Percutaneous Closure of Large-Sized Patent Ductus Arteriosus Using the Amplatzer Duct Occluder

- Operator : Myeong-Ki Hong

Percutaneous Closure of Large-Sized Patent Ductus Arteriosus Using the Amplatzer Duct Occluder
- Operator : Myeong-Ki Hong MD, PhD, Korea
Case presentation
The patient was 38 year-old female, and presented with dyspnea on exertion. Echocardiographic examination revealed abnormal flow from the descending aorta to the main pulmonary artery, representing patent ductus arteriosus (PDA) (Figure 1). The peak velocity of abnormal flow and defect size were 4.4m/s and 10 mm/s respectively. The patient underwent cardiac catheterization for occlusion of PDA

Patient underwent right and left heart catheterization using a 6F sheath in the femoral artery and a 7F sheath in the femoral vein. A descending aortogram was performed to evaluate the size, position and shape of the ductus (Figure 2). A 6F cournand catheter was advanced from the venous side into the PDA and placed in the descending aorta. This catheter was exchanged for the delivery sheath (8F) over a 0.035 inch exchange guidewire and the dilator was removed, leaving the sheath in the descending aorta (Figure 3). The delivery cable was passed through the loader and the 12-14 mm size occlusion device (ususally 2 mm larger than the narrowest size of the PDA) was screwed clockwise into the tip of the delivery cable. The device and the loader were immersed in saline solution as the amplatzer duct occluder was pulled into the loader. The loader was introduced into the delivery sheath and without rotation the device was advanced into the descending aorta. The sheath was retracted until the retention disk was opened in the proximal descending aorta (Figure 4). The sheath with the delivery cable was pulled back as one unit until the retention disk was snug against the aortic end of the ampulla. While maintaining tension on the delivery cable, the introducing sheath was withdrawn into the pulmonary artery to deploy the tubular frame of the prosthesis into the PDA, similar in a way to deployment of a self-expandable stent. With the device still attached to the cable, a descending aortogram was performed in the lateral projection to confirm device position (Figure 5). After proper device position was confirmed, the device was released by turning the cable counterclockwise using the pin vise. A repeat descending aortogram was performed 5 minutes after the release to assess the degree of residual shunt, which showed much reduced shunt flow (Figure 6).

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