ABSTRACT
BACKGROUND: Large patent ductus arteriosus can present in infancy with congestive cardiac failure and superadded pulmonary infection can necessitate mechanical ventilation. Surgical intervention is traditionally indicated for this subset of patients. We present our experience of transcatheter coil closure of the patent ductus arteriosus in such infants. METHODS AND RESULTS: Five infants weighing between 960 gm and 4.1 kg, aged between 17 days and 3 1/2 months were mechanically ventilated because of congestive cardiac failure with pneumonia. Echocardiography showed patient ductus arteriosus with a size of 1.8 to 4.2 mm and adequate ampulla. Bioptome-assisted coil delivery was done and successful patient ductus arteriosus closure was achieved in all. There were two instances of embolization of coils with successful retrieval and redeployment. All infants could be weaned off mechanical ventilation over the next 24-72 hours. A pre-term infant developed a Doppler gradient of 25 mmHg in the descending aorta that decreased to 12 mmHg five months later. There was no significant obstruction to pulmonary artery flow in any child. At three months follow-up, all the five infants were asymptomatic with no residual flow across the patient ductus arteriosus. CONCLUSIONS: Transcatheter coil closure of moderate to large patent ductus arteriosus is possible in sick ventilated infants weighing below 5 kg. It may be a better alternative to surgery in selected cases in view of minimal morbidity.
Subject(s)
Catheter Ablation , Ductus Arteriosus, Patent/surgery , Embolization, Therapeutic/methods , Follow-Up Studies , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Very Low Birth Weight , Treatment OutcomeABSTRACT
We report a case of massive spontaneous primary chylopericardium in a 2-month-old infant who was successfully treated with thoracic duct ligation and creation of a posterior pericardial window.
Subject(s)
Chylothorax/surgery , Humans , Infant , Ligation , Male , Pericardial Effusion/surgery , Pericardial Window Techniques , Pericardium/surgery , Thoracic Duct/surgery , ThoracotomyABSTRACT
We describe a novel technique that allows controlled and precise delivery of single or multiple coils simultaneously for occlusion of a coronary artery fistula using a bioptome passed via a long sheath positioned at the distal end of the fistula. The fistula was balloon occluded distal to the take-off of the native branches before, during and after coil delivery in two patients.