Saliba Z

Development of catheter-based treatment of patent ductus arteriosus: a medium-sized centre experience.

BACKGROUND Despite the availability of effective devices, percutaneous closure of patent ductus arteriosus (PDA) can be challenging in some situations. AIM To describe our initial experience of percutaneous PDA closure. METHODS Between 2001 and 2007, 73 consecutive patients aged 3 months to 70 years underwent transcatheter PDA closure. An Amplatzer duct occluder (ADO) was chosen for ducts greater than 2 mm (n=50) and a Detachable coil (DC) for smaller ducts (n=23). RESULTS The diameter of the ducts ranged from 1 to 7.2 (mean 2.9+/-1.3) mm. The prostheses were implanted successfully in all patients. The complete closure rate reached 98% in the ADO group and 100% in the DC group at 12 months. Four (5.4%) patients showed asymptomatic device protrusion: three patients (5, 6 and 10 kg) into the aortic isthmus and one patient (7 kg) into the pulmonary artery (PA). One patient (7 kg) experienced transient severe bradycardia due to pulmonary air embolism. Another patient (3.3 kg) had a permanent asymptomatic occlusion of the femoral artery. In a third patient (17 kg), the ADO migrated asymptomatically into the descending aorta and was discovered 12 months later. CONCLUSION Even during the learning curve, percutaneous PDA closure can give excellent results. Strict adherence to protocols and careful follow-up assessments are mandatory. In small infants, the use of the ADO may lead to obstruction in the aorta or PA, or to device migration. Cautious surveillance for untoward events is essential, especially in small infants with large ducts.

Angiography of an Aneurysmal Aorto–Left Ventricular Tunnel

The aortoventricular tunnel is an abnormal congenital extracardiac communication between the ascending aorta and 1 of the ventricles.1 Approximately 130 cases have been reported in the literature, 90% being aorto–left ventricular tunnels (ALVTs).2 Echocardiography is the best diagnostic tool for ALVT, and thus cardiac catheterization is not routinely performed unless more information is needed concerning the coronary arteries. Coronary artery anomalies may be associated with ALVT in 45% of patients.3,4 The ostium of the right coronary artery may lie within the …

Percutaneous closure of a large iatrogenic fistula between the inferior vena cava and the pulmonary vein in a child

We hereby describe a complex late postoperative veno‐venous fistula in a child, successfully treated by an interventional percutaneous procedure. It is a unique complication of diaphragmatic hernia surgery that has never been reported before: a late postoperative iatrogenic fistula, between the inferior vena cava and the right lower pulmonary vein, discovered in a 6‐year‐old boy operated at the age of 4 months for a right diaphragmatic hernia. The right to left shunt was completely and uneventfully suppressed by a percutaneous procedure separating the systemic venous return from the pulmonary venous return with an Amplatzer Vascular Plug II.

Catheter closure of a recanalized vertical vein after repair of total anomalous pulmonary venous connection

The vertical vein is sometimes left open in repair of total anomalous pulmonary venous connection. It usually closes later but can remain patent leading to a significant shunt. We describe a recanalized vertical vein in a 7‐year‐old having undergone repair in infancy. It was closed using an Amplatzer device.