Amplatzer Duct Occluder Research Articles

Closure of a secondary tracheoesophageal fistula in severe pneumonia using an Amplatzer Duct Occluder II during invasive mechanical ventilation: A case report.

Early and timely closure of secondary tracheoesophageal fistula (TEF) is crucial for critically ill patients. For those requiring invasive mechanical ventilation, the Amplatzer Duct Occluder II (ADO II) can be used as an emergency therapeutic option to rapidly close secondary TEF, providing opportunities for subsequent treatments. Secondary tracheoesophageal fistula (TEF) is a life-threatening condition characterized by high mortality, high recurrence rates, and multiple complications. Reports on the management of secondary TEF in critically ill patients are limited due to the challenges in treatment and the lack of suitable therapeutic options. We report a case of secondary TEF in a 69-year-old male diagnosed with severe pneumonia, whose condition deteriorated rapidly following the onset of TEF. Despite invasive mechanical ventilation, maintaining blood oxygen saturation above 80% was unachievable due to the TEF. Bedside bronchoscopy revealed expansion TEF expansion caused by gastrointestinal fluid reflux and respiratory machine pressure. The TEF was urgently closed using an ADO II device during invasive mechanical ventilation to prevent further deterioration. After the patient's condition stabilized, the ADO II was replaced with a Y-shaped tracheal membrane-covered stent for further TEF management. The patient's condition improved, meeting the criteria for liberation from invasive mechanical ventilation, and bedside chest X-rays revealed a gradual resolution of pulmonary inflammation. Selecting appropriate treatment modalities for early and timely closure of secondary TEF is crucial for critically ill patients. ADO II can serve as a rescue therapy to achieve rapid closure of secondary TEF in critically ill patients requiring invasive mechanical ventilation support, providing opportunities and time for subsequent treatment.

Transcatheter Closure of a Huge Congenital Coronary-Cameral Fistula With Amplatzer Occluder

Congenital coronary-cameral fistula is an abnormal connection between coronary arteries and a cardiac chamber. Although trans-catheter closure appears to be a safe alternative to surgical treatment but there is an imprecision about modality of choice. We describe a huge left coronary artery fistula to the right ventricle, found in an 8-year-old girl with dyspnea on exertion and chest pain. She was treated with an Amplatzer duct occluder. After procedure, echocardiography revealed, complete closure of fistula orifice and the girl remained completely asymptomatic during 48 months follow-up period. This study demonstrated that Amplatzer duct occluder might be a useful and safe armamentarium for coronary-cameral fistula treatment. Nevertheless, further experience and long-term follow-up studies are required to guarantee our results.

Aortopulmonary Window Device Closure

Aortopulmonary window (APW) is an uncommon congenital cardiac defect. Most infants presenting with APW will undergo conventional surgical repair. Experience with transcatheter closure of APW is limited. We report the case of a 5-year-old boy with APW, in whom transcatheter closure was performed successfully using Amplatzer ductal occluder device.

Transcatheter Device Closure of Postsurgical Residual Left to Right Shunt Lesions in Children during the Immediate Postoperative Period

Objectives Postoperative residual shunts in the form of ventricular septal defects (VSD) and patent ductus arteriosus (PDA), if hemodynamically significant, can lead to symptoms of left ventricular volume overload and delayed recovery. The standard management is redo surgery, which can lead to significant morbidity and mortality. Device closure of such defects offers an alternative management strategy in selected cases. This study aims to examine the utility of device closure of residual left-to-right shunts in the pediatric age group in the immediate postoperative period. Method A retrospective analysis of hospital records was done from March 2018 to December 2022 to analyze the device closure in postoperative residual shunts. The success rate, complications, hospital length of stay, and midterm follow-up were analyzed. Results A total of four postoperative patients underwent VSD device closure and one patient underwent PDA device closure. The median age at transcatheter procedure was 6 years (range 3–10 years). The median time interval between the surgical procedure and the device closure procedure was 4 days (range 2–15 days). The indication for device closure was left ventricular volume overload in three patients and two patients had persistent pleural effusion. Qp:Qs was more than 1.5:1 in all five patients. The amplatzer duct occluder I (ADO-I) device was used in four patients and the ADO-II in one patient. There was no residual shunt post-deployment, with no major complication. The mean follow-up period was 2 years and all the patients had no residual shunt. Conclusion This case series, with its limitation of only five cases, has shown that device closure of hemodynamically significant residual postoperative left-to-right shunt lesions is an effective alternative strategy to redo surgery in older children. Further study is required with a larger sample size, and a longer follow-up is needed to evaluate its long-term safety and efficacy.

Safety and efficacy of Amplatzer duct occluder II and konar-MF™ VSD occluder in the closure of perimembranous ventricular septal defects in children weighing less than 10 kg

IntroductionDevice closure of perimembranous ventricular septal defects (pmVSD) is a successful off-label treatment alternative. We aim to report and compare the outcomes of pmVSD closure in children weighing less than 10 kg using Amplatzer Duct Occluder II (ADOII) and Konar-MF VSD Occluder (MFO) devices.MethodsRetrospective clinical data review of 52 children with hemodynamically significant pmVSD, and sent for transcatheter closure using ADOII and MFO, between January 2018 and January 2023. Baseline, procedural, and follow-up data were compared according to the implanted deviceResultsADOII devices were implanted in 22 children with a median age of 11 months (IQR, 4.1–14.7) and weight of 7.4 kg (IQR, 2.7–9.7). MFO devices were implanted in 30 children with a median age of 11 months (IQR, 4.8–16.6) and weight of 8 kg (IQR, 4.1–9.6). ADOII were implanted (retrograde, 68.1%) in defects with a median left ventricular diameter of 4.6 mm (IQR, 3.8–5.7) and right ventricular diameter of 3.5 mm (IQR, 3.1–4.9) while MFO were implanted (antegrade, 63.3%) in defects with a median left ventricular diameter of 7 mm (IQR, 5.2–11.3) (p > 0.05) and right ventricular diameter of 5 mm (IQR, 2.0, 3.5–6.2) (p < 0.05). The procedural and fluoroscopy times were shorter with the MFO device (p < 0.05). On a median follow-up of 41.2 months (IQR, 19.7–49.3), valvular insufficiency was not observed. One 13-month-old child (6.3 kg) with ADOII developed a complete atrioventricular heart block (CAVB) six months postoperative and required pacemaker implantation. One 11-month-old child (5.9 kg) with MFO developed a CAVB 3 days postoperative and the device was removed. At 6 months post-procedure, only one child with MFO still experiences a minor residual shunt. There was one arterio-venous fistula that resolved spontaneously.ConclusionBoth the MFO and ADOII are effective closure devices in appropriately selected pmVSDs. CAVB can occur with both devices. The MFO is inherently advantageous for defects larger than 6 mm and subaortic rims smaller than 3 mm. In the literature, our series represents the first study comparing the mid-term outcomes of MFO and ADOII devices in children weighing less than 10 kg.

Transcatheter Patent Ductus Arteriosus Closure in Children With Different Devices and Long-Term Results.

With the development of transcatheter interventional techniques and the introduction of next-generation duct occluder devices, transcatheter closure has become the first treatment option for patent ductus arteriosus (PDA) in pediatric patients. In this study, we compared the effectiveness and safety of different devices for transcatheter PDA closure in pediatric patients, focusing on long-term outcomes. A total of 235 patients aged 0-18 years who underwent transcatheter PDA closure at a tertiary care center between January 2005 and February 2020 were included. The medical records of the cases were retrospectively evaluated. The median age of the patients was 2.3 years (range: 3.5 months to 17 years), with a mean weight of 12.8 kg (range: 5.7-43.2 kg). The mean PDA diameter at its narrowest point was 2.9 mm (range: 2.2-5.1 mm). Ductal anatomy was as follows: Type A in 98 (41.7%) patients, Type E in 36 (15.6%) patients, Type C in 32 (13.5%) patients, Type F in 27 (11.4%) patients, Type D in 23 (9.7%) patients, and Type B in 19 (8.1%) patients. Arterial access was used in 138 (57.1%) patients, venous + arterial access in 58 (24.6%) patients, and venous access only in 39 (16.5%) patients. Closure was performed with Amplatzer Duct Occluder (ADO; AGA Medical Corp., Golden Valley, MN, USA) II in 151 (64.2%) cases, ADO I in 43 (18.2%) cases, and coils in 41 (17.4%) cases. The mean fluoroscopy time and mean procedural time were 10.3 ± 4.2 minutes and 41 ± 7.2 minutes, respectively. The mean radiation dose was 1364 ± 497 cGy/min. The early closure rate after the procedure was 92%, while residual shunting on the first day post-procedure was observed in 1.8% of cases, decreasing to 0.1% at the one-month follow-up. The overall procedural success rate for all cases was 96.0%. The mean follow-up duration was 9.7 years (range: 2.9-13.8 years). For percutaneous PDA closure, ADO I devices are preferred for larger defects, whereas ADO II devices are prioritized for small- to medium-sized defects instead of coils.

Incidence, Risk Factors, and Outcomes of Conduction Disturbances After Percutaneous Closure of Perimembranous Ventricular Septal Defects in Children and Adolescents: A Mid-term Follow-up

Background: Conduction disturbance (CD) is a major complication of percutaneous closure of the perimembranous ventricular septal defect (pmVSD). Objectives: This study aimed to investigate the incidence, predisposing factors, and outcomes of sustained CD following percutaneous closure of these defects. Methods: All patients whose pmVSD was closed successfully with percutaneous methods within April 2016 to April 2021 were enrolled in this cohort study. The defects’ size, septal aneurysms, and distance to the aortic valve annulus were determined with transthoracic echocardiography and catheterization. Continuous heart monitoring was performed during the procedures and one hour after, and standard 12-lead electrocardiograms were obtained regularly to determine any CD and arrhythmias. Results: A total of 260 patients who had successful pmVSD closure were enrolled in the study. In this study, 135 (52%) and 125 (48%) patients were male and female, respectively. The mean age of the patients was 75.66 ± 68.89 months. The patients’ median follow-up was 36 months (range: 9-210 months). Thirty-one patients (11.9%) developed sustained CD, and 25 cases recovered to normal conduction. Additionally, 7 patients (2.7%) had several permanent conduction abnormalities, including four right bundle branch blocks, two left bundle branch blocks, and one bi-fascicular block. No one had a permanent atrioventricular block. Closure of non-aneurysmal defects and more prolonged procedures were independent risk factors of CD. Using Amplatzer duct occluder type II was associated with less incidence of conduction abnormalities. Conclusions: The incidence of sustained CD after transcatheter closure was relatively high; however, most cases recovered to normal conduction. The use of softer devices and the placement of devices into the septal aneurysms might lower the risk of CD.

Long-term outcomes of percutaneous closure of ventricular septal defects in children using different devices: A single centre experience from Egypt

BackgroundThe feasibility of percutaneous closure ventricular septal defects (VSD) in children has been previously proven. However, data on long-term outcomes are limited. We aim to evaluate the long-term outcome of our experience with percutaneous closure of VSD using various occluders.MethodsRetrospective institutional analysis of children who underwent transcatheter closure of perimembranous and muscular VSDs between September 2012 and February 2020. Patient demographics, procedural, and long-term follow-up data were comprehensively analyzed. Patients who lost to follow-up within two years post-procedure were excluded.ResultsWe identified 75 patients (54.7% males) with a median of 66 months (IQR, 46–96). The closure success rate at one year was 95.7%. Complete heart block was detected in two patients early post-procedure and resolved with steroids. The VSDs were perimembranous (52%), muscular (33.33%), and residual (14.67%). Implanted devices were Pfm Nit-Occlud LeˆVSD Coil (42.7%), HyperionTM VSD Muscular Occluder (28%), Amplatzer VSD muscular occluder (10.7%), Amplatzer Duct Occluder (14.7%), Occlutech Muscular VSD Occluder (2.7%), and Amplatzer Duct Occluder II (1.3%). No new arrhythmia or valve regurgitation was detected after two years post-procedure. Persisted complications on long-term follow-up included: residual shunting in 3(4%), mild tricuspid regurgitation in 2(2.7%), and aortic regurgitation in 2(2.7%), with one immediate post-catheterization mild aortic regurgitation worsened during follow-up, requiring surgical repair of VSD three years after device implantation. No deaths were reported.ConclusionLong-term outcomes of pediatric transcatheter VSD closure using different devices are satisfactory. Post-procedural adverse events are limited, but long-term surveillance is necessary to monitor their progression.

Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant

Link of Video Abstract: https://youtu.be/ZYpxn1S7yjwBackground: Coronary artery fistula is a rare entity of cardiovascular anomaly. The etiology is often congenital due to malformation of coronary artery vessels. They are mostly asymptomatic, while some cases may be present with complications such as congestive heart failure, myocardial infarction, or pulmonary hypertension. This case study aims to evaluate the Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant. Case Presentation: The 10-month-old female infant was present with a coronary artery fistula diagnosed at three months old. The echocardiography revealed a right coronary artery fistula to the right atrium with an ampulla size of 7.29 mm, waist of 3.11 mm, and length of 4.71 mm. The patient underwent cardiac catheterization and coronary artery fistula closure with a transvenous technique approach using Amplatzer duct occluder II. The procedure was successful, and the echocardiography examination found no residual flow from the fistula. This is the first reported case of successful coronary artery fistula closure using the Amplatzer duct occluder II device. Conclusion: Fistula closure using the Amplatzer Duct Occluder II device, in this case, is preferred because it is safe and efficient to use in small infants due to its small sheath delivery catheter caliber.

A Challenging Interventional Procedure: Transcatheter Closure of Tubular Patent Ductus Arteriosus in Patients with Pulmonary Hypertension.

Transcatheter closure of the tubular ducts remains the most challenging procedure, with higher complication rates than other types. This study evaluates the characteristics of transcatheter closure of tubular ducts with pulmonary hypertension. 73 patients with tubular ducts who underwent cardiac catheterization for transcatheter PDA closure were analyzed. The mean age and weight were 1.93 ± 2.68years and 8.83 ± 6.14kg, respectively. Transcatheter closure was attempted in 72 patients. Four cases (5.5%) were referred to surgery, while the procedure was completed in the remaining (94.5%). Amplatzer duct occluder (ADO) I or Cardiofix duct occluder (CDO) was the most commonly used devices. However, the use of Amplatzer vascular plug (AVP) II raised in recent years. The most common concern was aortic protrusion/stenosis in ADO I/CDO devices, but most regressed during follow-up. Iatrogenic coarctation of the aorta was observed in two with ADO I/CDO. Embolization of the device to the pulmonary artery was observed in three with CDO, AVP II, and AVP I. Significant left pulmonary artery stenosis requiring stenting developed in one after closure with an MVSDO device. Tubular ducts are highly associated with pulmonary arterial hypertension, and transcatheter closure of them is still challenging despite the developing device armamentarium. Although ADO I or similar devices are widely used, off-label devices are usually needed at increasing rates. The AVP II device is unsuitable for short tubular ducts but seems the best option for long ones.

Catheter closure for residual VSD after AVSD-TOF repair using ADO II (patient number 12 in Table S1). AVSD, atrioventricular septal defect; TOF, tetralogy of Fallot; ADO, Amplatzer duct occluder.

Catheter closure for residual VSD after AVSD-TOF repair using ADO II (patient number 12 in Table S1). AVSD, atrioventricular septal defect; TOF, tetralogy of Fallot; ADO, Amplatzer duct occluder.

Transcatheter closure of residual Gerbode VSD using ADO II after Rastelli operation (patient number 21 in Table S1). VSD, ventricular septal defect; ADO, Amplatzer duct occluder.

Transcatheter closure of residual Gerbode VSD using ADO II after Rastelli operation (patient number 21 in Table S1). VSD, ventricular septal defect; ADO, Amplatzer duct occluder.

Transcatheter closure of residual VSD in a small infant (3.8 kg) using ADO II (patient number 17 in Table S1). VSD, ventricular septal defect; ADO, Amplatzer duct occluder.

Transcatheter closure of residual VSD in a small infant (3.8 kg) using ADO II (patient number 17 in Table S1). VSD, ventricular septal defect; ADO, Amplatzer duct occluder.

Catheter interventional closure of veno-venous collaterals in cyanotic patients after partial cavopulmonary shunts in pediatric patients: clinical practice review.

The development of veno-venous collaterals is an important and treatable cause of cyanosis in patients who had undergone partial cavo-pulmonary connection (PCPC) operations. Nevertheless, the literature on this complicated therapeutic option is sparse. Patients can present cyanosis either immediately after the operation (<30 days), which delays or hinders discharge from the intensive care unit or cyanosis may occur late: (>30 days and/or in another hospital admission), after the operation. Hence, transcatheter closure of veno-venous collaterals is the treatment of choice. Four patients were selected who showed cyanosis at variable durations after PCPC; the morphology of the collaterals and their hemodynamic effect was described and the strategy for closure of such abnormal vessels is suggested. Veno-venous collaterals described in our series were seen originating mainly or mostly from innominate vein angles. The drainage sites were either above the diaphragm into a cardiac structure: the coronary sinus (CS) and/or atria; or below the diaphragm into the inferior vena cava (IVC) or hepatic veins through the paravertebral venous system and/or the azygous system. It is stated in the literature that several types of devices and coils can be used to close the collaterals such as the Amplatzer vascular plugs (AVPs), Amplatzer duct occluder II (ADOII), non-detachable and detachable coils. In this clinical review, the technical details that determine device type and size are explained. The recent generations of hydrogel-coated coils were also used in this series of patients to close the difficult types of collaterals with better results. All described vessels were closed successfully, without any complications. The patients had a significant rise in their transcutaneous oxygen saturations and hence, a clear clinical benefit.

Tran Catheter Closure of Ventricular Septal Defects (VSD): Preliminary Results in Children Weighing 5kg or Less

<i>Aim: </i>This study aims to evaluate feasibility and complications of device closure of ventricular septal defect (VSD) in children weighing 5kg. <i>Methods:</i> Between March 2018 and March 2021, total 15 patients with Ventricular Septal Defect (VSD) weighing 5Kg or less were taken to Cath lab for percutaneous VSD closure out of which 13 (86%) had successful transcatheter closure and 2 (14%) cases were unsuccessful and subsequently send for surgical closure. All of these13 patients under went transcatheter closure of VSD using either a Amplatzer duct occluder1, Amplatzer duct Occluder 2 or Amplatzer Muscular VSD Occluder. A retrospective review of the results and related complications was done. <i>Results:</i> Among these 15 patients, 7 were females, 6 were male and the mean age was 8.5 (4-16month. The mean weight in this study was 4.46Kg (2.3-5Kg). Mean VSD size was 4.5 (3-10mm), 9 patients had VSD sizes between 3to5mm, 3 had between5-10 mm and 1 with more than 10mm. Among types of VSD, 9 cases were having Perimembranous, 1 was upper muscular, 1was mid while 1was lower muscular and only 1 had outlet muscular VSD. Amplatzer Duct Occluder (ADOI) was used in 2 cases, 9 were closed with Amplatzer Duct Occluder (ADO2) and 2 were selected for closure with Amplatzer Muscular VSD Occluder. Transthoracic Echocardiography (TTE) in immediate post intervention period revealed all these devices in situ with no or minimal residual flow which subsided within 24 hours period. As far as complications are concerned, we had one device embolization noted in our study. Tricuspid regurgitation (TR) was noted at the time of discharge in 4 patients but subsided after 48 hours while trivial aortic regurgitation was noted (AR) only in one case which is under close follow up and not increasing in severity after 6 months follow-up. <i>Conclusions</i>: Transcatheter closure of VSD in children 5kg or less is feasible and safe alternative to surgical VSD closure.

The Amplatzer duct occluder (ADOII) and Piccolo devices for patent ductus arteriosus closure: a large single institution series.

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. 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. 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%). 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.

PO-01-083 PERCUTANEOUS CLOSURE OF PERI-DEVICE LEAK FOLLOWING LEFT ATRIAL APPENDAGE CLOSURE USING AN AMPLATZER DUCT OCCLUDER

Percutaneous left atrial appendage (LAA) closure has been recognised as an alternative therapy for stroke prevention in selected patients with non-valvular atrial fibrillation (AF) who have difficulties with long-term oral anticoagulation. Peri-device leaks (PDLs) are frequently diagnosed after LAA closure procedures, regardless of closure methods. PDL > 5mm is related with further embolic events. Nevertheless, management of severe PDL has been a challenging concern which requires multiple teams involved. To report our single centre experiences of percutaneous closure of sever PDL using an Amplatzer closure device. Patients with PDL >5mm after the LAA closure at our centre were reviewed for secondary percutaneous closure. In a case-specific approach, an Amplatzer occluder was implanted under TEE and fluoroscopic guidance depending on the morphology of the defect. Patients' characteristics, procedural details and clinical outcomes was collected and analysed. Three patients (average age 67 ± 9 years old, 2 female) with severe PDL using either Watchman device (n=1) or Lariet device (n=2) were studied. The CHADs2VASC2 score was 4 ± 2, with HASBLED score of 4 ± 1. They all have multilobed LAA morphology (bi-lobar in 2 patients) and one patient suffered TIA in 6 weeks post LAA closure. PDLs with a neck size of 8.3 ± 2.9 mm (range 5-10 mm) were demonstrated on transoesophageal echocardiogram (TOE) and left atrium computed tomography. The percutaneous closure of PDLs were underwent at 10 ± 2 months after their LAA closure under general anaesthesia and TOE guidance. Three Amplatzer Duct Occluder II (ADO II) with an average size of 6.3 ± 0.2 mm were delivered to close the leaks successfully (Please see example cases in Figure 1). No peri-device residual flow was identified on TOE and LAA angiography after the secondary closure. No procedural complication occurred. There was no residual leak or peri-device thrombus formation on follow-up TOE in 60 days and anticoagulation was then stopped after the TOE confirmation. No further thromboembolic event was reported during an average follow-up of 9 ± 5months. Percutaneous closure of PDL using a tailored approach using ADO II device represents a safe, and feasible management associated with favourable clinical outcomes.

Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device

BackgroundHemolysis after Patent ductus arteriosus (PDA) device closure is rare. Although in most cases, hemolysis settles on its own; however, in some cases it may not settle spontaneously and may require additional procedures like putting additional coils, gel foam or thrombin instillation, balloon occlusion, or removing it surgically. We report a case of adult PDA device closure who persisted with hemolysis and was managed by transcatheter retrieval.Case presentationA 52-year-old gentleman presented to us with a diagnosis of large PDA with operable hemodynamics. Descending thoracic aortic Angio showed a large 11 mm PDA. Transcatheter device closure was done in the same sitting with a 16 × 14 Amplatzer Ductal Occluder I(ADO) device,;however, after device release, the aortic end of the device was not fully formed and there was residual flow. The next morning patient started with gross hematuria with persistent residual flow. We tried to manage with conservative means including hydration, and blood transfusion; however, residual flow persisted for 10 days and his hemoglobin dropped from 13 gm/dl preprocedural to 7 gm/dl, creatinine increased from 0.5 mg/dl to 1.9 mg/dl, bilirubin increased to 3.5 mg/dl & urine showed hemoglobinuria. As the patient continued to deteriorate it was planned to retrieve the device by transcatheter approach. 10 French amplatzer sheath was parked in the pulmonary artery near the ductus. We tried with a combination of multiple catheters and Gooseneck snare (10 mm) and finally, we successfully retrieved with a combination of Multipurpose (MP) catheter and 10 mm Gooseneck snare. After that, we closed the defect successfully with a double disk device (muscular Ventricular septal defect 14 mm Amplatzer). The patient’s hematuria settled and was discharged after 2 days with normal hemoglobin and creatinine.ConclusionsPatent ductus arteriosus ADO 1 device should not be released if the aortic end of the disk is not fully formed Patient should be carefully monitored for hemolysis if evidence of residual shunt and given supportive treatment. If conservative treatment fails, residual flow needs to be eliminated. Transcatheter retrieval although technically challenging is a feasible treatment. A muscular VSD device is a good alternative to the usual PDA device to close PDA, especially in adults.

Effectiveness and Safety of Transcatheter Closure of Various Ventricular Septal Defects Using Second-Generation Amplatzer Duct Occluders

Objective: This study was designed to determine the long-term safety and efficacy of using the Amplatzer Duct Occluder II (ADO II) for the closure of various ventricular septal defects (VSDs). Methods: From January 2011 to December 2019, selected VSD patients were treated through transcatheter intervention using ADO II occluders. The closure results and complications from 188 patients, involving 167 perimembranous ventricular septal defects (pmVSDs), 9 intracristal VSDs, 11 post surgery residual shunts and 1 post closure residual shunt with the mean outlet diameter3.1 ± 0.8 mm under angiography, were enrolled in this study. Results: The success rate was 98.9% for all procedures. During the median 77-month follow-up period, no cases of complete atrioventricular block (cAVB), infective endocarditis or death occurred. One major adverse event (0.5%) was recorded: cerebrovascular accident occurred 1 day after the procedure in one patient who was transferred to the neurology department. The residual shunt rate was 44.6%, which was the most common minor adverse event. The cardiac conduction block rate was 4.3%. Specifically, one pmVSD patient developed intermittent LBBB during the 28-month follow-up. There were 3 patients (1.6%) with new-onset mild tricuspid insufficiency, and the insufficiency degree was stable during follow-up. There was no new-onset aortic insufficiency that occurred. Conclusions: Transcatheter closure of pmVSDs, some intracristal VSDs, some postsurgery or postclosure residual shunts using ADO II occluders were both safe and effective and yielded excellent long-term results in selected patients.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Management of bronchopleural fistula using Amplatzer duct occluder device.