AS-131: A Different Approach for Long Tubular Ducts
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Congenital Heart Disease (Abstract no. AS-131) AS-131 A Different Approach for Long Tubular Ducts. Bhanu Duggal. Grant Medical College and Sir JJ Hospital, Mumbai, India. Background: Long tubular ducts (ie, Type C and Type E by the Kritchenoff classification) are seldom amenable to closure by the classical Amplatzer duct occluder. The new ADO II device is partic- ularly designed for the Methods: Sixty patients aged 6 months to 40 years underwent patent ductus arteriosus (PDA) closure in the previous 1.5 years. Of these, 6 cases required PDA closure with devices other than ADO I. In 3 patients, the ducts were small 2 mm and long 6 . These were closed with ADO II ductal occluders. In another patient with type C duct, the duct was 6 mm wide and 10 mm long.This was closed with a coil-filled Amplatzer plug. In 2 patients, the duct was large, and PA pressures were suprasystemic, but device placement brought down the pulmonary artery pressures, and the duct was closed successfully with a ventricular septal defect (VSD) device. In another patient with a large PDA, subaortic membrane and severe left ventricular dysfunction, the duct was closed with a muscular VSD device because the duct was 14 mm wide. Results: 8 cases had a ductal morphology different from the clas- sical Type A duct. In the initial stages the occlusion of two of these ducts with ADOI occluder resulted in a precarious deployment of the device with its axis tilted downwards. In both there was a residual shunt which gradually occluded in one patient. In the subsequent cases we deferred the use of ADOI. In 3 patients the ducts were long and tubular (Type C with diameters ranging from 2-3 mm and lengths from 4-6 mm). These were closed with ADO II ductal occluders. One of these patients weighed only 5 kg and the low profile of ADOII device along with its Torque Vue low profile catheter was of added advantage. In another patient with type C duct which was 6 mm in width and 10 mm in length; ductal closure was accomplished with a coil filled Amplatzer plug. In 2 patients the ducts were 12 and 14 mm in diameter, tubular (4-5 mm in length) with suprasystemic PA pressures. Trial of device placement brought down the pulmonary artery pressures and the duct was closed successfully with a VSD device. Conclusion: Though a large number of PDAs can be occluded with the standard ADO I ductal occluder, an individualized approach is needed for every case. Careful attention to the ductal morphology, size and hemodynamics can significantly reduce misadventures in the car- diac catheterization lab. In cases with severe pulmonary hypertension and no significant fall of pulmonary artery pressures with balloon occlusion a trial of device occlusion may be warranted, if the clinical profile is not commensurate with Eisenmenger’s. Device occlusion definitely provides a more complete occlusion of the duct than the balloon and could be of value in certain cases. 56B The American Journal of Cardiology MONTH ANGIOPLASTY SUMMIT ABSTRACTS/2010 E- P O S T E R A B S T R A C T S
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Transcript of AS-131: A Different Approach for Long Tubular Ducts
Congenital Heart Disease
(Abstract no. AS-131)
AS-131A Different Approach for Long Tubular Ducts. Bhanu Duggal.Grant Medical College and Sir JJ Hospital, Mumbai, India.
Background: Long tubular ducts (ie, Type C and Type E by theKritchenoff classification) are seldom amenable to closure by theclassical Amplatzer duct occluder. The new ADO II device is partic-ularly designed for the
Methods: Sixty patients aged 6 months to 40 years underwentpatent ductus arteriosus (PDA) closure in the previous 1.5 years. Ofthese, 6 cases required PDA closure with devices other than ADO I. In3 patients, the ducts were small 2 mm and long 6 . These were closedwith ADO II ductal occluders. In another patient with type C duct, theduct was 6 mm wide and 10 mm long.This was closed with a coil-filledAmplatzer plug. In 2 patients, the duct was large, and PA pressureswere suprasystemic, but device placement brought down the pulmonaryartery pressures, and the duct was closed successfully with a ventricularseptal defect (VSD) device. In another patient with a large PDA,subaortic membrane and severe left ventricular dysfunction, the duct
was closed with a muscular VSD device because the duct was 14 mmwide.
Results: 8 cases had a ductal morphology different from the clas-sical Type A duct. In the initial stages the occlusion of two of theseducts with ADOI occluder resulted in a precarious deployment of thedevice with its axis tilted downwards. In both there was a residual shuntwhich gradually occluded in one patient. In the subsequent cases wedeferred the use of ADOI. In 3 patients the ducts were long and tubular(Type C with diameters ranging from 2-3 mm and lengths from 4-6mm). These were closed with ADO II ductal occluders. One of thesepatients weighed only 5 kg and the low profile of ADOII device alongwith its Torque Vue low profile catheter was of added advantage. Inanother patient with type C duct which was 6 mm in width and 10 mmin length; ductal closure was accomplished with a coil filled Amplatzerplug. In 2 patients the ducts were 12 and 14 mm in diameter, tubular(4-5 mm in length) with suprasystemic PA pressures. Trial of deviceplacement brought down the pulmonary artery pressures and the ductwas closed successfully with a VSD device.
Conclusion: Though a large number of PDAs can be occluded withthe standard ADO I ductal occluder, an individualized approach isneeded for every case. Careful attention to the ductal morphology, sizeand hemodynamics can significantly reduce misadventures in the car-diac catheterization lab. In cases with severe pulmonary hypertensionand no significant fall of pulmonary artery pressures with balloonocclusion a trial of device occlusion may be warranted, if the clinicalprofile is not commensurate with Eisenmenger’s. Device occlusiondefinitely provides a more complete occlusion of the duct than theballoon and could be of value in certain cases.
56B The American Journal of Cardiology� MONTH ANGIOPLASTY SUMMIT ABSTRACTS/2010
E-POSTER
ABSTRACTS
