Percutaneous closure of patent ductus arteriosus in adults using different devices.

Surgical closure of patent ductus arteriosus in adults involves a number of risks because there are associated anatomic and histologic alterations. Between October 1992 and August 2008, 23 patients were referred to our department with isolated patent ductus arteriosus. Their age ranged from 16-75 years (median 25.5 years) and their weight from 52-80 kg (median 57 kg). The pulmonary diameter ranged from 1.8-5.8 mm (mean 3.5 mm), and pulmonary artery pressure, from 9-72 mmHg (mean 15 mmHg). The rate of ductal occlusion achieved with the Rashkind patent ductus arteriosus occluder was 85.7%, and it was 100% with the Amplatzer duct occluder and the Nit-Occlud coil. The average hospitalization time and follow-up duration were 24 hours and 2 years, respectively. The only immediate complication was an inguinal hematoma, and there were no late complications. In adults, closure of patent ductus arteriosus using a number of different devices, especially the latest generation devices, was safe and effective, regardless of morphologic and histologic characteristics.

Cierre percutáneo del ductus con diferentes dispositivos en adultos / Percutaneous closure of patent ductus arteriosus in adults using different devices

El cierre quirúrgico del conducto arterioso en adultos implica riesgos debido a sus cambios anatómicos e histológicos. Desde octubre de 1992 hasta agosto de 2008, fueron referidos a nuestro servicio 23 pacientes con conducto arterioso persistente aislado; edad, 16-75 años (mediana, 25,5); peso, 52-80 kg (mediana, 57); diámetro pulmonar, 1,8-5,8 mm (media, 3,5); presión media en la arteria pulmonar, 9-72 mmHg (media, 15). Las tasas de oclusión fueron del 85,7% con los dispositivos Rashkind-PDA y del 100% con Amplatzer Duct-Occluder y Nit-Occlud coil. Tiempo medio de internación y seguimiento: 24 h y 2 años respectivamente. La única complicación inmediata fue un hematoma inguinal; no hubo complicaciones alejadas. En adultos, el cierre del conducto arterioso con diferentes dispositivos, especialmente los de última generación, resultó seguro y eficaz, independientemente de su morfología y estado histológico (AU)

Surgical closure of patent ductus arteriosus in adults involves a number of risks because there are associated anatomic and histologic alterations. Between October 1992 and August 2008, 23 patients were referred to our department with isolated patent ductus arteriosus. Their age ranged from 16-75 years (median 25.5 years) and their weight from 52-80 kg (median 57 kg). The pulmonary diameter ranged from 1.8-5.8 mm (mean 3.5 mm), and pulmonary artery pressure, from 9-72 mmHg (mean 15 mmHg). The rate of ductal occlusion achieved with the Rashkind patent ductus arteriosus occluder was 85.7%, and it was 100% with the Amplatzer duct occluder and the Nit-Occlud coil. The average hospitalization time and follow-up duration were 24 hours and 2 years, respectively. The only immediate complication was an inguinal hematoma, and there were no late complications. In adults, closure of patent ductus arteriosus using a number of different devices, especially the latest generation devices, was safe and effective, regardless of morphologic and histologic characteristics (AU)

Percutaneous closure of a modified Blalock-Taussig shunt using an amplatzer vascular plug.

Modified Blalock-Taussig shunts are usually clamped during the successive corrective or palliative surgical procedures carried out to treat underlying congenital heart disease, though at times they may be left permeable for a number of reasons. Subsequently, when this is no longer considered necessary and closure is indicated, the method of choice is percutaneous embolization using various coils or other devices. We report on a series of patients in whom this type of shunt was closed successfully via an arterial approach using a new device: the Amplatzer Vascular Plug. In addition to employing a controlled-release system, this type of plug has the advantage that it can be implanted using low-profile catheters. The patients were 1, 4 and 23 years old, respectively, and no complications were reported. The fluoroscopy time was 10, 11 and 9 minutes, respectively, and patients were followed up for 42 months.

Embolización percutánea de anastomosis modificada de Blalock-Taussig con Amplatzer Vascular Plug / Percutaneous closure of a modified blalock-taussig shunt using an amplatzer vascular plug

La anastomosis de Blalock-Taussig modificada habitualmente se liga durante las sucesivas cirugías correctoras o paliativas de las cardiopatías congénitas subyacentes, aunque a veces se la mantiene permeable por diversas razones. A posteriori, cuando se considera que ya no es necesaria, se indica su oclusión, y actualmente la embolización percutánea con diversos coils o dispositivos es el método de elección. Comunicamos una serie de pacientes con este tipo de anastomosis ocluidas exitosamente desde un abordaje arterial con el nuevo dispositivo Amplatzer Vascular Plug que, además de tener un sistema de liberación controlada, cuenta con la ventaja de que se puede implantar a través de catéteres de pequeño calibre. Los pacientes eran de 1, 4 y 23 años; no hubo complicaciones. Los tiempos de fluoroscopia fueron 10, 11 y 9 min respectivamente, con seguimiento hasta 42 meses (AU)

Modified Blalock-Taussig shunts are usually clamped during the successive corrective or palliative surgical procedures carried out to treat underlying congenital heart disease, though at times they may be left permeable for a number of reasons. Subsequently, when this is no longer considered necessary and closure is indicated, the method of choice is percutaneous embolization using various coils or other devices. We report on a series of patients in whom this type of shunt was closed successfully via an arterial approach using a new device: the Amplatzer Vascular Plug. In addition to employing a controlled-release system, this type of plug has the advantage that it can be implanted using low-profile catheters. The patients were 1, 4 and 23 years old, respectively, and no complications were reported. The fluoroscopy time was 10, 11 and 9 minutes, respectively, and patients were followed up for 42 months (AU)

[Pulsatile Fontan: transcatheter closure of patent pulmonary artery. Follow up mid-term]. / Fontan pulsátil: oclusión transcatéter de la arteria pulmonar permeable. Seguimiento a mediano plazo.

OBJECTIVE: We report the percutaneous closure of the pulmonary artery with residual shunt in patients with Fontan type circuit. METHOD: Patients aged 9 and 11 years, with SaO2 of 88 and 96%, respectively. One of them coursing with headaches and functional class II. Both patients with total cavopulmonary anastomosis and fenestrated extracardiac conduit and permeable pulmonary artery (pulsatile Fontan). An Amplatzer duct-occluder device was implanted in the pulmonary artery entering from the femoral vein. Follow-up by means of clinical examination, imaging, and catetherization was pursued. RESULTS: Case 1, patency fenestration, Qp/Qs: 0.7/1. Case 2, closed fenestration, Qp/Qs; 1.3/1. We obtained immediate occlusion with 6/4 and 8/6 devices, respectively; pressure recordings revealed modification of the arterial morphology to biphasic; pulmonary pressure dropped 2 mm Hg in the first patient, without alteration in the second case; no changes in SaO2 were registered. Time of fluoroscopy was 57 and 45 minutes, respectively. Follow-up was maintained for 2.8 and 2.3 years, respectively. In patient 1, headaches disappeared and the fenestration was occluded with an Amplatzer septal-occluder one year later, raising SaO2 to 96%; no complications occurred nor was recanalization of the pulmonary artery needed in either case. CONCLUSIONS: Percutaneous occlusion of patent pulmonary artery in patients with Fontan type circuit is a feasible and effective procedure, and avoids overload of the single ventricle.

Fontan pulsátil: oclusión transcatéter de la arteria pulmonar permeable. Seguimiento a mediano plazo / Pulsatile Fontan: transcatheter closure of patent pulmonary artery. Follow up mid-term

OBJECTIVE: We report the percutaneous closure of the pulmonary artery with residual shunt in patients with Fontan type circuit. METHOD: Patients aged 9 and 11 years, with SaO2 of 88 and 96%, respectively. One of them coursing with headaches and functional class II. Both patients with total cavopulmonary anastomosis and fenestrated extracardiac conduit and permeable pulmonary artery (pulsatile Fontan). An Amplatzer duct-occluder device was implanted in the pulmonary artery entering from the femoral vein. Follow-up by means of clinical examination, imaging, and catetherization was pursued. RESULTS: Case 1, patency fenestration, Qp/Qs: 0.7/1. Case 2, closed fenestration, Qp/Qs; 1.3/1. We obtained immediate occlusion with 6/4 and 8/6 devices, respectively; pressure recordings revealed modification of the arterial morphology to biphasic; pulmonary pressure dropped 2 mm Hg in the first patient, without alteration in the second case; no changes in SaO2 were registered. Time of fluoroscopy was 57 and 45 minutes, respectively. Follow-up was maintained for 2.8 and 2.3 years, respectively. In patient 1, headaches disappeared and the fenestration was occluded with an Amplatzer septal-occluder one year later, raising SaO2 to 96%; no complications occurred nor was recanalization of the pulmonary artery needed in either case. CONCLUSIONS: Percutaneous occlusion of patent pulmonary artery in patients with Fontan type circuit is a feasible and effective procedure, and avoids overload of the single ventricle.

Cierre de fístula coronaria con Amplatzer vascular plug en el paciente pediátrico / Closure of a Coronary Fistula with an Amplatzer Vascular Plug in a Pediatric Patient

La fístula coronaria congénita es una patología poco frecuente y en general asintomática, por lo que muchas veces se diagnostica por un hallazgo incidental. Con dependencia de la repercusión hemodinámica, algunos siguen una conducta conservadora, otros indican tratamiento quirúrgico o, más recientemente, oclusión por cateterismo. Se presenta el caso de una paciente con una gran fístula coronaria-cameral, que se trató mediante embolización percutánea con dispositivo Amplatzer vascular plug. No se presentaron complicaciones durante el procedimiento ni en el seguimiento.

Congenital coronary fistula is an infrequent condition generally asymptomatic, which is mostly diagnosed by an incidental finding. Depending on the presence of hemodynamic compromise, coronary fistulas may be treated with a conservative approach, with surgery or, recently, with transcatheter closure. We present a case report of a patient with a large coronarycameral fistula treated with percutaneous embolization with Amplatzer vascular plug. No complications developed during the procedure and follow-up.

[Patent ductus arteriosus closure using a new device: the Nit-Occlud device]. / Cierre del ductus arterioso permeable con un nuevo tipo de dispositivo: Nit-Occlud.

Between May 2003 and July 2006, we carried out percutaneous patent ductus arteriosus closure using a Nit-Occlud device in 28 patients, who had a median age of 1.8 years (range 0.5-21 years) and a median weight of 10.9 kg (range 5.9-64 kg). The ductus arteriosus had several different morphologic forms, and there was one postsurgical recanalization of the ductus arteriosus. The median minimum ductal diameter was 1.8 mm and the median maximum aortic ampulla diameter was 6.5 mm. The occlusion rate immediately after intervention was 53.5%, which increased to 95.2% by 12 months and to 100% by 18 months. The median follow-up time was 20.5 months. The Nit-Occlud device provided an effective and safe means of patent ductus arteriosus closure, irrespective of ductus morphology.

Cierre del ductus arterioso permeable con un nuevo tipo de dispositivo: Nit-Occlud / Patent ductus arteriosus closure using a new device: the Nit-Occlud device

Entre mayo de 2003 y julio de 2006, efectuamos cierre ductal con dispositivo Nit-Occlud en 28 pacientes con edades de 0,5-21 años (mediana, 1,8 años) y peso de 5,9-64 kg (mediana, 10,9 kg). Los conductos tuvieron una variada morfología, e incluían una recanalización posquirúrgica. Las medias del diámetro ductal mínimo y el extremo aórtico fueron de 1,8 y 6,5 mm, respectivamente. La tasa de oclusión inmediata fue del 53,5%, y llegó al 95,2% al año y al 100% a los 18 meses. La media de seguimiento fue de 20,5 meses. El Nit-Occlud resultó útil y seguro para el cierre ductal, independientemente de su tipo morfológico (AU)

Between May 2003 and July 2006, we carried out percutaneous patent ductus arteriosus closure using a Nit-Occlud device in 28 patients, who had a median age of 1.8 years (range 0.5-21 years) and a median weight of 10.9 kg (range 5.9-64 kg). The ductus arteriosus had several different morphologic forms, and there was one postsurgical recanalization of the ductus arteriosus. The median minimum ductal diameter was 1.8 mm and the median maximum aortic ampulla diameter was 6.5 mm. The occlusion rate immediately after intervention was 53.5%, which increased to 95.2% by 12 months and to 100% by 18 months. The median follow-up time was 20.5 months. The Nit-Occlud device provided an effective and safe means of patent ductus arteriosus closure, irrespective of ductus morphology (AU)

Stent ductal en cardiopatías congénitas dependientes del ductus: seguimiento a mediano plazo / Ductal stenting in congenital heart disease with ductus dependent circulation: mid-term follow up

Objetivo: Presentar nuestra experiencia con el empleo de stent para mantener la permeabilidad ductal en cardiopatías congénitas dependientes del ductus. Método y resultados: En tres pacientes de entre 2 y 9 días de vida con atresia pulmonar se colocaron cuatro stents por cateterismo, sin complicaciones. El tiempo de seguimiento promedio fue de 411 días (123 a 721 días). Dos stents se redilataron exitosamente. Un paciente fue sometido a cirugía, uno interrumpió sus controles cuatro meses después y otro espera cirugía. La saturación promedio aumentó del 61 por ciento al 80 por ciento. Conclusiones: En pacientes con cardiopatías cuya circulación depende del ductus arterioso, el implante del stent fue factible y efectivo a corto y mediano plazos.

Stent ductal en cardiopatías congénitas dependientes del ductus: seguimiento a mediano plazo / Ductal stenting in congenital heart disease with ductus dependent circulation: mid-term follow up

Objetivo: Presentar nuestra experiencia con el empleo de stent para mantener la permeabilidad ductal en cardiopatías congénitas dependientes del ductus. Método y resultados: En tres pacientes de entre 2 y 9 días de vida con atresia pulmonar se colocaron cuatro stents por cateterismo, sin complicaciones. El tiempo de seguimiento promedio fue de 411 días (123 a 721 días). Dos stents se redilataron exitosamente. Un paciente fue sometido a cirugía, uno interrumpió sus controles cuatro meses después y otro espera cirugía. La saturación promedio aumentó del 61 por ciento al 80 por ciento. Conclusiones: En pacientes con cardiopatías cuya circulación depende del ductus arterioso, el implante del stent fue factible y efectivo a corto y mediano plazos. (AU)

Stent ductal en cardiopatías congénitas dependientes del ductus: seguimiento a mediano plazo / Ductal stenting in congenital heart disease with ductus dependent circulation: mid-term follow up

Objetivo: Presentar nuestra experiencia con el empleo de stent para mantener la permeabilidad ductal en cardiopatías congénitas dependientes del ductus. Método y resultados: En tres pacientes de entre 2 y 9 días de vida con atresia pulmonar se colocaron cuatro stents por cateterismo, sin complicaciones. El tiempo de seguimiento promedio fue de 411 días (123 a 721 días). Dos stents se redilataron exitosamente. Un paciente fue sometido a cirugía, uno interrumpió sus controles cuatro meses después y otro espera cirugía. La saturación promedio aumentó del 61 por ciento al 80 por ciento. Conclusiones: En pacientes con cardiopatías cuya circulación depende del ductus arterioso, el implante del stent fue factible y efectivo a corto y mediano plazos. (AU)