PDA Occluder Research Articles

D-5 | Novel Use of Snare Catheter for Piccolo PDA Occluder Device Delivery to Avoid Tricuspid Valve Regurgitation in Premature Infants

D-5 | Novel Use of Snare Catheter for Piccolo PDA Occluder Device Delivery to Avoid Tricuspid Valve Regurgitation in Premature Infants

TCTAP C-188 Transcatheter Closure of Ruptured Sinus of Valsalva With PDA Occluder Device in Previously Surgically Repaired Ventricular Septal Defect

TCTAP C-188 Transcatheter Closure of Ruptured Sinus of Valsalva With PDA Occluder Device in Previously Surgically Repaired Ventricular Septal Defect

Transcatheter mechanical thrombectomy of neonatal occlusive aortic thrombus using an Amplatzer Piccolo PDA occluder.

Neonatal aortic thrombus is a rare and critical condition that can present mimicking severe coarctation of the aorta or interrupted aortic arch. Transcatheter thrombectomy for this lesion has not been well described. We report a premature neonate with an occlusive proximal descending aorta thrombus, who underwent transcatheter mechanical thrombectomy using an Amplatzer Piccolo PDA occluder (Abbott, North Chicago, IL, USA). The procedure was successful with no subsequent distal thromboembolic events.

Percutaneous Transapical Access for Performing Interventional Procedures in Patients with Structural Heart Pathologies: a Single Center Experience

The paper describes the experience of percutaneous transapical access (PTA) usage for performing transcatheter structural interventions in 7 patients. Four patients had paravalvular insufficiency of the prosthetic mitral valve, one patient had a reshunt of ventricular septal defect and a pseudoaneurysm in the area of fibrous mitral-aortic continuity. Two patients underwent PTA for diagnostic examination. The visualization methods, planning algorithm, and technique of the procedure have been described. The overall efficiency was 100%, the degree of paravalvular leak was reduced in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction.
 The aim. This study was designed to evaluate modern outlooks about the use of PTA during interventions, enhance the available data and extrapolate the authors’ own experience with the development of their own conclusions and recommendations.
 Materials and methods. To differentiate structural pathology, the initial selection of patients was performed according to the findings of transthoracic and transesophageal ultrasound. The next step in planning of PTA is analysis of computed tomography (CT) data with 3D reconstruction.
 PTA and subsequent interventions were performed in the hybrid catheterization laboratory after evaluation of CT data, guided by transesophageal echocardiography (TEE), and with the establishment of optimal angles of the angiograph arc for the best fluoroscopic imaging. Besides, in order to avoid trauma of left anterior descending coronary artery, selective angiography was performed. Surgical team support was essential in all cases.
 Results. The overall efficiency was 100%, reduction of the degree of paravalvular leak was achieved in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction.
 Discussion. The subject of our research was PTA for structural interventions. Available data of the world literature shows that this technology has been developed since the end of the last century.
 The main complications that can be encountered during the intervention by PTA were: hemothorax; hemopericardium/tamponade; rupture of the coronary artery; pneumothorax; arrhythmia; death.
 In four out of five cases, we used a Lifetech HeartR PDA occluder to close the puncture site of the left ventricular apex. In the fifth case, LifeTech mVSD occluder was used.
 Conclusions. Correction of structural pathology by routine use of PTA requires a comprehensive approach to the diagnosis of this pathology using transthoracic and transesophageal echocardiography, contrast-enhanced CT and 3D reconstruction. Support of a multidisciplinary team to provide transition to conventional cardiac surgery access in case of periprocedural complications is mandatory. Due to the emergence of specialized implants, as well as the development of imaging techniques, PTA requires attention and further study.

Acute aortic dissection as a late and fatal complication of transcatheter persistent ductus arteriosus occlusion: a case report.

Background Persistent ductus arteriosus (PDA) is a common congenital heart defect, of which, the preferred treatment in children and adults is transcatheter occlusion. This report describes the first reported case of acute aortic dissection as a late complication of transcatheter PDA occlusion.Case summary A 66-year-old healthy woman, with a history of transcatheter PDA closure 12 years previously, died suddenly at home. Post-mortem revealed pericardial tamponade complicating an acute aortic dissection, with a large intimal tear identified adjacent to the PDA occluder.Discussion Transcatheter occlusion is accepted as a safe and effective treatment in older children and adults, important in preventing haemodynamic sequelae such as heart failure and pulmonary hypertension. Complications are uncommon and mostly acute, including device embolization and haemolysis. Aortic dissection has been reported as an acute complication but only in the setting of incorrect device deployment. This is the first description of aortic dissection as a late complication of transcatheter PDA occlusion and although rare has important ramifications given it is a potentially fatal outcome of a common procedure.

P1490 Congenital right coronary artery fistula into right atrium diagnosed with help of multimodality imaging

Abstract Introduction Coronary artery fistula (CAF) is an anomaly in which abnormal connections are present between the coronary artery and the cardiac chambers or a major vessel. It is an uncommon anomaly with an estimated incidence of 1 in 50,000 live births and usually occurs in isolation. We report a case of CAF into right atrium in a patient who admitted to our outpatient department with dyspnea and fatique. With help of transthoracic echocardiography (TTE), transesophageal echocardiography (TOE) and cardiac computerized tomography (CCT) we put the definite diagnosis and decided to close this fistula percutaneously with a PDA occluder. Case A 43-year- old male admitted to our outpatient department with complaints of exertional dyspnea and fatique for 5 years. His physical examination revealed a holosystolic murmur on the aortic valve area. His TTE showed enlarged right heart chambers with a high pulmonary artery systolic pressure (50 mmHg) and a suspicious flow from the aortic root into right atrium. Qp/Qs was 2.1. TOE depicted a shunt between aorta and right atrium as well, we couldn’t truly demonstrate the connection though . In order to define the defect precisely, we performed a cardiac CT. Cardiac CT clearly showed a markedly dilated and mildly tortuous and calcified fistula arising from the osteal part of right coronary artery draining into right atrium. Right coronary artery was thin and there was no stenosis. Cardiac CT helped us to exclude coronary arter disease as well. As it was suitable to close percutaneously, we decided to close it with a PDA occluder. Conclusion CAF is a rare, generally congenital anomaly and may cause right heart chamber dilatation and pulmonary hypertension if the diagnosis is missed. It is important to support and clarify the underlying pathology with help of other cardiovascular imaging modalities like cardiac CT and cardiac magnetic resonance imaging (CMR), if TTE and TOE cannot demonstrate us the exact pathology.In our case our choice of extra method was cardiac CT, as we wanted to exclude accompanying coronary artery disease at the same time. In today’s era, the use of multimodality imaging is increasing with a tremendous rate and it helps clinical cardiologists, cardiovascular imaging specialists and interventional cardiologists all. Abstract P1490 Figure. 2D,3D TOE and CCT images of CAF

Preliminary results of the CeraflexTM PDA occluder and device behaviour during releasing.

The CeraFlexTM PDA occluder is a new flexible device with a unique delivery system that may be beneficial with regard to not changing the device position after releasing. We prospectively evaluate the efficacy of the device and also the device behaviour patterns during release. The study included 21 patients. Their median age was 1.2 years (from 6 months to 28 years) and weight was 9.6 kg (from 5.4 to 82 kg). All of the ducts were conical except one atypical ductus. Median ductal diameter at the pulmonary end was 3.8 mm (from 2.2 to 8.2 mm). The ductus was closed using an antegrade approach, but special attention was paid to the patterns of device behaviour during and just after releasing. Three different modes of device behaviour were observed during and just after releasing: (1) Neither difficulty nor change of position in 13 patients (62%), (2) a little difficulty in releasing but no change of position in 6 (29%), and (3) change of the device position in 2 (9%). There was no residual shunt on the next day except in one patient, in whom late device embolisation occurred. The device was retrieved and another, bigger device implanted. The CeraFlexTM PDA occlude device seems to be safe and efficacious for patent ductus arteriosus closure. Its unique delivery system generally fixes the device in a stable position that does not change after release (91%). Minor difficulty in releasing is not uncommon; however, the major disadvantage is the need for larger sheaths for delivery.

Trans-catheter Device Closure of Ruptured Sinus of Valsalva Aneurysms using PDA Occluder Devices

Trans-catheter Device Closure of Ruptured Sinus of Valsalva Aneurysms using PDA Occluder Devices

Fontan circuit fenestration occlusion with Occlutech patent ductus arteriosus occluder

We present a case of Fontan fenestration closure using an Occlutech patent ductus arteriosus occluder. The patient was diagnosed with tricuspid atresia, pulmonary atresia and secundum ASD at birth. He had a bilateral modified Blalock-Taussig shunt to promote growth of hypoplastic branch pulmonary arteries. He had a bidirectional Glenn Shunt at 11 years of age, and a total cavo-pulmonary connection (TCPC) with a fenestration at 19 years of age. He presented a year later with severe exercise intolerance and cyanosis. Cardiac catheterisation showed hypoxemia, normal pulmonary pressures, patent Fontan circuit and branch pulmonary arteries, and a Fontan circuit-to-right atrium fenestration with right to left shunting. A short shank Occlutech PDA occluder with a waist of 8mm, a pulmonary end of 10mm, an aortic disk of 16mm, and a length of 7mm, was selected to close the fenestration through the transvenous approach. The fenestration achieved complete immediate occlusion with this device.

Safety and efficacy of percutaneous device closure of large post tricuspid shunts in pediatric patients with severe PAH at short term and midterm follow up

Background: Transcatheter closure of large post-tricuspid shunts in patients with severe pulmonary arterial hypertension remains a challenging problem. Among this unique subset of patients there is an entire spectrum of severity of pulmonary vascular disease with variable pulmonary vascular resistance and reversibility especially in older children. Aims: The current study was done to assess the safety and efficacy of percutaneous device closure of large post tricuspid shunts in pediatric patients with severe PAH at short and mid term follow up. Methods: A total of 42 pediatric patients underwent transcatheter closure of large post tricuspid shunts with severe PAH. All subjects underwent clinical examination, electrocardiography, chest x-rays and echocardiography before discharge and at 1, 6 and 12 months after the procedure and yearly thereafter. Results: Most of the patients (64 %) were having patent ductus arteriosus followed by ventricular septal defect in 8 patients (19.04%), aorto-pulmonary window in 5 patients (12%) and coronary cameral fistula in 2 patients (5%). Cardi-O-Fix VSD occluder was the most commonly used device (45%), Cardi-O-Fix PDA occluder (21%) and Amplatzer duct occluder in 17% patients. Pre-procedural pulmonary artery systolic pressure decreased significantly from mean 81.12 mmHg to mean 43.17 mmHg post procedure over a mean follow-up of 18.5 months. Only two major complications viz; severe aortic obstruction and symptomatic complete heart block were noticed in two children. Conclusions: Our study showed that the transcatheter closure of large post tricuspid shunts in pediatric patients with severe PAH was safe, feasible and efficacious alternative to conventional surgery.

Transcatheter closure of anastomotic leakage after surgical procedures for noninfected ascending aortic pathology

Objective To evaluate the safety and efficiency of transcatheter anastomotic leakage closure after surgical procedures for non-infected ascending aortic pathology with different occlusion devices. Methods From Dec. 2013 to Sep. 2015, six cases received interventional therapy for anastomotic leakage after surgical procedures for non-infected ascending aortic pathology using occluders. Four cases were with proximal graft-vessel anastomotic leakage, including two pseudoaneurysms at the site of aortic roots and two ascending aorta to right atrium shunts. The other two cases were with artificial grafts to intraoperative stent anastomotic leakage leading to endoleak type Ib. The anastomotic leakage was totally occluded by single ADO Ⅱ respectively in four cases. Two detachable coils were implanted in one case with artificial graft to intraoperative stent anastomotic leakage, but mild residual shunt to false lumen was detected by DSA and follow-up CTA. The second interventional procedure was carried out one month later, and one ADO Ⅱ was used to close the residual leakage totally. One PDA occluder was implanted along arteriovenous guide-wire track via aortic root to right atrium fistula in one case. Results All the anastomotic leakages of the six cases were totally excluded by different occlude devices percutaneously. The technical success rate was 100%. Follow-up time was from 1 month to 4 years. The patients' clinical condition improved obviously. Follow- up CTA showed no recurrence of anastomotic leakage. Complete thrombosis and marked shrinkage of the pseudoaneurysm were achieved in two cases, and the partial thrombosis and shrinkage of the false lumen were achieved in 2 cases. Conclusion Trans-catheter closure is an alternative treatment for ascending aortic surgical anastomotic leakage, which may achieve satisfactory short- and mid-term results. Key words: Aortic diseases; Postoperative complications; Anastomotic leak; Radiology, interventional

0076: Transcatheter closure of the arterial duct with the Occlutech PDA occluder

Transcatheter closure of the arterial duct using the Occlutech PDA occluder. From March 2013 to April 2015, 16 patients underwent percutaneous arterial duct closure with the new Occlutech PDA occluder. There were 10 females and 6 males. All patients had significant L-to-R shunt with enlarged left ventricle. At implantation, the mean age was 87 months (median 35 months) and mean weight was 16±11kg (7.2 to 54kg). The procedure was realized under local anaesthesia. Size of the duct was 2.96±0.94mm (range 1.7 to 5.5mm) on angiography. According to Krichenko classification of PDA, ducts were: type A (n=14), Type B (n=1) and type E (n=1). The systolic pulmonary artery pressure was 43±17mmHg (range 24 to 91mmHg). Implantation succeeded in all. Closure was performed by the standard 4/6mm occluder (n=8), the standard 6/8mm occluder (n=3), the standard 5/7mm occluder (n=3), the standard 3.5/ 5mm (n=1) and the standard 8/10mm occluder (n=1) using a 6 or 7 F delivery sheath. After implantation, trivial shunt was noticed on angiography in 12 patients, 4 had no shunt. The fluoroscopic time was 6.5±8.7 minutes and radiation dose 6.0±4 Gycm2. After closure, femoral thrombosis was noticed in 2 patients but resolved completely under heparin therapy. On control Doppler echocardiography (1 to 18 months), duct was closed in all patients but one with only one month follow-up. No obstruction of the left pulmonary artery or isthmic stenosis was noticed. Percutaneous closure of PDA with the new Occlutech PDA occluder is safe and effective. The device is easy to handle and there is no learning curve for operators using the classic Amplatzer duct occluder. Further studies with longer follow-up are necessary to confirm these good results.

Rupture of Sinus of Valsalva Aneurysm (Type V Sakakibara Type) Treated by the Amplatzer Pda Occluder Device

Rupture of Sinus of Valsalva Aneurysm (Type V Sakakibara Type) Treated by the Amplatzer Pda Occluder Device

A giant pulmonary arteriovenous malformation without hereditary hemorrhagic telangiectasia: successful interventional embolization using a PDA occluder

A giant pulmonary arteriovenous malformation without hereditary hemorrhagic telangiectasia: successful interventional embolization using a PDA occluder

568 Single Center Experience in Paravalvular Leak Closure: Procedural Success and Long-Term Follow-Up

568 Single Center Experience in Paravalvular Leak Closure: Procedural Success and Long-Term Follow-Up

Percutaneous Closure of a Patent Ductus Arteriosus with the Cera™ PDA Occluder: Another Good Option in the Toolbox

The percutaneous closure of patent ductus arteriosus (PDA) has been considered the treatment of choice by most authors and several devices with different structural characteristics have been used. The initial experience with the novel Cera™ PDA Occluder is reported. From March 2010 through December 2011, patients weighing over 5 kg, with PDA diagnosed by transthoracic echocardiograms (TTE) with color Doppler flow mapping, and no associated defects, were submitted to the procedure. Follow-up was performed by TTE within one, three and six months after the procedure and yearly thereafter. Overall, 18 patients were referred for percutaneous occlusion, of which 61.2% were female. Mean age and weight were, respectively, 13.7 + 9.3 years and 42.9 + 20.1 kg. Regarding morphology, 11 were type A, 6 were type E and 1 was a residual postoperative defect. Mean diameter was 4.2 mm. Implant was possible in all patients. Ten 6–4 mm, one 8–6 mm, three 10–8 mm and four 12–10 mm devices were used. All defects were completely closed by the first follow-up TTE. There were no deaths or complications in this series. The Cera™ prosthesis may be used for the occlusion of small or large defects with excellent results in children and adults. The procedure is ease, safe, has a high efficacy and low morbidity and may be an excellent option for the percutaneous closure of PDA. Due to its flexibility, oversized devices greater than the 2 mm usually recommended should be used. Fechamento de Canais Arteriais com o Dispositivo Cera™ PDA Occluder: Mais uma Boa Opção na Caixa de Ferramentas O fechamento percutâneo de persistência dos canais arteriais (PCA) tem sido considerado tratamento de escolha pela maioria dos autores, e diversos dispositivos com diferentes características estruturais têm sido utilizados. Apresentamos a experiência inicial do grupo com a nova prótese Cera™ PDA Occluder. Entre março de 2010 e dezembro de 2011 foram submetidos ao procedimento pacientes com mais de 5 kg de peso, com PCA diagnosticada por meio de ecocardiograma transtorácico com mapeamento de fluxo em cores (ETT), sem defeitos associados. O seguimento foi feito com ETT no primeiro, no terceiro e no sexto meses subsequentes, e, a seguir, anualmente. No total, 18 pacientes foram encaminhados para oclusão percutânea, dos quais 61,2% eram do sexo feminino. As médias das idades e dos pesos foram, respectivamente, de 13,7 ± 9,3 anos e 42,9 ± 20,1 kg. Quanto à morfologia, 11 canais foram do tipo A, 6 foram do tipo E, e 1 pertuito residual após cirurgia. A média dos diâmetros foi de 4,2 mm. O implante foi possível em todos os casos. Foram utilizadas 10 próteses 6–4 mm, 1 prótese 8–6 mm, 3 próteses 10–8 mm e 4 próteses 12–10 mm. Todos os canais estavam completamente fechados por ocasião do primeiro ETT de controle. Não houve óbitos ou complicações nesta casuística. A prótese Cera™ pode ser utilizada para o fechamento de canais de pequeno ou grande calibres com excelente resultado, em crianças e adultos. O procedimento é fácil, seguro, com alta eficácia e baixa morbidade, e pode ser excelente opção para o fechamento percutâneo de PCA. Suas características de flexibilidade sugerem que sejam utilizadas próteses superdimensionadas acima dos 2 mm habitualmente recomendados.

Transcatheter occlusion of pulmonary arteriovenous fistula by closure of the effluent vein with transseptal puncture

We describe a case of a 38-year-old female with pulmonary arteriovenous fistula (PAVF), who underwent successful transcatheter occlusion of the effluent vein via a transpulmonary venous approach with transseptal puncture....

Left Coronary Artery-to-Right Atrium Fistula: An Evaluation of MSCT Angiography Before and After Transcatheter Closure with a PDA Occluder

The MSCT manifestations of a left coronary artery-to-right atrium fistula before and after the transcatheter closure were reported. Before treatment, MSCT showed a dilated left coronary sinus and the dilated left main trunk, which coursed along the coronary sulcus to form the left circumflex artery, draining directly into the right atrium in the left middle part. The fistula was occluded with a PDA occluder. Four days after the occlusion, MSCT showed that the fistula was completely occluded and there was massive thrombosis in the central part and around the occluder. The thrombus was found even in the segment near to the start point of the oblique marginal artery.

A novel method of hybrid intraoperative catheter‐based closure of ventricular septal defects using the Amplatzer® PDA occluder

In five patients, an apical muscular septal defect was closed in a hybrid approach using the Amplatzer® duct occluder during open heart surgery, whereas concomitant defects were treated surgically. In addition to their different heart defects that needed surgery, all had a muscular ventricular septal defect in the apex of the heart, poorly accessible for traditional, surgical approach. We describe the method and outcome in these patients. The tip of a forceps was advanced from the left into the right ventricle through the ventricular septal defect. The delivery sheath was caught under visual control in the right ventricle and pulled back into the left ventricle. The disc was developed and pulled back until it was felt tugging at the septum. Then the core was developed. The end of the device was visible in the right ventricle and was secured with a Prolene® suture. The procedures were event-free. During early follow-up there were either no or only insignificant shunts in the region of the prior trabecular defects in four patients. The unsatisfactory result in the last patient was caused by inaccurate preoperative assessment. The method seems valuable in patients in need of other intracardiac surgery.

Use of a Patent Ductus Arteriosus Occluder in the Treatment of a Renal Artery-Inferior Vena Cava Fistula

We report a case where an 8 mm mushroom patent ductus arteriosus occluder was used in a 59-year-old woman to resolve a renal artery-inferior vena cave fistula that occurred following a right nephrectomy performed 27 years previously. Complete occlusion of the fistula was achieved. This case highlights the novel use of a PDA occluder and provides evidence that this may be a viable technique for the management of arteriovenous fistulas with similar vessel relationships, anatomical characteristics, and occlusion demands as the fistula described in this report. Use of a Patent Ductus Arteriosus Occluder in the Treatment of a Renal Artery–Inferior Vena Cava FistulaEJVES ExtraVol. 17Issue 2PreviewWe report a case where an 8-mm mushroom patent ductus arteriosus occluder was used in a 59-year-old woman to resolve a renal artery–inferior vena cava fistula that occurred following a right nephrectomy performed 27 years earlier. Complete occlusion of the fistula was achieved. This case highlights the novel use of a PDA occluder and provides evidence that this may be a viable technique for the management of arteriovenous fistulas with similar vessel relationships, anatomical characteristics and occlusion demands as the fistula described in this report. Full-Text PDF Open Access