title: Trans-pulmonary echocardiography as a guide for device closure of patent ductus arteriosus.
abstract: OBJECTIVE
  The aim of this study was to develop trans-pulmonary echocardiography (TPE) to guide device closure of patent ductus arteriosus (DC-PDA).
  
  
  BACKGROUND
  Aortography requires a large amount of contrast yet may give us an inadequate image to evaluate anatomy or residual shunt in patients with large PDA or dilated vessels and is precluded in patients with renal dysfunction. Practically, there is no imaging modality to monitor the entire procedure except for trans-esophageal echocardiography that requires general anesthesia.
  
  
  METHODS
  Subjects were seven patients with ages ranged from 6- to 77-years old and body weight > 15 kg. The size of the PDA ranged from 1.8 to 6.3 mm with pulmonary to systemic flow ratios from 1.2 to 2.2. During DC-PDA using Ampaltzer Duct Occluder or coil, an intra-cardiac echocardiographic (ICE) catheter was advanced into pulmonary arteries and standard views were developed to guide DC-PDA.
  
  
  RESULTS
  We have developed two standard views; the main pulmonary artery view (MPA view) and the left pulmonary artery view (LPA view). The MPA view provided aortic short axis view equivalent to that seen by trans-thoracic echocardiography in children. The LPA view, obtained by the echo probe in the LPA and turned it up upside down, provided long axis view of the PDA allowing more precise anatomical evaluation. TPE allowed us to monitor the entire procedure and determine residual shunts.
  
  
  CONCLUSIONS
  TPE in the MPA and LPA view can be an effective guide for DC-PDA. This report leads to new application of this imaging device.
authors: Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.
authors: Yoshiyuki
authors: Y
authors: Kudo
authors: Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.
authors: Kenji
authors: K
authors: Suda
authors: Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.
authors: Hironaga
authors: H
authors: Yoshimoto
authors: Department of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan.
authors: Yozo
authors: Y
authors: Teramachi
authors: Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.
authors: Shintaro
authors: S
authors: Kishimoto
authors: Department of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan.
authors: Motofumi
authors: M
authors: Iemura
authors: Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.
authors: Toyojiro
authors: T
authors: Matsuishi
mesh_terms: D000293:Adolescent; D000368:Aged; D001027:Aortography; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002648:Child; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D055989:Septal Occluder Device; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Amplatzer duct occluder; aortography; intracardiac echocardiography; monitoring tool; residual shunt