1014 YA Park, et al. • Clinical outcomes of transcatheter closure of PDA in small children Some patients had one or more comorbidities (Table 2). Four LVEDD had decreased from a mean of 31.2±4.7 to 28.8±4.6 mm patients had Down syndrome. 2. Results of the procedures Of the 115 patients, the device was successfully deployed in 114 patients (99%). COOK Detachable Coil® (COOK Medical Inc, Bloomington, IN, USA) (n=2, 2%), Nit­ Occlud® (PFM AG, Cologne, Germany) (n=60, 52%) and Amplatzer duct occluder® at 1­ month follow­ up. The mean systolic pulmonary artery pressure was 34.6±1.4 mmHg (range: 15 to 85 mmHg). Pulmonary hyper­ tension, evaluated during cardiac catheterization, was defined as pulmonary artery systolic pressure more than 40 mmHg9). Thirty­ four patients had pulmonary hypertension. Pulmonary hyper­ tension, evaluated using TR jet pressure and septal configuration on echocardiography, regressed in all 34 patients during follow­ up. (ADO, AGA Medical Corp., Plymouth, MN, USA) (n=53, 46%) Among them, 11 patients had severe pulmonary hypertension with were used (Fig. 1). Coils were favored in cases of a rather small pulmonary artery systolic pressure of more than 60 mmHg. The ductus, and in cases of moderate to large ductus, ADO was used. clinical characteristics and treatment results of these patients are Sixty patients (52%) had increased LVEDD and 41 patients summarizes in Table 3. Most of them presented with large PDA, showed normalization at 1­ week echocardiographic follow­ up. The and seven patients had associated heart lesions; 2 had VSD, 2 had Table 2. Associated Heart Lesions (n=42) Associated heart lesions Ventricular septal defect Atrial septal defect Coarctation of aorta Congenital aortic valve stenosis Hypoplastic left pulmonary artery 13 (11%) 11 (10%) 9 ( 8%) 3 ( 3%) 3 ( 3%) ASD, 1 had CoA and 1 had AS. Immediately after the procedure, 5 patients showed normalization of pulmonary artery pressure. Five patients showed normalization of pulmonary artery pressure at 1­ month echocardiographic follow­ up and the remaining patient showed normalization at 3­ month follow­ up. Fig. 1. A) Aortograms in the lateral view after implantation of COOK Detachable Coil®. B) Aortograms after implantation of PFM Nit-Occlud®. C) Aortogram following implantation of a 10/8 mm Amplatzer duct occluder® shows a residual shunt through the device. Table 3. Clinical Data of Patients who had Severe Pulmonary Hypertension (n=11) Age (month) Weight (kg) PDA size (mm) Qp/Qs Device Comorbidity PAP (post-closure) Follow-up duration (month) Abbreviations: Qp/Qs ratio, the ratio to pulmonary blood flow to systemic flow; PAP, pulmonary artery pressure; ADO, Amplatzer duct occluder®;VSD, ventricular septal defect; ASD, atrial septal defect; AS, aortic valve stenosis; CoA, coarctation of aorta Patient 1 2 3 4 5 6 7 8 9 10 11 8 8 7 4 5 5 4 14 5 7 6 6.5 7.4 8 4.2 4.9 5.9 5.7 10 6.2 6.6 7 6 5 8 8 5 3 8 6.5 6.8 7 4 2.89 1.8 2.92 2.5 2.2 2.9 2.28 2.29 4.06 2.34 3.22 ADO ADO ADO ADO ADO ADO ADO ADO ADO ADO ADO None VSD None ASD AS None CoA CoA None ASD VSD PAP (pre-closure) 60/25 (35) 85/55 (70) 70/40 (55) 65/25 (40) 60/30 (45) 70/35 (55) 70/35 (50) 70/35 (50) 65/35 (50) 80/50 (65) 60/20 (35) 30/10 (20) 50/20 (35) 50/30 (40) 55/20 (35) 40/15 (30) 40/20 (30) 45/15 (30) 40/20 (30) 35/ 5 (20) 55/20 (35) 50/15 (30) 59 18 64 34 50 41 23 16 12 4 7