Percutaneous closure of the patent ductus arteriosus using the Nit-Occlud PDA-R (reverse) device: initial experience reporting immediate and short-term results.

PURPOSE: To review the initial clinical outcomes of patent ductus arteriosus (PDA) closure using the new Nit-Occlud PDA-R device (NOPDA-R). MATERIALS AND METHODS: The NOPDA-R is a self-expandable, nitinol-made, premounted and cone-shaped device with two distinctive features: reverse reconfiguration of the distal disc and a peculiar "snare-like" release mechanism. From May to December 2010, 20 consecutive patients were included. RESULTS: Median age was 4.7 years (range, 6 months to 21 years) and weight was 16.4 kg (range, 6-49 kg). Mean PDA diameter at its narrowest point, usually the pulmonary end, was 2.92 ± 0.61 mm (range, 2.1-4.5 mm), length was 7.05 ± 1.17 mm (range, 4.7-9.2 mm) and diameter of the aortic ampulla was 9.52 ± 1.62 mm (range, 6-13 mm). Pulmonary artery mean pressure was 20.6 ± 4.49 mmHg (range, 14-28 mmHg) and Qp/Qs ratio was 2.0 ± 0.29 (range, 1.6- 2.5). Implantation success rate was 100%. The median cylinder diameter of the device was 6.53 ± 1.05 mm (range, 5.5-8.5 mm) leading to a final selected device 124% larger (cylinder diameter) than the narrowest PDA diameter. Assessed by transthoracic color-Doppler echocardiography at 24 hours, 1 month, and 3 months after implantation, complete closure was achieved in 60%, 90%, and 95% of patients, respectively. There were no complications and all patients were discharged home the next day. CONCLUSION: Percutaneous PDA closure using the new NOPDA-R device was feasible, safe, and effective. Longer follow-up time and a larger number of patients are required to assess long-term performance.

Utilización del "balón con cuchillas" para ampliación de comunicación interauricular restrictiva en lactantes menores de 6 meses: resultados inmediatos y a mediano plazo / Blade Balloon Septostomy to Enlarge a Restrictive Atrial Septal Defect in Infants under 6 Months: Immediate and Medium-Term Outcomes

Los pacientes con cardiopatías congénitas complejas requieren con cierta frecuencia una comunicación interauricular no restrictiva para mantener una saturación de oxígeno arterial y un gasto cardíaco adecuados. En este trabajo se describen seis pacientes menores de 6 meses con cardiopatías congénitas cianóticas graves, en los cuales se realizó dilatación de una comunicación interauricular restrictiva utilizando un balón con cuchillas. Se presentan los resultados inmediatos y a mediano plazo. En todos los pacientes se logró un incremento importante y duradero del tamaño del defecto interauricular y una mejoría clínica sostenida posprocedimiento. Se resalta la utilización de la ecocardiografía intraprocedimiento para guiar y evaluar los resultados. Consideramos que, utilizada con cautela en casos seleccionados, la ampliación de una CIA restrictiva con balón con cuchillas en lactantes menores de 6 meses es una alternativa segura y eficaz, con resultados satisfactorios. La monitorización ecocardiográfica es muy importante para el éxito del procedimiento.

A nonrestrictive atrial septal defect is mandatory in order to maintain adequate arterial oxygen saturation and cardiac output in patients with complex congenital heart defects. We describe six patients under 6 months with severe cyanotic congenital heart defects in whom blade balloon septostomy was performed to enlarge a restrictive atrial septal defect. Immediate and medium-term outcomes are presented. The procedure was successful in all patients, producing a larger and long-lasting atrial septal defect and sustained clinical improvement. The use of intraprocedure echocardiography to guide and evaluate the results is highlighted. We consider that balloon septostomy is a safe and effective option to enlarge a restrictive ASD in carefully selected cases in infants less than 6 months old, with satisfactory outcomes. Echocardiography guidance is very important to warrant success of the procedure.

Uso del "balón con cuchillas" para la ampliación de una comunicación interauricular restrictiva / Blade Balloon Atrial Septostomy to Enlarge a Restrictive Atrial Septal Defect

La presencia de una comunicación interauricular no restrictiva es obligatoria para mantener un gasto cardíaco adecuado o para lograr una mezcla de sangre aceptable en algunos pacientes portadores de cardiopatías congénitas complejas. Describimos un paciente en quien luego de un intento fallido de dilatación estática con balón de una comunicación interauricular restrictiva se utilizó un balón con cuchillas con éxito para su ampliación.

A nonrestrictive atrial septal defect is mandatory in order to maintain an adequate cardiac output or to achieve an acceptable blood mixing in some patients with complex congenital heart defects. We successfully performed a blade balloon septostomy in a patient with a restrictive atrial septal defect who had previously undergone a failed static balloon dilation of the atrial septum.