Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable ...Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable with several drawbacks.Here we describe a novel minimally invasive technique,a product of mini-thoracotomy and traditional percutaneous technique skills,accomplished exclusively under echocardiography guidance.Methods:Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected.The symptoms were varying degrees of tachypnea,tachycardia,heart failure,failure to thrive,recurrent respiratory tract infections,or intensive care unit treatment for a longer duration.Through a left parasternal mini-thoracotomy,two parallel purse-string sutures were placed on the pulmonary trunk.After purse-string circle puncture,under exclusively transesophageal echocardiography guidance,a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set.The safety-suture prevented device migration in case of dislocation.The basic demographics,PDA size,device size and type,intrapulmonary manipulation time,operation time,PDA parameters(length,diameter,type of duct),redeployment of the device,residual shunt,and retention of safety-suture were all recorded and analyzed.The follow-up was done with transthoracic echocardiography on the 2^(nd)postoperative day,1,3,6,and 12 months,and yearly thereafter.Results:Fifty-two infants with a mean age of 8 months±2.8 months(Interquartile range=0)underwent Perpulmonary device closure of PDA.Successful PDA occlusion was accomplished event-free in all subjects.The mean PDA,mean device,and mean operation time were 5.6 mm±1.4 mm,7.9 mm±1.7 mm,and 61.2 min±12.9 min,respectively.The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up.Eighteen infants had retained safety-suture for added safety.There were no reports of the device or procedure-related complications.Conclusion:Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring>4 mm among infants.The safety-suture,in case of dislocation,prevents migration and associated complications.展开更多
Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter】5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery a...Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter】5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery and past through the PDA.Along the wirea balloon catheter was adopted to explore the real internal eiameter and thedistensibility of the PDA.Using a multi-usable catheter which remade fromthe coronary angiographic catheter and had a relative larger cavity was easyto push the coil.Result:The diameters of 3 patients were 6.0,6.3 and40 minutes.A small shunt existed in only one case and disappeared onemonth late.Conclusion:The improved method is safe and valuable forclmical application.展开更多
Objective To assess the effect of transcatheter closure of patent ductus arteriosus (PDA) by comparing five different devices.Methods 354 patients (135 males, 219 females) underwent transcatheter closure of PDA using ...Objective To assess the effect of transcatheter closure of patent ductus arteriosus (PDA) by comparing five different devices.Methods 354 patients (135 males, 219 females) underwent transcatheter closure of PDA using the Porstmann Ivalon plug, Rashkind double umbrella, Sideris button device, Coils and Amplatzer occluders.The mean PDA diameter at its narrowest segment was 3.1 ± 1.3 mm. Qp/Qs was 2.2 ± 0.5. Follow-up evaluation was performed with color flow mapping of the main pulmonary artery at 24 h and 6 months after closure.Results Successful occlusion was observed in 92％ (23/25) for the Porstmann device, 98.7％ (77/78)for the Rashkind device, 100％ (43/43) for the Sideris device, 100％ (69/69) for the Coil and 100％(139/139) for the Amplatzer device. No residual shunts were needed for the Porstmann, while 1.4％ -15％ of patients who received the Rashkind, Sideris, coils or Amplatzer needed residual shunts during follow-up. There were complications of 24％ (6/25) for the Porstmann, 3.8％ (3/78) for the Rashkind,1.4％ (1/69) for Coils and 1.4％ (2/139) for the Amplatzer. No complications were found in patients with the Sideris device.Conclusion The results showed that the Sideris device, coils and the Amplatzer device are more effective and safer than the others for the occlusion of PDA in children.展开更多
文摘Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable with several drawbacks.Here we describe a novel minimally invasive technique,a product of mini-thoracotomy and traditional percutaneous technique skills,accomplished exclusively under echocardiography guidance.Methods:Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected.The symptoms were varying degrees of tachypnea,tachycardia,heart failure,failure to thrive,recurrent respiratory tract infections,or intensive care unit treatment for a longer duration.Through a left parasternal mini-thoracotomy,two parallel purse-string sutures were placed on the pulmonary trunk.After purse-string circle puncture,under exclusively transesophageal echocardiography guidance,a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set.The safety-suture prevented device migration in case of dislocation.The basic demographics,PDA size,device size and type,intrapulmonary manipulation time,operation time,PDA parameters(length,diameter,type of duct),redeployment of the device,residual shunt,and retention of safety-suture were all recorded and analyzed.The follow-up was done with transthoracic echocardiography on the 2^(nd)postoperative day,1,3,6,and 12 months,and yearly thereafter.Results:Fifty-two infants with a mean age of 8 months±2.8 months(Interquartile range=0)underwent Perpulmonary device closure of PDA.Successful PDA occlusion was accomplished event-free in all subjects.The mean PDA,mean device,and mean operation time were 5.6 mm±1.4 mm,7.9 mm±1.7 mm,and 61.2 min±12.9 min,respectively.The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up.Eighteen infants had retained safety-suture for added safety.There were no reports of the device or procedure-related complications.Conclusion:Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring>4 mm among infants.The safety-suture,in case of dislocation,prevents migration and associated complications.
文摘Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter】5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery and past through the PDA.Along the wirea balloon catheter was adopted to explore the real internal eiameter and thedistensibility of the PDA.Using a multi-usable catheter which remade fromthe coronary angiographic catheter and had a relative larger cavity was easyto push the coil.Result:The diameters of 3 patients were 6.0,6.3 and40 minutes.A small shunt existed in only one case and disappeared onemonth late.Conclusion:The improved method is safe and valuable forclmical application.
文摘Objective To assess the effect of transcatheter closure of patent ductus arteriosus (PDA) by comparing five different devices.Methods 354 patients (135 males, 219 females) underwent transcatheter closure of PDA using the Porstmann Ivalon plug, Rashkind double umbrella, Sideris button device, Coils and Amplatzer occluders.The mean PDA diameter at its narrowest segment was 3.1 ± 1.3 mm. Qp/Qs was 2.2 ± 0.5. Follow-up evaluation was performed with color flow mapping of the main pulmonary artery at 24 h and 6 months after closure.Results Successful occlusion was observed in 92％ (23/25) for the Porstmann device, 98.7％ (77/78)for the Rashkind device, 100％ (43/43) for the Sideris device, 100％ (69/69) for the Coil and 100％(139/139) for the Amplatzer device. No residual shunts were needed for the Porstmann, while 1.4％ -15％ of patients who received the Rashkind, Sideris, coils or Amplatzer needed residual shunts during follow-up. There were complications of 24％ (6/25) for the Porstmann, 3.8％ (3/78) for the Rashkind,1.4％ (1/69) for Coils and 1.4％ (2/139) for the Amplatzer. No complications were found in patients with the Sideris device.Conclusion The results showed that the Sideris device, coils and the Amplatzer device are more effective and safer than the others for the occlusion of PDA in children.
