title: Over-the-wire-technique device implantation.
abstract: BACKGROUND
  Transcatheter closure of cardiac defects is a mainstay of treatment in congenital and structural heart disease. Occasionally, the devices used are useful in nonstandard or difficult positions but device embolization and malposition can be complicating factors necessitating percutaneous retrieval or emergency surgery. We describe a new "over-the-wire" technique that allows guided safe deployment and easy retrievability if required.
  
  
  METHODS
  We describe 5 cases in which Amplatzer devices were delivered over a wire in challenging anatomy in high-risk patients. These cases included baffle leak in complex congenital heart disease, paravalvular leak, a large patent ductus arteriosus, and complex ventricular septal defects. In each case, the device was punctured close to the release mechanism and a guidewire fed through it, the device and guidewire then being loaded into the appropriate delivery system. The procedure is described in each case, illustrating the use of the technique.
  
  
  CONCLUSIONS
  We describe a novel over-the-wire technique that is useful in deployment of Amplatzer devices in difficult and challenging anatomy, allowing careful controlled delivery and easy retrieval. This will help minimize procedural patient risk in complex cases.
authors.affiliation: Paediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Italy. gianfra.but@lycos.com
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
authors.forename: Biagio
authors.initials: B
authors.lastname: Castaldi
authors.forename: Simon T
authors.initials: ST
authors.lastname: Macdonald
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D062906:Cardiac Catheters; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011677:Punctures; D015641:Radiography, Interventional; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult