1/11. Aortic obstruction caused by device occlusion of patent arterial duct.A 2 year old girl is reported in whom deployment of the Amplatzer ductal occluder caused significant aortic obstruction, requiring surgical removal of the device. This case emphasises the need for careful echocardiographic and angiographic assessment of the position of the Amplatzer ductal occluder before and after detaching the device from its delivery system, with particular emphasis on the position of the aortic retention ring. Careful assessment of ductal anatomy must guide case selection.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
2/11. Transcatheter coil closure of large patent ductus arteriosus with 0.052-inch Gianturco coils using myocardial biopsy forceps in a 70-year-old woman.Small patent ductus arteriosus is generally closed in children using a transcatheter coil. This is done less often in older patients or those with large patent ductus arteriosus. We report successful antegrade transcatheter coil closure of patent ductus arteriosus in a 70-year-old woman. Into the patent ductus arteriosus, using flexible myocardial biopsy forceps, we placed two large 0.052-inch Gianturco coils, which were easily used as multipurpose vascular occlusion coils. The forceps and the coils were readily available and provided complete occlusion. Other delivery devices cannot deliver such large coils. Transcatheter coil closure thus appears to be safe and effective for closing large patent ductus arteriosus in the elderly.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
3/11. Retrograde wire-assisted percutaneous transcatheter closure of persistent ductus arteriosus with Amplatzer duct occluder in the elderly: A new application.Percutaneous transcatheter closure of persistent ductus arteriosus (PDA) has been well established in the pediatric field. For moderate- to large-sized PDA, the newly developed Amplatzer duct occluder had offered a good solution, but it depends on stiff wire and delivery sheath. We reported two elderly patients of PDA with vascular anatomy too difficult to be antegradely approached and were closed by a retrograde technique by an assisting wire from the descending aorta. The wire served as a guide and tracked the delivery system to cross the ductus from the venous side smoothly. This retrograde wire-assisted technique could be utilized to overcome the PDA of difficult vascular anatomy, which could not be easily fulfilled by conventional antegrade venous approach.- - - - - - - - - - ranking = 2keywords = delivery (Clic here for more details about this article) |
4/11. Transcatheter management of patent ductus arteriosus in sick ventilated small infants.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.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
5/11. Transcatheter closure of patent ductus arteriosus with buttoned device: first successful clinical application in a child.Several devices are available for transcatheter closure of PDA. Most of the available devices either require complicated intracardiac maneuvering or need a large-sized sheath for implantation of the device. A recently described "buttoned" device developed by Sideris et al. that can be delivered across the ductus via a 7F sheath had undergone successful trials in animal models. Because of the ease of device implantation and the requirement for a smaller-sized sheath for delivery than that used with other devices, we have used this custom-made double-disc device in a 5-year-old child and have shown successful closure of the ductus by angiography and by color Doppler studies. Further clinical trials with this device seem warranted.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
6/11. Patent ductus arteriosus after prolonged treatment with indomethacin during pregnancy: case report.indomethacin was administered to suppress premature uterine contractions in a twin pregnancy from the 27th until the 32nd week of pregnancy. Patent ductus arteriosus was diagnosed after delivery in one twin and persisted patent for a period of 4 weeks. A hypothesis of the constrictive influence of prostaglandin synthetase inhibitors on the fetal ductus arteriosus during intrauterine and neonatal periods is suggested.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
7/11. Pulmonary hypertension and pregnancy: a series of eight cases.This is the report of a series of eight patients with pulmonary hypertension (primary and secondary) who delivered at the McMaster University Medical Centre between 1978 and 1987. Seven of the eight patients delivered vaginally and had a successful outcome. The eighth patient was admitted as an emergency and died shortly after Caesarean section under general anaesthesia, performed to save the infant. The other seven patients were all managed by a team, including anaesthetists, cardiologists and obstetricians, from about 25 wk. The patients were hospitalized pre-partum and received oxygen therapy and anticoagulation with heparin. analgesia in labour was managed, once anticoagulation was reversed, by low concentrations of epidural bupivacaine (0.125%-0.375%) and fentanyl. The patients were monitored during labour and delivery with oximetry and arterial and central venous pressure lines. Pulmonary arterial lines were not used because of increased risk and questionable usefulness. Vaginal delivery was managed with vacuum extraction or forceps lift-out to minimize the stress of pushing. After delivery, all patients were monitored in an intensive care unit for several days, anticoagulation was restarted, and all patients were discharged home taking oral anticoagulant therapy. The successful management of pulmonary hypertension in pregnancy should include team management started early in pregnancy and controlled vaginal delivery utilizing epidural analgesia.- - - - - - - - - - ranking = 4keywords = delivery (Clic here for more details about this article) |
8/11. Transcatheter closure of oversized persistent ductus arteriosus by simultaneous delivery of two Rashkind umbrella devices.Transcatheter closure of persistent ductus arteriosus (PDA) with a diameter of > 9 mm is considered to be impossible or at least difficult with the occlusion systems that are currently available. We report a simple technique for occluding oversized PDAs with two diameter of 13 mm was successfully occluded in a 40-year-old man. Complete closure without residual shunt was documented by echocardiogram and angiogram.- - - - - - - - - - ranking = 4keywords = delivery (Clic here for more details about this article) |
9/11. Spring coil embolization of a patent ductus arteriosus in an adult.To date, coil embolization has been reserved for occlusion of the small patent ductus arteriosus (PDA) because of potential dislodgement of the coils. We report a case of a larger, hemodynamically significant PDA in an adult which was successfully closed by two spring coils using a "crossed catheter" technique for coil delivery.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
10/11. Simultaneous delivery of two patent arterial duct coils via one venous sheath.A female child, 10 months of age, weighing 7.2 kg, was catheterised for closure of a patent arterial duct. aortography was performed in the lateral projection and the minimum diameter of the arterial duct was assessed by comparing it to the size of the catheter. The duct size was estimated between 3 and 3.5 mm at the narrowest point, therefore, it was decided to deliver two 5 mm patent arterial duct coils to avoid placement of an 8 mm coil in this small child. Similar operations were subsequently performed in two further children. Simultaneous delivery of two coils via a single long venous sheath is easy, fast, and safe. This simple and inexpensive procedure can reduce irradiation and anaesthesia time.- - - - - - - - - - ranking = 5keywords = delivery (Clic here for more details about this article) |
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