Successful Transcatheter Closure Research Articles

Value of Intracardiac Echocardiography in the Interventional Closure of Patent Foramen Ovale with Adjacent Atrial Septal Defect

Objective. This study aimed to investigate the application value of intracardiac echocardiography (ICE) in transcatheter closure of a patent foramen ovale (PFO) combined with an adjacent atrial septal defect (ASD). Methods. This retrospective study included five patients with PFO combined with adjacent ASD who underwent transcatheter closure and were admitted to the Zhongshan Hospital of Fudan University from June to September 2023. General conditions, ultrasound and ICE findings, and operative data were recorded and followed up for 2–6 months. Results. Of the five patients, two and three had embolic stroke of undetermined source and migraine, respectively, aged 45.6 ± 12.0 years. All patients underwent successful transcatheter closure via the PFO tunnel under the guidance of ICE, without complications or new stroke, and showed significantly reduced migraine at the follow-up. Conclusion. In patients with PFO combined with adjacent ASD, closure of a PFO tunnel could be successfully achieved under ICE guidance; its clinical efficacy was accurate and worthy of promotion.

Successful transcatheter closure of the right coronary artery-left ventricular fistula with coronary artery ectasia and aneurysm

Successful transcatheter closure of the right coronary artery-left ventricular fistula with coronary artery ectasia and aneurysm

Successful Transcatheter Closure of Iatrogenic Mitral Regurgitation After Aortic Valve Surgery

We present 2 cases of significant mitral regurgitation secondary to pericardial patch avulsion from the anterior mitral valve leaflet after aortic valve replacement with aortic annulus enlargement. Both cases were successfully managed by transcatheter repair with off-label implantation of occluder devices.

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.

P113 TRANSCATHETER CORRECTION OF RESIDUAL INFERIOR SINUS VENOSUS DEFECT AFTER SURGICAL CLOSURE

Abstract A 21–year old male who underwent surgical closure of an isolated inferior type sinus venosus atrial septal defect (SV–ASD) at 6 years of age was admitted to our institute for acute superior limb hypotonia and dysarthria, with brain computed tomography scan positive for an ischaemic event. The contrast transcranial Doppler (CTD) was positive for right–to–left shunt (RLS). The transesophageal echocardiogram (TOE) revealed a small ASD (3.8 mm) near the inferior vena cava (IVC) with a small baseline left–to–right shunt and severe RLS after Valsalva’s Manovre (&amp;gt;20 bubbles) (fig.A–B). No clear intra–cardiac source of embolization was detected on workup. After a multidisciplinary discussion, percutaneous closure of residual ASD was planned. The main challenge was represented by inadequate inferior–posterior rim towards the IVC (&amp;lt;5 mm). A Figulla Flex II ASD Occluder with the smallest waist of 4 mm was implanted with no evidence of residual intraprocedural shunt; no intraprocedural complications were observed (fig.C). The 1 month follow–up CTD was negative for RLS. Conclusions Residual ASD is a rare late complication after surgical closure of the ASD(1). We describe the case of a successful transcatheter closure of a small ASD in the presence of a deficient posterior–inferior rim which, in general, is considered an unfeasible anatomy for percutaneous procedure (2). The appropriate choice of treatment for a residual ASD should be carefully considered on a case–by–case basis. Reference 1) S. Ogura;Y.Takaya1; T. Akagi; K. Nakagawa; H. Ito.Percutaneous closure of residual atrial septal defect after surgical closure. Cardiovascular Intervention and Therapeutics (2021) 36:256–259 2) M. Chessa; G. Butera; A. Giamberti; R. M. Bini; M.Carminati. Transcatheter Closure of Residual Atrial Septal Defects After Surgical Closure. Journal of Interventional Cardiology vol.15, No. 3,2002

Patent Ductus Arteriosus Device Closure with AMPLATZER Duct Occluder-II in a Low Birth Weight Preterm Neonate- First Experience in Pakistan

We report a successful closure of large patent ductus arteriosus (PDA) in a low-birth weight preterm neonate using an ADO IIdevice for the first time in AFIC/NIHD Rawalpindi. A hemodynamically significant PDA in a preterm neonate carries anincreased risk of morbidity, including chronic lung disease, necrotizing enterocolitis and renal impairment. After the failure ofmedical therapy, successful, timely and safe transcatheter closure of PDA using appropriate equipment is a milestone inmanaging PDA in preterm neonates.

Transcatheter closure with a "single lobe" Amplatzer Vascular Plug of a tubular patent ductus arteriosus in a neonate with transposition of the great arteries and heart failure.

A patent ductus arteriosus in patients with transposition of the great arteries is usually beneficial to allow shunting between pulmonary and systemic circulations. However, if the duct is too large, it can cause haemodynamic instability, pulmonary oedema and compromised organ perfusion. We present a neonate in whom a 5 mm short and tubular ductus arteriosus was causing significant cardiac failure with necrotising enterocolitis and liver impairment, leaving him too unstable for the arterial switch operation. At day 14 of life (3.1 kg), the baby underwent successful transcatheter closure using an Amplatzer vascular plug (Abbott, Chicago, Il, USA) delivered through a 5Fr catheter from the aortic side. The procedure was uncomplicated and successful as the neonate was extubated 2 days later. He subsequently underwent successful arterial switch surgery.

Outcomes of Transcatheter Closure in Outlet-Type Ventricular Septal Defect after 1 Year

<b>Background:</b> Ventricular septal defect (VSD) is the most common congenital heart disease. Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD. However, there is a limit data for outlet VSD, especially impact to the aortic valve leaflet after transcatheter closure. This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect (OVSD) after 1 postoperative year. <b>Methods:</b> A retrospective study was performed including 50 patients who underwent transcatheter (n = 25) and surgical (n = 25) OVSD closure during the exact time frame at two medical centres. <b>Results:</b> The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group (7.0 <i>vs.</i> 2.8 years; 27.0 <i>vs.</i> 11.4 kg; <i>p </i>< 0.01). The defect size in the surgical group was significantly larger than that in the transcatheter group (5.0 <i>vs.</i> 3.0 mm; <i>p</i> < 0.01). All OVSD patients have successful transcatheter closure (100%) as effective as surgical closure. Less than small residual shunt was present 20% and 8% immediately after the procedure in the transcatheter and surgical groups (<i>p </i>= 0.50), which decreased to 12% and 4% at the 1-year follow-up (<i>p </i>= 0.61), respectively. No incidence of complete atrioventricular block and other complications was observed in both groups, and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups (<i>p </i>= 1.0). <b>Conclusions:</b> Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.

Circumflex Coronary Artery Fistulae Draining into Right Atrium: A Case Report

Coronary artery fistula (CAF) is an anomaly making a coronary artery communicate with a heart cavity or a great vessel, thus bypassing the myocardial capillary bed. CAF is frequently diagnosed as an incidental finding. Herein, we present the case of a 4-year-old boy. He was referred for a pediatric cardiology assessment due to a continuous murmur at the middle sternal border. Echocardiogram showed dilated left coronary artery and an abnormal diastolic flow in the right atrium. The right-sided chambers were slightly enlarged, but ventricular contractility was normal. CAF was suspected. Angiography and CT confirmed the diagnosis of coronary fistula from the circumflex coronary artery to the right atrium. Successful transcatheter closure with an Amplatzer PiccoloOccluder was performed with complete occlusion.

Abstract 15278: Transcatheter Closure of Atrial Septal Defect Over the Age of 60

Introduction: The long-term benefits of transcatheter device closure of a secundum atrial septal defect (ASD) over 60 remain controversial. The aim of the study was to assess the predictors of death late after device closure in these elderly patients. Methods: This retrospective study enrolled 87 patients with successful ASD transcatheter closure over 60 and at least 1 year follow-up after closure. The mean age was 73.3±5 years, and 74 of them were female (85%). All patients had an isolated secundum ASD with a mean defect size of 18±4 (9-30) mm. At the time of closure 10 patients were known with pulmonary hypertension (11%), 52 with atrial arrhythmia (61%), 56 with heart failure (64%), and 15 with coronary artery disease (17%). Demographic, clinical and echo data were compared between values at the time of closure, and at the last follow-up. Predictors of death were analyzed with multivariate Cox regression. Results: After the mean follow-up of 5±4 years 11 patients developed high LV filling pressure, 15 patients had new atrial arrhythmia and 10 patients right heart failure. At the last FU a significant decrease in right ventricular (45±5 vs 38±8 mm, p=0.032) and right atrium dimension (62±10 vs. 59 ±10mm, p=0.045) were seen, together with right ventricular systolic pressure improvement (51±18 vs. 40±19 mmHg, p=0.038). The left atrium showed significant further dilatation after closure (60±9 vs. 62±9.5, p=0.048). The presence of pulmonary hypertension, right ventricular dilatation and tricuspid regurgitation correlated with the right heart failure after closure, and the atrial dimension, tricuspid regurgitation, and high filling pressure with new atrial arrhythmia. Fourteen patients died during follow-up. On multivariate analysis the main predictor of death was right heart failure (HR: 10; 95% CI 2,15-41). Conclusions: In terms of right heart remodeling, elderly patients still benefit from late ASD catheter closure. However, those who develop right heart failure after closure are at a high risk of death (HR:10). Diastolic dysfunction after the defect closure was not a predictor of death.

Abstract 14411: Transcatheter Closure of Residual Leak Using Gore Cardioform Occluder After Failed Surgical Ligation of Left Atrial Appendage

Introduction: In non-valvular atrial fibrillation, the left atrial appendage (LAA) is the most common site for thromboembolic formation. The current recommendation is that patients with afib and a CHA2DS2-VASC risk score &gt;2 who undergo cardiac surgery should simultaneously have surgical left atrial appendage closure (Grade 1b). A rare complication that can occur includes incomplete LAA surgical closure with the residual leak, leading to an increased risk of stroke or thromboembolic events. We present two cases with residual leaks on follow-up after surgical ligation of LAA. Methods: Two patients aged 75 to 80 years old with a history of paroxysmal atrial fibrillation, surgical mitral valve repair, and surgical left atrial appendage ligation underwent a transesophageal echocardiogram (TEE) to evaluate the LAA. The CHA2DS2-VASC risk score was 3 for both patients. There was evidence of a residual leak greater than 5 mm between the left atrium and left atrial appendage. Results: Given the residual leak and risk scores, both patients had an increased risk of stroke. Therefore both patients underwent successful transcatheter closure of the left atrial appendage using a 20 mm Gore CARDIOFORM occluder. TEE was used to confirm no residual color flow and confirmed complete closure of the defects. Patients were continued on oral anticoagulation (DOAC) for six weeks with the plan to switch to antiplatelets. Conclusions: Studies have shown that surgical ligation of LAA can result in a residual leak which can increase the risk of systemic embolization. Following failed surgical ligation of LAA, transcatheter closure of residual leak with Gore CARDIOFORM occluder may be a safe and effective strategy for management. Further studies are needed to evaluate the safety, efficacy, and outcomes of utilizing a septal occluder device in patients with residual leaks due to failed surgical ligation of LAA.

Alteration of Pulmonary Venous Flow Doppler Post Transcatheter Closure of Atrial Septal Defect

Background: Atrial septal defect is a common congenital heart anomaly results in hemodynamically significant right ventriclular volume overload and an increase in the pulmonary venous flow.&#x0D; Aim: Evaluate changes of pulmonary venous flow parameters after transcatheter closure of secundum atrial septal defect.&#x0D; Patients and Methods: 50 patients with atrial septal defect aged from 3.5 to 31 years were included in the study. Pulmonary venous flow Doppler and right ventricular function were evaluated before and after successful transcatheter closure by transthoracic and transesophageal echocardiography.&#x0D; Results: The defect size ranged from 15 to 37mm with a mean (24.96 ±7.52), Normal systolic and diastolic waves of pulmonary venous flow Doppler were replaced by a continuous antegrade wave (mean 60±13.6 cm/s) in all atrial septal defect patients. Post-closure, the normal pulmonary venous flow pattern was regained, two separate waves, with a significant decrease in mean peak Systolic wave velocity (44.54±8.12 cm/sec vs 69.61±12.37, P=0.000), the mean peak Diastolic Wave velocity (55.85±9.81 cm/sec vs 72.65±10.38, P=0.000) and a significant increase in the mean peak atrial reversal wave velocity (28.75±4.63cm/sec vs 21.18±3.64, P=0.000). In multivariate regression analysis, significant predictors of haemodynamic significant ASD were ASD size,(odds ratio 1.508, P=0.007, 95% CI 1.153,2.671) and ASD/IAS ratio (odds ratio 2.313, P=0.001, 95% CI 1.064,3.104).&#x0D; Conclusions: Atrial septal defect patients have characteristic pulmonary venous flow pattern: continuous antegrade wave with systolic predominance and decrease in atrial reversal wave, which return to normal after closure. These changes could be helpful echocardiographic tool in prediction of successful closure of the defect.

Prenatal Diagnosis of a Large Left Coronary Artery to Right Ventricle Fistula With 3-Dimensional/4-Dimensional Spatiotemporal Image Correlation Rendering Followed by Successful Neonatal Transcatheter Closure.

Prenatal Diagnosis of a Large Left Coronary Artery to Right Ventricle Fistula With 3-Dimensional/4-Dimensional Spatiotemporal Image Correlation Rendering Followed by Successful Neonatal Transcatheter Closure.

Renal Function After Transcatheter Piccolo Patent Ductus Arteriosus Closure With Contrast Angiography in Extremely Premature Infants

Transcatheter patent ductus arteriosus (PDA) device closure is increasingly performed in extremely premature infants. Contrast angiography improves the procedural safety and effectiveness by precise anatomic delineation. Contrast nephropathy is a concern in clinically ill premature infants, especially with the presence of renal insufficiency. We hypothesized that the benefit of transcatheter PDA closure outweighs the harm of contrast nephropathy in extremely premature infants. A total of 160 infants underwent successful transcatheter (n=59) and surgical (n=101) PDA closure at a median age of 26 (7 to 78) days. The surgical group had a lower procedural weight (870 vs 960 g, p=0.014). In the transcatheter group, serum creatinine decreased from 0.48 to 0.45 mg/100 ml at 24 hours (p=0.003, n=59) and decreased further to 0.37 mg/100 ml at 5 to 7 days after closure (p &lt;0.001). Median contrast amount was 1.9 ml/kg (0.6 to 6.1). In 8 infants with pre-existing renal insufficiency who underwent transcatheter closure, serum creatine significantly improved from 1.44 to 1.36 mg/100 ml at 24 hours and 0.79 mg/100 ml at 5 to 7 days after closure (p &lt;0.001). There was no difference in improvement of serum creatinine between transcatheter and surgical closure groups. In conclusion, despite the use of contrast, serum creatinine significantly improved with transcatheter PDA closure even in infants with pre-existing renal insufficiency. Contrast angiography should not be discouraged for transcatheter PDA closure because of the concern for contrast nephropathy in extremely premature infants.

SUCCESSFUL PERCUTANEOUS CLOSURE OF POST-MYOCARDIAL INFARCTION, VENTRICULAR SEPTAL RUPTURE IN A PATIENT WITH COVID-19: A CASE REPORT

Ventricular septal rupture (VSR) is a rare life-threatening complication of myocardial infarction. Transcatheter or surgical closure could be both used for VSR management but using the transcatheter method is associated with less mortality rate. Regardless of the controversial issues, the best timing for the procedure in post-myocardial infarction, the patient’s clinical condition and underlying diseases might complicate the management. We present a patient with positive COVID -19 test who developed VSR, following myocardial infarction. Successful transcatheter closure was carried out and the health condition improved, as well.

Phase contrast cardiac magnetic resonance imaging versus transoesophageal echocardiography for the evaluation of feasibility for transcatheter closure of atrial septal defects

BackgroundThis prospective study was aimed at comparing phase contrast cardiac magnetic resonance imaging (PC-CMR) with 2D transoesophageal echocardiography (TEE) for determining potential candidature for transcatheter closure in ostium secundum ASD (OS-ASD) patients. We included consecutive adult patients with OS-ASD for the evaluation of feasibility for transcatheter closure using 2D-TEE and PC-CMR over a period of 2 years. Patients who fulfilled the conventional criteria for transcatheter closure, i.e. maximum ASD diameter ≤ 34 mm, adequate rims (≥ 5 mm, except for anterosuperior rim), and normal pulmonary venous drainage on both imaging modalities, were taken for device closure. In patients where there was discrepancy in the measurements of ASD diameter or rim size, making them eligible for device closure on one imaging modality and ineligible on the other hand, provisional device closure was attempted. All patients who underwent transcatheter closure were followed up to 6 months to rule out any complications.ResultsA total of 58 patients (mean age 35.93 ± 10.59 years) were enrolled in the study. Overall, there was significant positive correlation between 2D-TEE and CMR measurements of maximal ASD diameter and rim size (p < 0.001). However, TEE significantly underestimated maximal ASD diameter and posteroinferior rim size in comparison with CMR (p = 0.013 and p = 0.023, respectively). 46 (79.3%) patients were suitable for transcatheter closure on CMR, while 44 (75.9%) were eligible on TEE. Transcatheter closure was attempted in 48 patients based on imaging findings and was successful in 46 (95.8%) patients. Device closure was unsuccessful in 2 patients with defect size < 34 mm on TEE but > 34 mm on CMR. Among 7 patients with deficient posteroinferior rim on TEE, 5 had sufficient rim on CMR and underwent successful transcatheter closure. CMR detected anomalous pulmonary venous drainage in one patient which was missed on TEE, hence excluding the patient from transcatheter closure. Mean device size was 28.3 ± 7.4 mm and correlated more strongly with the defect dimensions on PC-CMR (r = 0.85, p < 0.001) compared to TEE (r = 0.71, p = 0.02).ConclusionsPC-CMR may to be superior to 2D-TEE for the preprocedural planning and feasibility assessment for transcatheter closure in adult patients with ostium secundum ASD.

Electrical cardiometry in monitoring percutaneous closure of ductus arteriosus in preterm infants: a case study on five patients.

Patent ductus arteriosus closure by catheter-based interventions has become the preferred therapeutic choice. However, hemodynamic perturbances associated to this procedure have not yet been investigated. This study sought to examine the on-site hemodynamic impact caused by the procedure in preterm neonates. In this study, hemodynamic monitoring was obtained in a non-invasive way using electrical cardiometry in five preterm infants who underwent percutaneous patent ductus arteriosus closing at ASST Grande Ospedale Metropolitano Niguarda of Milan. All five infants underwent successful transcatheter closures. All patients experienced immediate hemodynamic changes upon ductal closing. Significative modifications occurred mainly in heart contractility, cardiac output, and stroke volume. In three cases, there was also a significative increase of systemic vascular resistance which persisted for 4h after closing. While in two cases they spontaneously reduced with an amelioration of cardiac output and contractility, in the other case they were persistently high, associated with an hypertensive crisis and a progressive reduction of cardiac functions. For these reasons, milrinone was started and hemodynamic parameters returned normal in about 3h, so therapy was discontinued. Conclusions: Our single-center, prospective, consecutive, case series demonstrated hemodynamic aberrations due to sudden closure of a patent ductus arteriosus. Moreover, post procedural hemodynamic monitoring is important to precociously detect possible cardiac impairment and start an adequate therapy. What is Known: • It has previously suggested a temporarily impairment in cardiac output following patent ductus arteriosus closing. • Little is known about the other hemodynamic parameters during the procedure and how they change in the next hours according to the new hemodynamic status. What is New: • The persistence of increased systemic vascular resistance after percutaneous closure of ductus arteriosus could suggest the occurrence of hemodynamic complications. • Electrical cardiometry was useful to early detect postoperative hemodynamic changes.

Successful transcatheter closure of an adult coronary artery fistula using the micro vascular plug device.

Successful transcatheter closure of an adult coronary artery fistula using the micro vascular plug device.

486 A blue man standing

An 85-year-old was admitted in Internal Medic Ward for recurrent episodes of acute respiratory failure. His electrocardiogram showed a new onset of atrial flutter with spontaneous reversal to sinus rhythm (narrow QRS complex and normal atrioventricular conduction). The dyspnoea was worse with the patient sitting and was better when lying supine. Also, he report back pain associated to his major kyphoscoliosis. Results of chest radiography and blood test were normal. The arterial blood gas test revealed a hypocapnic hypoxemic respiratory failure, therefore the patient oxygen supplementation with noninvasive ventilation (NIV) was started, but peripheral oxygen saturation was persistently below 88% despite the high flow oxygenation. The patient underwent nasopharyngeal (NP) swab (ruling out SARS-CoV-2), high-resolution computed tomography (which was not pathologic), and computed tomography angiography (excluding pulmonary embolism). A transthoracic echocardiography was performed showing concentric hypertrophy, left atriomegaly and severe aortic ectasia of the root and of his ascending part, normal pulmonary pression and an aneurism of the interatrial septum with the presence of right-to-left shunt after using agitate saline contrast with Valsalva maneuver. Transesophageal echocardiography (TTE) confirmed the presence of severe structural interatrial septal abnormality with wide left convex aneurysm and an atrial septum defect (ASD) as ostium secundum, causing severe bidirectional shunt. Therefore, the patient underwent a successful transcatheter closure of secundum ASD with device Amplatzer Septal Occluder 018, while monitored with cardiac catheterization and transesophageal echocardiography. After few days, the patient was discharged at home without oxygen therapy. At the 3-month follow-up visit he reported no respiratory symptoms. Platypnea-orthodeoxia syndrome (POS) is an uncommon disorder characterized by dyspnoea and hypoxemia that occurs when the patient is sitting or standing and disappear quickly when recumbent. POS is characterized by both an anatomic and a functional component. The anatomic element is typically an interatrial communication such as ASD or Patent Foramen Ovale, which cause blood shunt left-to-right due to a higher pressure in left atrium and a greater compliance of the right ventricle, in the presence of normal pulmonary artery pressure. The syndrome occurs when a functional element, such as an increased atrial pressure or a decreased compliance of the right ventricle, reverses the flow. The shunts are often small and could remain asymptomatic: the high left atrial pressure let the defect close until there is a reverse pression which stretched atrial septum in particular in the upright position. In fact, when the patient is standing, the inferior vena cava comes in line with the defect increasing the right-to-left flow, sparking the respiratory symptoms. This could be linked to a cardiac or an extracardiac condition; in this case the presence of kyphoscoliosis and severe aortic ectasia of the root and of his ascending part, played an important role. The diagnosis is mainly made by echocardiography and cardiac catheterization to verify the mismatch in oxygen saturation between the pulmonary vein and the aorta. The diagnosis of POS is challenging, often considered only after other possible diagnosis is excluded. When POS is triggered by an interatrial defect in the absence of severe pulmonary hypertension, the usual treatment is a percutaneous or surgical closure.

Is Two Dimensional Echocardiography sufficient for selection of device for successful transcatheter closure of Patent Ductus Arteriosus in Children?

Background and Aims: Two dimensional transthoracic echocardiography (2DE) is widely used for detecting congenital heart disease and is possible to obtain precise measurement of Patent ductus arteriosus (PDA) for device selection required for transcatheter closure. Primary aim of the study is to determine whether echocardiographic assessment alone can be used for selection of device for transcatheter closure of PDA.&#x0D; Methods: Children with PDA and planned for transcatheter intervention were included in this cross-sectional study of one year. PDA was assessed with 2DE and prediction of device size was made.&#x0D; Results: The results were obtained from 107 children. The median age and weight at intervention were 3.8 years (ranging from 6 months to14 years) and 12 kg (ranging from 3.5 to 60 kg). Type A (Conical) PDA was the commonest PDA morphology accounting for 87.8% and 85% in 2DE and angiography respectively. There was no difference (p &lt; 0.05) in the narrowest diameter at pulmonary end measured by 2DE and angiography, however ampulla diameter and ductal length were statistically different (p = 0.95). The predicted size of device by 2DE was discordant (p &lt; 0.05) to the actual device used in a total study population, however when patients with severe pulmonary hypertension, non-type A and larger PDA (narrowest diameter &gt; 6mm) were excluded, the predicted size of device by 2DE was statistically concordant (p = 0.1) to the actual device used in 89 (83%) patients.&#x0D; Conclusion: Two dimensional Transthoracic echocardiography alone may be helpful in choosing the device during transcatheter closure of PDA in selective group of patients.