Initial clinical experience in transcatheter closure of large patent arterial ducts in infants using the modified and angled Amplatzler duct occluder

Abstract

T RANSCATHETER OCCLUSION OF SMALL ARTERIAL ducts, of less than 4 millimetres in diameter, and closure of larger ducts with devices, have now become accepted as attractive alternatives to surgery. Indeed, interventional closure has become the treatment of choice in most of the patients now born with patency of the arterial duct. 1,2 Despite the tremendous improvements in technique and hardware available, closing large ducts in very sick and underweight infants remains a challenge for paediatric interventionists. This is because bigger devices require larger delivery sheaths, and carry the risk of possible obstruction to aorta and left pulmonary artery. 3,4 Moreover, negotiating a large device around the curve of the right ventricular outflow tract and through the pulmonary trunk, which is very tight and at right angles in infants, is difficult or impossible, the sheath becoming kinked and thereby increasing the procedural and fluoroscopic time. This subset of patients with very large tubular ducts, typically weighing less than 5 kilograms, in left ventricular Initial clinical experience in transcatheter closure of large patent arterial ducts in infants using the modified and angled Amplatzer duct occluder

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease

“…Ezt követően a közepes méretű vagy nagyméretű nyitott ductus arteriosusokat is sikeresen zártak többfajta mikrospirál vagy egyéb eszköz és különböző technikák alkalmazá-sával. 237,244,253,261,262,264,270,280,283,284,286,[288][289][290]295 Egy tanulmány 104 közepes vagy nagyméretű nyitott ductus arteriosusban szenvedő, mikrospirállal végzett záráson átesett beteg adatait mutatta be, a sikeresség aránya két hónapos utánkövetés után 100%, 16 hónappal később pedig 98% volt. 237 Az Amerikai Egyesült Államok Élelmiszer-és Gyógyszerügyi hatósága a közelmúltban, 2003-ban engedélyezte az AMPLATZER ductalis occluderek használatát, ezzel az akár 16 mm-es nyitott ductus arteriosusok is könnyedén és hosszú távú residualis sönt fennmaradása nélkül zárhatóak.…”

Transcatheter Closure of Moderate-to-Large Patent Ductus Arteriosus in Infants Using Amplatzer Duct Occluder

“…An angled device can be useful in infants with a relatively short ductus to minimize protrusion of the upper part of the retention flange. 26 Recently, a swivel-disk device has been developed to diminish the possibility of developing a pressure gradient in the aorta. 27 In the present series, progressive left ventricular outflow tract obstruction because of a fibromuscular ridge occurred in 1 patient and the cause of an acquired subaortic ridge in this patient remains unclear.…”

Pediatric Cardiac Interventions

“…Modifications of the ADO device have taken place to overcome certain technical difficulties. The angled ADO was developed to overcome the protrusion of the original device in the aortic lumen of smaller children causing partial aortic obstruction (36,37). However, the manufacturer never pursued this device.…”