Problems encountered during introduction of Gianturco coils for transcatheter occlusion of the patent arterial duct

Galal, Omar; Moor, Michael de; Fadley, Fadel Al; Qureshi, Shakeel A.; Naffa, S.; Oufi, S.; Suhl, M.; Abbag, Fuad; Schmaltz, A. A.

doi:10.1093/oxfordjournals.eurheartj.a015307

Cited by 36 publications

(24 citation statements)

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“…Ancak ADO cihazının antegrad yolla yerleştirilmesi duktusun pulmoner arter tarafından geçilmesini gerektirdiğinden erişkin hastalarda işlem süresini uzatan hatta bazen de konvansiyonel yöntem-lerle mümkün kılmayan bir durumdur (17,37). Bu durum duktusun düşük basınca maruz kaldığı pulmoner arter tarafının sıklıkla kıvrım-lı (tortuous) olması ve ayrıca kalsifiye yapılanma nedeniyle esnek bir girişinin olmaması ile ilişkili olabilir (8,16,17,22).…”

Section: Discussionunclassified

“…Tüm olgularda cihazın venöz tarafa embolize olması cihazın küçük seçildiğini düşündürtmektedir. Bu durum yüksek şant akımı ve geniş damar lümenleri nedeniyle yetersiz kontrastlı görüntüleme sonucunda duktusun yapısı ve ölçüleri hakkında sağlıklı bilgi edinilememesi ve bu sebeple küçük tercih edilen cihazın aortopulmoner yüksek basınç farkı ve kalsifik, sarmal yapısı bozulmuş anevrizmatik yapılı erişkin duktuslarının cihazı iyi saramaması nedeniyle düşük basınçlı venöz tarafa embolize olması ile açıklanabilir (17,28,(35)(36)(37).…”

Section: Discussionunclassified

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Closure of patent ductus arteriosus with duct occluder device in adult patients: evaluation of the approaches to facilitate the procedure

Paç¹,

Polat²,

Oflaz³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Erişkin hastaların patent duktus arteriyozus'ları (PDA) anatomik değişikler nedeniyle transkateter yöntemle kapatılması komplike olabilir. Bu çalışmanın amacı, erişkin hastaların Amplatzer duktus tıkayıcı (ADO) cihazı kullanarak transkateter yöntemle PDA kapatılmasında işlemi kolaylaştırıcı yaklaşımların değerlendirilmesidir. Yöntemler: Bu prospektif çalışmada yaşları 18 ile 56 arasında değişen orta-geniş PDA'lı ardışık 33 hasta ADO cihazı ile transkateter yöntemle kapatılma işlemine alındı. Patent duktus arteriyozus'u antegrad geçebilmek için 14 hastada konvansiyonel yöntem, geriye kalan 18 olguda ise retrograd tel kılavuzu yaklaşımı kullanıldı. On dakika işlem süresinde PDA'dan geçilemeyen olgularda yakalayıcı yardımıyla duktustan antegrad geçildi. Hastalar işlem sonrası 24. saat,1, 3, 6 ve 12 ay takiplerinde değerlendirildi. Verileri karşılaştırmalarda yerine göre Student t, MannWhitney U veya Ki-kare testleri kullanıldı. Bulgular: Otuz iki hastada PDA başarı ile kapatıldı. PDA'dan antegrad olarak, 14 olgunun 10'unda konvansiyonel yöntemle, kalan 18 olgunun 17'sinde ise retrograd tel kılavuzluğunda geçildi (p=0.07). Başarısız olunan 5 olguda yakalayıcı yöntemi ile PDA'dan antegrad geçildi. Kullanılan cihazların ortalama çapları PDA en dar çapından 3.76 mm kadar genişti. Bir hastada kısa duktus nedeniyle küçük tercih edilen cihaz kendiliğin-den embolize oldu. Tüm hastaların PDA'ları takipte tam kapanmıştı ve komplikasyon izlenmedi. Sonuç: Patent duktus arteriyozus'dan antegrad geçebilmek için retrograd kılavuz tel kullanım tekniği etkili bir yöntemdir ve erişkin hastalarda alternatif bir yöntem olarak değerlendirilebilir. Önerilenden daha büyük çapta ADO cihazı uygun duktal ampullası olan erişkin hastalarda güven-lidir ve cihaz migrasyonunu engelleyebilir. ABSTRACTObjective: The anatomic changes of the patent ductus arteriosus (PDA) in adult patients can complicate its transcatheter occlusion. The aim of the study was to determine procedural approaches to facilitate transcatheter closure of PDA in adult patients using the Amplatzer duct occluder (ADO). Methods: In this prospective study, 33 consecutive adult patients with a moderate to large-sized PDA underwent transcatheter closure. Conventional antegrade approach was used in 14 patients, while retrograde wire-guided assisted approach in remaining 18 patients to access the PDA antegrade. If the initial procedure failed, snare-assisted technique was used to pass through the ductus antegradely. For comparative statistics, the Student's t-test, Mann-Whitney U test and Chi-square test were used as appropriate. Results: Thirty-two patients had successful PDA occlusion. PDA ostium could be engaged in 10 of 14 patients by conventional approach, while 17 of remaining 18 patients by retrograde wire-guided assisted approach (p=0.07). PDAs could be passed antegradely using the snare-assisted technique in those five patients in whom the initial procedure failed. The mean size of implanted devices was 3.76 mm larger than the narrowest size of the PDA. Spontaneo...

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Section: Discussionunclassified

Closure of patent ductus arteriosus with duct occluder device in adult patients: evaluation of the approaches to facilitate the procedure

Paç¹,

Polat²,

Oflaz³

et al. 2011

Anadolu Kardiyol Derg

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show abstract

“…[28,31,32] Literatürde cihaz embolizasyonu %0 ila %16 arasında bildirilmiştir. [33][34][35] Kontrolsüz salınımlı koil kullandı-ğımız bir hastada inen aorta koil düştü ve iliyak artere emboli oldu.…”

Section: Discussionunclassified

Results of patent ductus arteriosus closure during adulthood using different devices

Erdem¹

2011

Turkish J Thorac Cardiovasc Surg

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“…However, Gianturco coils have become the most indicated device for small-diameter defects (up to 3 mm) due to their low cost 2 , good efficacy, and low complication rate. The major complication is embolization 3 of the device, with an incidence ranging from 3.8% 4 to 20% 3 , especially in ductus arteriosus greater than 4 mm and those with tubular morphology. The risk is attenuated due to the possibility of coil retrieval during the interventional catheterization itself 5 , or due to the use of other more appropriate devices, such as the Amplatzer prosthesis 6 .…”

Section: Surgical Treatment Of Coil Embolization To the Pulmonary Artmentioning

confidence: 99%

“…Because of the great dimension of the ductus arteriosus, 3 Gianturco coils (William Cook, Europe) were chosen and stacked. The procedure was not successful due to an accident in occluding the ductus arteriosus, with migration of the coils to the left pulmonary tree.…”

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confidence: 99%

Tratamento cirúrgico da embolização de coil para artéria pulmonar após tentativa de fechamento percutâneo do canal arterial

Atik¹,

Jatene²,

Costa³

et al. 2004

Arq. Bras. Cardiol.

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0infections. On physical examination, the patient was in good general condition, active, afebrile, acyanotic, eupneic, and his pulses were wide in his 4 limbs. His weight was 22 kg and his height 116 cm. His heart rate was 90 bpm, and his blood pressure was 100/50 mmHg. His precordial area showed no deformities, and the cardiac apex was palpated on the fifth left intercostal space in the midclavicular line. The second cardiac sound on the pulmonary focus had increased intensity. A continuous murmur of great intensity was heard in the high left sternal margin, accompanied by a thrill of equal intensity. The pulmonary auscultation was normal, and no visceromegaly was evidenced.The electrocardiogram showed sinus rhythm with a heart rate of 120 bpm, signs of left ventricular overload and diffuse alterations in ventricular repolarization. A simple chest X-ray showed a mildly enlarged cardiac area, bulging of the middle arch, and accentuation of the pulmonary vasculature, mainly in the hilar region.Doppler 2-dimensional echocardiography confirmed the clinical suspicion of persistent ductus arteriosus with increased pulmonary blood flow and a diameter of 4.5 mm. It was characterized as having moderate hemodynamic repercussion.The percutaneous treatment was chosen to close the ductus arteriosus. Because of the great dimension of the ductus arteriosus, 3 Gianturco coils (William Cook, Europe) were chosen and stacked. The procedure was not successful due to an accident in occluding the ductus arteriosus, with migration of the coils to the left pulmonary tree. In the same procedure, retrieval of 2 coils was possible; the last one became embedded in one branch of the left pulmonary artery, and could not be retrieved ( fig. 1).The patient underwent a complementary investigation to locate the precise site of coil embolization and to determine its repercussion on pulmonary perfusion. Pulmonary perfusion scintigraphy showed a decreased flow to the left lung (34%) as compared with that to the right lung (61%). In addition, chest computed tomography identified the presence of hypoattenuation of metallic density in the projection of the left descending interlobular artery.Because of the impairment of pulmonary perfusion to the left caused by coil embolization, surgical treatment was performed in a programmed and elective manner approximately 6 months after interventional catheterization. Under balanced general anesthesia, the following steps were taken: median sternotomy, longitudinal pericardiotomy, and installation of extracorporeal circulation through the ascending aorta and bicaval cannulation. Section and suture of the ductus arteriosus was performed during the cooling Case Report

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Problems encountered during introduction of Gianturco coils for transcatheter occlusion of the patent arterial duct

Cited by 36 publications

References 0 publications

Closure of patent ductus arteriosus with duct occluder device in adult patients: evaluation of the approaches to facilitate the procedure

Closure of patent ductus arteriosus with duct occluder device in adult patients: evaluation of the approaches to facilitate the procedure

Results of patent ductus arteriosus closure during adulthood using different devices

Tratamento cirúrgico da embolização de coil para artéria pulmonar após tentativa de fechamento percutâneo do canal arterial

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