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Permeability of a Blalock-Taussig shunt can increase the risk of endocarditis and ventricular overload. Percutaneous embolization of these shunts gives variable results. We report our experience in 10 patients with percutaneous closure of modified Blalock-Taussig shunts using retrograde arterial embolization with Gianturco coils. The patients' median age was 2.8 years, and their median weight was 12 kg. Most patients had minor stenosis of the distal portion of the anastomosis. In all cases, complete closure of the shunt was achieved without complications using a median of one coil per patient. The technique was feasible, safe, effective, and inexpensive.

OBJECTIVE - To report the results of percutaneous occlusion of persistent ductus arteriosus with the Amplatzer prosthesis in 2 Brazilian cardiological centers. METHODS - From May 1998 to July 2000, 33 patients with clinical and laboratory diagnosis of persistent ductus arteriosus underwent attempts at percutaneous implantation of the Amplatzer prosthesis. The median age was 36 months (from 6 months to 38 years), and the median weight was 14kg (from 6 to 92kg). Sixteen patients (48.5%) were under 2 years of age at the time of the procedure. All patients were followed up with periodical clinical and echocardiographic evaluations to assess the presence and degree of residual shunt and possible complications, such as pseudocoarctation of the aorta and left pulmonary artery stenosis. RESULTS - The minimum diameter of the arterial ducts ranged from 2.5 to 7.0mm (mean of 4.0+/-1.0, median of 3.9). The rate of success for implantation of the prosthesis was 100%. Femoral pulse was lost in 1 patient. The echocardiogram revealed total closure prior to hospital discharge in 30 patients, and in the follow-up visit 3 months later in the 3 remaining patients. The mean follow-up duration was 6.4+/-3.4 months. All patients were clinically well, asymptomatic, and did not need medication. No patient had narrowing of the left pulmonary artery or of the aorta. No early or late embolic events occurred, nor did infectious endarteritis. A new hospital admission was not required for any patient. CONCLUSION - The Amplatzer prosthesis for persistent ductus arteriosus is safe and highly effective for occlusion of ductus arteriosus of varied diameters, including large ones in small symptomatic infants.

Two children (a 9 year old boy and a 2.5 year old girl) with coronary artery fistulae communicating with the right ventricle underwent successful transcatheter occlusion using an antegrade technique. A Rashkind double umbrella device was used in one case and an Amplatzer duct occluder in the other.

In this report, we describe our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. From November 1992 to November 1996, 5 symptomatic patients, aged from 47 to 70 years, underwent transcatheter occlusion of fistulas using a retrograde arterial approach. All had chest pain or dyspnea on exertion. Detachable balloons were used in 4 patients, and Gianturco coils in 1. Detachable balloons were implanted through a Debrun system, while the coils were implanted through a 5 French right coronary Judkins catheter. Both were passed through an 8 French guiding catheter (Amplatz II). Each patient had a single fistula. The fistulas originated from the right coronary artery in 3 patients, and from the circumflex artery in 2. They drained into the pulmonary trunk in 3 patients, into the right atrium in 1, and into a bronchial artery in the other. All fistulas were occluded completely in the catheterization laboratory, and the procedures were uncomplicated. At follow up, 3 patients underwent coronary angiography, and there was no evidence of recanalization. Transcatheter embolization in adults of single congenital coronary fistulas with detachable balloons and coils is safe and effective and can be regarded as an acceptable alternative to surgery.

Purpose: To evaluate the overall experience of our institution with percutaneous occlusion of the patent ductus arteriosus., Methods: Since December/92, 150 patients underwent 178 procedures (85-Rashkind technique; 87-Gianturco coils; 6-Duct Occlud). Median age was 6.5 years (1 to 57). Mean minimum ductal diameter was 3.05 +/- 1.24 mm (1 to 8). Clinical and echocardiographic evaluations were performed periodically., Results: Adequate implantation was achieved in 143 (95.3%) patients. Prevalence of immediate residual shunting was 52.1%, falling to 15.9% during follow-up. This figure decreased to 5.2% after new additional procedures. Umbrella and coil embolization occurred in 1 and 12 procedures, respectively. Hemolysis and mild stenosis of left pulmonary artery were observed in one patient each. There was no mortality., Conclusion: This therapeutic modality is safe and efficacious with good follow-up results.

The authors report their experience with the percutaneous closure of the patent ductus arteriosus with the Rashkind technique. They performed 42 procedures with a success of 97.6% and one embolization episode. The mean age was 8.7 +/- 6.7 years, the mean weight was 25.0 +/- 15.8 Kg and the minimum diameter of the ductus was 4.0 +/- 1.3 mm. The immediate overall prevalence of residual shunt was 48.8% falling to 21% in a mean follow-up of 17 +/- 13 months in 29 cases. Two patients underwent late reocclusion: one with a new umbrella and the other with a coil. Another patient had an immediate severe residual shunt and it was reoccluded in the same procedure with a coil. The anatomical type and minimum internal diameter of the ductus, age and weight, size of the umbrella and the rotation of the umbrella were not predictors of residual shunt. There were no deaths, hemolysis, endarteritis or fracture of the umbrella's arms. One patient remained with a slight gradient in the left pulmonary artery. The authors conclude that the Rashkind technique is safe and efficient and has good long term results. It should be considered as the first line therapeutic modality in the treatment of selected patients with persistent ductus arteriosus.