Use of Amplatzer duct occluder to close severely hypertensive ducts: utility of transient balloon occlusion.
BACKGROUND
The dividing line between a patent ductus arteriosus with severe but reversible pulmonary artery hypertension and an Eisenmenger duct remains elusive. Increasing experience with the Amplatzer duct occluder has made non-surgical closure of even large patent ductus arteriosus simple and safe. However, data on the use of this device in severly hypertensive ducti is sparse.


RESULTS
There were six patients (2 males, 4 females), wherein transient ductal occlusion was done with an embolectomy balloon catheter. The post-occlusion hemodynamics along with overall clinical and hemodynamic assessment was used to decide the likelihood of benefit of closure and the choice of the device. In four of six patients of patent ductus arteriosus with severe pulmonary artery hypertension (pulmonary vascular resistance index> 8.0 U/m2) the duct was successfully closed using the Amplatzer duct occluder, while in two an Amplatzer ventricular septal defect occluder was used.


CONCLUSIONS
Transient balloon occlusion is quite helpful for assessing patients with patent ductus arteriosus with severe pulmonary hypertension, and short-term non-invasive follow-up has shown this strategy to be safe and useful.
Roy
Ambuj
A
Department of Cardiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi.
Juneja
Rajnish
R
Saxena
Anita
A
D000328:Adult; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods; D002648:Child; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D007223:Infant; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D011859:Radiography