THE OSTIA VENAE HEPATICAE AND THE RETHROHEPATIC ...

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TRANSCA<strong>THE</strong>TER CLOSURE OF LARGE PATENT DUCTUS BY AMPLATZER TM DUCT OCCLUDER ? DELIVERY SYSTEM Kritvikrom Durongpisitkul, Jarupim Soongswang, Duangmanee Laohaprasitiporn, Apichart Nana Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Key words : PDA = Transcatheter closure of patent ductus arteriosus (380) Although the technique of coil embolization rapidly gained popularity for transcatheter closure of patent ductus arteriosus (PDA) this, however, was known to be effectively only in small PDA. Reports of transcatheter ductal occlusion device for large PDA, Rashkind PDA occluder and Sideris “button” device, were published in the past. The relatively large sheath (8-11 French) required for placement of such devices, however, was a major disadvantage. A new self-expandable, repositionable, Amplatzer TM duct occluder ? (ADO) was used to close a large PDA in our patient. The procedure was conducted under FDA investigation protocol and approval by the ethic committee with inform consent obtained from the parents. A ten years old boy who is in functional class I had grade 4/6 continuous murmur on examnination. The chest radiography revealed a CT ratio of 0.6 with increased pulmonary vascularity. The ECG showed evidence of left ventricular hepertrophy. Echocardiogram revealed PDA measured 5 mm. During the cardiac catheterization the initial hemodynamic revealed a normal pulmonary artery pressure (27/15 nmmHg) with calculated Qp:Qs = 4.6:1. The angiogram revealed type A-1 PDA with smallest diameter measured 6.8 mm and largest (ampulla) diameter measured 8.8 mm. A multipurpose catheter was placed through PDA antergradely with wire exchanged for 6 F delivery sheath. A 10/8 mm ADO was selected and delivered retrogradely with dise open in aorta and pull back to PDA respectively. Residual left to right shunt was noted initially. Brief epsode of hematuria (6 hours) was noted during the first 24 hours. Follow-up at two weeks, 3 and 6 months revealed tiny residual left to right shunt. Conclusion: We demonstrated the capability of the Amplatzer TM duct occluder ? that could be effectively and safely deployed to close a large PDA. Futher studies with long term follow-up are required to establish its value in a large number of patients. 281
282 INTERMEDIATE TERM FOLLOW-UP ON TRANSCA<strong>THE</strong>TER CLOSURE OF ATRIAL SEPTAL DEFECTS BY AMPLATZER TM SEPTAL OCCLUDER Kritvikrom Durongpisitkul, Jarupim Soongswang, Duangmanee Laohaprasitiporn, Apichart Nana. Division of Pediatric Cardiology, Department of Pediatrics. Faculty of Medicine, Siriraj Hospital, Mahidol University. Key words : ASD = Transcatheter closure of atrial septal defects Faculty of Medicine Siriraj Hospital (381) Background: Surgical repair of secundum atrial septal defects (ASD) is a safe procedure, however, it is associated with morbidity and thoracotomy scar. The Amplatzer TM Septal Occluder (ASO) is a new device designed for closure of ASD. Objective: We report our clinical experience with closure of ASD by using the ASO with intermediate term follow-up. Patients & Methods: Patients having ASD met established criteria for transcatheter closure were selected. Procedures were performed under general anesthesia. ASD was measured by transesophageal echocardiogram (TEE) and balloon occlusion method (stretched diameter). The ASO was chosen to be equal to ±1 mm of the stretched diameter. Device was advanced transvenously into a guiding sheath and deployed under fluroscopic and TEE guidance. Results : There were 26 patients with mean age of 17.2±15.9 years old (2 to 60) and mean weight of 22±37.5 kg (10.7 to 62.5). The mean ASD diameter measured by TEE was 18.3±5.2 mm. with stretched diameter of 22±7.5mm. Four patients who had ASD stretched diameter over 32 mm were excluded because of the larger size devices were not available. Device were deployed in 22 patients with size from 9 to 30 mm (median=22mm). Immediate after closure tiny residual shunt was observed at the core of the device in each case. At 24 hours only two patients had small (
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THE OSTIA VENAE HEPATICAE AND THE R
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WHEN SHOULD WE ORDER PREOPERATIVE C
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toneal lidocaine instillation (Grou
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consisting of 40 patients, received
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absent group. A modified behavioral
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cally-ill patients suffered cyanosi
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severity of pruritus. The incidence
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cream and plastic occlusive dressin
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IMPROVED DETECTION OF RADIOFREQUENC
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THE PREVALENCE OF CHLAMYDIA PNEUMON
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THE PREVALENCE OF CHLAMYDIA PNEUMON
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COMPARATIVE TREATMENT OF ORAL CANDI
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DEEP FUNGAL AND HIGHER BACTERIAL SK
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CLINICAL AND MICROBIOLOGIC FINDINGS
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LASER HAIR REMOVAL AFFECTS SEBACEOU
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Result: The mean age of onset was 5
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DEEP FUNGAL AND HIGHER BACTERIAL SK
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section as metachromatic staining c
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202 Faculty of Medicine Siriraj Hos
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204 PHOTOTESTING IN ORIENTAL PATIEN
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206 specimens, respectively. The sp
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212 HEMOGLOBINOPATHIES : A COMPARAT
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214 tomized cases were 137.99³29.5
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222 Characterization of mutations o
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Page 65 and 66: 230 Faculty of Medicine Siriraj Hos
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Page 81 and 82: 246 THE MANAGEMENT OF SACROCOCCYGEA
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Page 95 and 96: 260 INTESTINAL PARASITIC INFECTIONS
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Page 111 and 112: 276 Objective : To measure the rela
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Page 133 and 134: 298 maintenance of local homeostasi
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Page 149 and 150: 314 NORMAL APPEARANCES OF TECHNETIU
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Page 157 and 158: 322 THE RELATIONSHIP BETWEEN MYOFAS
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Mahidol University Annual Research
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336 individuals with SAO and in the
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342 EVALUATION OF MONOCLONAL ANTIBO
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