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At least 1,099 records · Page 61Linked to original sources
PubMed2001

Changes in coil morphology following transcatheter coil occlusion of the patent ductus arteriosus using a modified snare technique.

We observed a decrease in length of the Gianturco coils following transcatheter occlusion of the patent ductus arteriosus (PDA). Coil length was measured on chest radiograph within 24 hr of coil placement and compared to the length at the time of follow-up. Echocardiograms were also reviewed for evidence of duct recanalization. Twenty-seven patients met inclusion criteria. The median time to follow-up was 5 months (1--12 months). Twenty-four out of 27 (89%) patients had a decrease in coil length by 1.9 +/- 1.1 mm (P < 0.01). This was an average decrease of 16%. One patient had an increase in length and two patients had no change in coil length. Nineteen out of 27 patients had echocardiograms. Despite the change in coil length, there was no evidence of flow acceleration in the pulmonary artery or descending aorta. No patients had evidence of duct recanalization.

Adolescent↗
PubMed2001

Bioptome-assisted simultaneous delivery of multiple coils for occlusion of the large patent ductus arteriosus.

We describe a novel method that allows bioptome-assisted delivery of multiple Gianturco coils simultaneously for occlusion of the large patent ductus arteriosus (PDA). Two or more coils were intertwined at one end and held by a bioptome (5.2 Fr) and pulled into a short introducer. The coils were then deployed in the PDA via a long sheath (7-11 Fr) previously placed across the duct via the femoral vein. Twelve patients (6 months to 64 years; median, 10.5 years) with large PDAs (4.7 +/- 1.3 mm; range, 3.1-8.4 mm; PA mean pressure, 40 +/- 17 mm Hg; pulse pressure 63 +/- 18 mm Hg) underwent bioptome-assisted occlusion with multiple coils at our institutions. The procedure was uneventful in nine patients (fluoroscopy time, 6-23 min) and prolonged in three patients (fluoroscopy time, 26, 72, and 120 min) because of dislodgment of the coil mass and embolization of an additional coil. Successful coil deployment was feasible in all patients. Three patients required repeat coil deployment for flow elimination (hemolysis occurred in two). Flow elimination was demonstrated on the last follow-up evaluation in all except two patients. One infant has developed significant left pulmonary artery stenosis. Bioptome-assisted PDA occlusion using multiple coils delivered simultaneously may be a promising alternative to devices for transcatheter closure of large PDAs. Cathet Cardiovasc Intervent 2001;54:95-100.

Adolescent↗
PubMed1980

Pulsed Doppler echocardiographic diagnosis of patent ductus arteriosus: sensitivity, specificity, limitations, and technical features.

To determine the diagnostic features, sensitivity, and specificity of pulsed Doppler echocardiographic (PDE) diagnosis of patent ductus arteriosus (PDA), 110 infants with heart disease were examined by PDE from the precordial and suprasternal notch approaches. On precordial examination, PDA was diagnosed upon recording of diastolic ductal flow into the pulmonary artery. From the suprasternal approach, PDA was suspected upon recording of continuous turbulent flow in the right pulmonary artery. A PDA was proved by invasive means in 45 of 110 cases. Precordial PDE had diagnosed PDA in 43 of 45 cases. In eight of 110, continuous turbulent flow was present in the pulmonary artery from the precordial approach, but no PDA jet was recorded. In two of eight, PDA was present, and in six of eight others systemic-to-pulmonic communications were present. Precordial PDE diagnosis of PDA had a sensitivity of 96%, specificity of 100%, positive predictive index of 100%, and negative predictive index of 97%. From the suprasternal notch approach, PDA was suspected in 51 cases, with six false-positive diagnoses, yielding a sensitivity of 100%, specificity of 91%, positive predictive index of 88%, and negative predictive index of 100%. Since the diastolic ductal jet flowing into the pulmonary artery was specific for PDA in all patients in whom it was recorded from a precordial approach, that approach and diagnostic feature, with sensitivity and positive predictive index of 100%, would seem preferred for PDE diagnosis of PDA. This would be especially important if the PDE diagnosis of PDA were to be used in place of invasive documentation of PDA, and in the differential diagnosis of PDA and other systemic-to-pulmonic communications. The suprasternal approach, while not specific for PDA, may have the advantage of sensitive detection or exclusion of a variety of systemic-to-pulmonic communications.

Adolescent↗
PubMed1983

Left ventricular and aortic catheterization and angiography via a patent ductus arteriosus: a new technique.

A new "transductal" technique of aortic arch and left ventricular angiography in patients with patent ductus arteriosus (PDA) is described by introducing the catheter to the aortic arch from the pulmonary artery via the PDA. Over a 4-year period, 44 infants and children with complicated PDA underwent cardiac catheterization with this technique at our institution. Twenty-five of the 30 in the group with PDA alone and 12 of 14 in the group with associated cardiac defects had successful aortic arch catheterization and angiography, an 84% success rate. No complications were encountered during the procedure. The technique offers a safe alternative to retrograde arterial catheterization in patients with PDA who have other associated lesions.

Adolescent↗
PubMed1983

Catheter for visualization of patent ductus arteriosus.

We have developed a new catheter for transvenous angiography in patent ductus arteriosus (PDA) that has given excellent results in 31 patients (age range seven months to 17 years). Optimal selective opacification of PDA is due to maintaining the catheter side holes in close proximity to the PDA and to rapid delivery of relatively large volumes of contrast medium into the ampulla of the PDA without the catheter recoiling. The venous route of catheter insertion precludes possible arterial injury.

Cardiac Catheterization↗
PubMed1984

Peripheral arterial contrast echocardiography: a new method for the detection of left-to-right shunting patent ductus arteriosus.

A modified echocardiographic method (peripheral arterial contrast echocardiography, PACE) using suprasternal notch (SSN) echocardiography and rapid hand injection of 5% glucose solution through peripheral arteries is introduced. This method was used to determine the presence of a left-to-right shunting via patent ductus arteriosus (PDA) in 50 patients with various congenital heart disease among neonates, infants, and young children. Echocardiographic findings were compared with cardiac catheterization/angiography, surgery, and/or autopsy. Diagnosis of PDA made by PACE was sensitive in 98.5% and specific in 100% of cases. Thus, the PACE examination is a reliable bed-side technique to detect qualitatively the presence or absence of a left-to-right shunting PDA accompanied with acyanotic or cyanotic heart disease.

Child, Preschool↗
PubMed1993

Patent ductus arteriosus presenting in old age.

This report describes an unusual case of patent ductus arteriosus, presenting in old age. The patient is the oldest living female with patient ductus reported thus far in the medical literature. She initially presented with chest pressure and dyspnea, and subsequently developed subacute bacterial endocarditis and typical angina pectoris with ECG changes, but with normal coronary anatomy.

Aged↗
PubMed1993

Transcatheter occlusion of the patent ductus arteriosus in the presence of mild isthmal hypoplasia.

Between January 1990 and February 1992, 5 asymptomatic patients were identified with hypoplasia of the aortic isthmus at the time of cardiac catheterization for closure of a small patent ductus arteriosus. Isthmal diameters measured from lateral aortograms were 62 +/- 11% of age-matched controls. All patients had a small communication occluded with a 12 mm device and remained asymptomatic at 6-30 months follow up. Residual shunting was demonstrated by color Doppler in 2 patients. No child has developed an arm-leg systolic blood pressure gradient or systemic hypertension. Following device placement, Doppler interrogation across the isthmus in 2 patients demonstrated a velocity shift of 2.1 m/s. Transcatheter occlusion of the patient ductus arteriosus associated with mild isthmal hypoplasia of the aortic arch appears safe and effective and does not result in a clinically significant impairment to isthmal flow in short-term follow-up.

Aortic Coarctation↗
PubMed1995

Repeat use of occluding spring coils to close residual patent ductus arteriosus.

Recent studies have shown that small- and moderate-size patent ductus arteriosus (PDA) may be closed with occluding spring coils. As with other percutaneous devices, a low incidence of residual PDAs has been observed in medium-term follow-up. This report describes experience with closing residual PDA by repeat use of occluding spring coils.

Angioplasty, Balloon, Coronary↗
PubMed1995

Transcatheter closure of residual patent ductus arteriosus shunting after the Rashkind occluder device using single or multiple Gianturco coils.

Transcatheter closure of a patent ductus arteriosus (PDA) using the Rashkind occluder or the buttoned device is accompanied with a 7-38% incidence of residual shunt. Closure of the residual shunt with a second device is expensive, associated with possible morbidity, can be technically challenging, and occasionally does not completely eliminate the shunt. Our objective was to assess the immediate and short-term results of transcatheter closure of residual PDA after the Rashkind device using single or multiple Gianturco coils. Five patients (one male/four female) underwent transcatheter closure of residual PDA at a median age of 8.4 yr (range 2-10.1 yr) and median weight of 23 kg (range 11.8-32 kg). A 4F catheter was used for delivery of the coils in all patients. Three patients underwent multiple coil and two single coil closure with complete elimination of the shunt. There was complete elimination of the shunt as documented by repeat angiography immediately after the coil closure. The median fluoroscopy time was 24 min (range, 22-55 min). All patients were discharged home on the same day. There were no complications Follow-up evaluation was performed with color flow mapping of the main pulmonary artery within 4 hr after closure and 6 weeks later with echocardiography and chest radiography. We conclude that transcatheter closure is an effective therapy for patients with residual PDA after the Rashkind device using the single or multiple coil technique. This technique can be performed on an out-patient basis without the need for general anesthesia and at a lower expense than a repeat occluder device or surgery.

Cardiac Catheterization↗
PubMed1995

Transcatheter embolization coil closure of patent ductus arteriosus--modified delivery for enhanced control during coil positioning.

The use of Gianturco coils (Cook, Inc., Bloomington, IN) has been recently described as a method of occluding restrictive patent ductus arteriosus (PDA). Precise control of the coil during positioning or withdrawal is difficult. We designed an inexpensive and readily available system to control the coil during delivery and repositioning. A 5 French Mallincrodt vertebral catheter was heat tapered to allow slight, but definite resistance of a 0.035" guide wire when it was passed through the catheter. The delivery system has been used to successfully coil occlude restrictive PDAs in seven patients. The system has added no additional costs to the procedure and has provided improved control of the coil position prior to release of the coil.

Cardiac Catheterization↗
PubMed2004

Bioptome-assisted coil occlusion of moderate-large patent ductus arteriosus in infants and small children.

Coil occlusion of patent ductus arteriosus (PDA), although inexpensive, is technically challenging for the moderate-large ducts in small children. Bioptome assistance allows better control and precision. We describe case selection strategies, technique, immediate and short-term results of bioptome-assisted closure of moderate-large (>/= 3 mm) PDA in 86 infants and children </= 10 kg (age, 18 days to 3 years; median, 8 months; weight, 6.6 +/- 1.9 kg; duct size, 3.6 +/- 0.8 mm; pulmonary artery mean pressures, 33 +/- 12 mm Hg). Patients with PDA > 6 mm (> 4 mm for children under 5 kg) and/or shallow ampullae (by echocardiography) underwent operation (n = 41). Specific technical modifications included use of long sheaths (5.5-8 Fr) for duct delineation and coil delivery, cutting of coils turns (51 patients) to accommodate the coils in the ampulla, and simultaneous delivery of multiple coils (n = 43). As far as possible, coils were deployed entirely in the ampulla. Median fluoroscopy time was 7.3 min (1.2-42 min). Successful deployment was feasible in all (final pulmonary artery mean pressures, 20 +/- 4.6 mm Hg). Coils embolized in 14 (16%) patients (all retrieved). Complete occlusion occurred immediately in 63 patients (73%) and in 77 patients (89%) at 24 hr. Three patients had new gradients in the left pulmonary artery. Follow-up (62 patients; median duration, 13 months) revealed small residual Doppler flows in 11 patients (18%) at the most recent visit. Bioptome-assisted coil occlusion of moderate-large PDA in selected infants and small children is feasible with encouraging results.

Blood Flow Velocity↗
PubMed2004

Transcatheter patent foramen ovale closure for secondary prevention of paradoxical embolic events: acute results from the FORECAST registry.

Patients with patent foramen ovale (PFO) and paradoxical embolism are at increased risk for recurrent events. Percutaneous PFO closure is a new treatment modality aimed at secondary prevention. We report the multicenter experience of interventional closure of PFO using two different devices in 272 patients. The mean age was 51 +/- 14.2 years and 52.9% were males. The implantation procedure resulted in an initial complete shunt closure rate of 74.3% with a periprocedural complication rate of 6.6%. There were no deaths or pericardial tamponade. The mean procedure time was less than 44 min under either conscious sedation, local or general anesthesia. This is the largest report to date demonstrating the procedural safety, reliability, and feasibility of the transcatheter PFO closure technique with the STARFlex and CardioSEAL septal implants. Randomized clinical trials are currently in progress to identify patients most likely to benefit from this intervention.

Adult↗
PubMed2004

Clinical outcomes of patent foramen ovale closure for paradoxical emboli without echocardiographic guidance.

The objective of this study was to determine the feasibility of device closure of patent foramen ovale (PFO) for presumed paradoxical emboli without echocardiographic guidance or balloon sizing and the clinical outcome after device closure. Closure of the PFO has been proposed as an alternative to anticoagulation in patients with presumed paradoxical emboli. At present, most centers perform device closure with transesophageal echocardiographic guidance and balloon sizing of the defect. Between May 1998 and April 2002, 92 consecutive patients underwent device closure for a PFO using fluoroscopic monitoring only. Procedural success and major complications were recorded. Follow-up outcomes were recurrence rate and residual atrial shunting on transthoracic echocardiography. All patients (mean age, 45 +/- 13 years; 52% male) had successful device deployment using either the CardioSeal (n = 78) and Amplatzer (n = 14) PFO occluders with no major complications. Mean procedure time and fluoroscopy time was 27 +/- 13 and 6 +/- 4 min, respectively. One patient had a residual shunt on echocardiography at 1 year. Cumulative event-free survival for recurrence of paradoxical embolus at 1 year was 97.3% +/- 1.8%. This study provides a basis for device closure of PFO becoming a safe, day-case procedure, resulting in a low rate of residual shunting and recurrent thromboembolic events.

Adult↗
PubMed2005

Interventional treatment of patent ductus arteriosus in 2004.

In 2004, the interventional treatment of patent ductus arteriosus (PDA) is definitive and curative. In current practice, coils are used for smaller PDA, and devices are employed for larger PDA. Developing technologies offer small improvements in control and results, but do not appear to promise major changes in practice. This review summarizes the current and emerging interventional technologies directed at PDA closures.

Coronary Angiography↗
PubMed2005

Transcatheter closure of a 22 mm patent ductus arteriosus with an Amplatzer atrial septal occluder.

Transcatheter techniques for closure of patent ductus arteriosus (PDA) have been used for almost 40 years. We report a case of a 24-year-old female with a 22 mm PDA, congestive heart failure, and atrial fibrillation. She underwent transcatheter PDA closure with an Amplatzer atrial septal occluder (ASO). Following the procedure, she developed hemolysis due to a large residual shunt. However, the shunt gradually resolved until complete closure was achieved within 8 months. An attempt to restore sinus rhythm with electrical cardioversion was successful and the patient is now, 2 years after procedure, in New York Heart Association functional class I. Off-label use of an ASO for closure of a very large PDA yielded an excellent clinical result.

Adult↗