Closure of the patent ductus arteriosus with the new duct occluder II additional sizes device.

OBJECTIVE: The objective of this study was to evaluate the technical feasibility, safety, and efficacy of the new device Amplatzer duct occluder II additional sizes (ADO II AS) for closure of patent ductus arteriosus (PDA). BACKGROUND: Transcatheter device closure is the standard care for PDA. Currently available technology is not designed for closure of small PDA in young children. METHODS: From April to July 2011, seven children (five females, median age 1.5 years, median weight 11.4 kg) underwent PDA closure with the ADO II AS. Six had isolated PDA, one had PDA associated with preductal coarctation. We evaluated early and short-term results. RESULTS: All but one PDA was closed via an antegrade approach. Mean fluoroscopy and procedural times were 8.0 ± 3.9 and 49.8 ± 27.9 min, respectively. No complications occurred. Immediate trivial residual shunt was present in one patient. In all devices, the retention disks laid flat against the walls of the pulmonary artery and aorta, without protrusion into the vessel lumen. The echocardiography performed after 24 hr did not show any residual shunt. At a median follow-up of 2 months, the PDAs were completely occluded without obstruction of the pulmonary arteries or aorta. CONCLUSIONS: The new device ADO II AS was safely deployed with complete resolution of the PDA shunt. The lower profile and symmetry of this device allows for venous or arterial approach and smaller delivery catheter size. The ADO II AS might be a preferable alternative for closure of small-moderate PDAs.

Holmes heart in the adult: transesophageal echocardiographic findings and long-term natural survival.

We describe a 59-year-old patient with Holmes heart (single ventricle with normally related great arteries). To our knowledge, this is the oldest patient in the literature with this rare congenital heart disease and the oldest one with single ventricle and unrestricted pulmonary blood flow who has developed Eisenmenger's physiology. A transesophageal echocardiographic examination showed a single large ventricle that was a morphologic left ventricle with a normally appearing aorta originating from this chamber and a normally related pulmonary artery arising from a hypoplastic right infundibulum located anteriorly-superiorly and to the left of the left ventricle. The cardiac catheterization confirmed the echocardiographic findings and revealed a pulmonary artery pressure of 160/60 mmHg. There were no systolic gradients across the pulmonary and aortic outflow tracts. The estimated pulmonary vascular resistance was 2720 dynes-sec-cm-5. Oximetry showed oxygen saturation in the left ventricle of 84% and femoral artery saturation of 77.7%. Our report further demonstrates that pulmonary stenosis is not the ultimate determinant of prolonged natural survival in patients with single ventricle. Since this patient is too old for cardiopulmonary transplantation, we plan to follow him conservatively with medical therapy.