chiung Chen, MD

Key words: aortic coarctation, balloon angioplasty, infants, neonates, transcatheter management

Treatment of native aortic coarctation (AC) by balloon angioplasty (BA) is a controversial issue,1–6 but gradually the procedure is gaining acceptance in the management of children7–12 with native coarctation. However, it remains controversial in neonates and young infants.2,13,14 Because of the excellent results that we have been able to achieve with BA in neonatal and infant coarctations,13,15–19 we have utilized this technique as a first-line t...

Management of Platypnea-Orthodeoxia Syndrome by Transcatheter Closure of Atrial Communication: Hemodynamic Characteristics, Clin

Gabriel Delgado, MD, Ignacio Inglessis, MD, Francisco Martin-Herrero, MD, Danita Yoerger, MD, Richard Liberthson, MD, Fernando Buoanno, MD, Igor Palacios, MD

Platypnea-orthodeoxia syndrome (POS) is defined as dyspnea and arterial desaturation induced by upright posture and relieved by recumbence.1,2 Although the precise underlying mechanism by which an atrial communication accounts for this disorder is unknown, it is thought to be secondary to right to left shunt through an atrial septal defect, most commonly a PFO.3 It has been reported in association with increased4 or normal right-sided heart pressures.5,6 POS is a rare disorder with no more than 50 cases described since initially reported in 1949.7 Management of POS by surgical8 and percutaneou...

Percutaneous Closure of a Post-traumatic Muscular Ventricular Septal Defect Using the Amplatzer Duct Occluder

Stephanie Schwalm, MD, Ziyad Hijazi, MD, Lissa Sugeng, MD, Roberto Lang, MD

Post-traumatic ventricular septal defect (VSD) after penetrating cardiac trauma is infrequent, with an estimated incidence of 1–4.5% of cases.1,3 The decision to close a traumatic VSD is similar to that of a non-traumatic VSD and is based on the degree of shunting, the patient’s symptoms, and cardiac hemodynamics. We report a case of post-traumatic muscular VSD in an 18-year-old after sustaining a penetrating stab wound to the chest. The patient developed symptoms of shortness of breath and exercise intolerance due to a moderately sized VSD with significant left-to-right shuntin...

Catheter Closure of Perforated Secundum Atrial Septal Defect Under Intracardiac Echocardiographic Guidance Using a Single Amplat

Mario Zanchetta, MD, Gianluca Rigatelli, MD, Luigi Pedon, MD, Marco Zennaro, MD, Antonio Carrozza, MD, *Eustaquio Onorato, MD

Transcatheter closure of single secundum atrial septal defects (ASDs) or patent foramen ovale (PFO) is a well-accepted alternative to surgical repair in selected patients,1 and intracardiac echocardiography (ICE) has been demonstrated to be superior to conventional transesophageal echocardiography (TEE) monitoring for guiding device placement.2
On the contrary, perforated ASDs3 still remain a challenge for both sonographers and interventionists. This morphological variation has been successfully treated by percutaneous placement of two Amplatzer septal occlude...

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