New Minimally Invasive Technique of Perpulmonary Device Closure of Patent Ductus Arteriosus Through a Parasternal Approach Li Hongxin, MD, Guo Wenbin,

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New Minimally Invasive Technique of Perpulmonary Device Closure of Patent Ductus Arteriosus Through a Parasternal Approach Li Hongxin, MD, Guo Wenbin, MD, Mei Zhu, MD, Fei Liang, MD, Wenlong Zhang, MD, Haroon Mujahid, MBBS, Chengwei Zou, MD The Annals of Thoracic Surgery Volume 93, Issue 3, Pages 862-868 (March 2012) DOI: 10.1016/j.athoracsur.2011.12.017 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Three types of devices: (A) cone-shaped ductal occluder; (B) modified concentric ventricular septal occluder; and (C) a specially designed ductal occluder—a double-disc device with the pulmonary disc 1 mm and the aortic disc 2 mm larger than the connecting waist. The Annals of Thoracic Surgery 2012 93, 862-868DOI: (10.1016/j.athoracsur.2011.12.017) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Direct delivery system. (B) Probe-assisted delivery system. The Annals of Thoracic Surgery 2012 93, 862-868DOI: (10.1016/j.athoracsur.2011.12.017) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 A 2.5-cm parasternal incision was made in the left second intercostal space. The Annals of Thoracic Surgery 2012 93, 862-868DOI: (10.1016/j.athoracsur.2011.12.017) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The sheath was advanced superiorly through the patent ductus arteriosus (PDA) into the descending aorta. The retention disc of the device was deployed subsequently. The Annals of Thoracic Surgery 2012 93, 862-868DOI: (10.1016/j.athoracsur.2011.12.017) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) A large patent ductus arteriosus with a diameter of 17 mm at the pulmonary end. (B) After deployment, a dumbbell-like device (arrow) was shown on the screen. (AO = aorta; MPA = main pulmonary artery.) The Annals of Thoracic Surgery 2012 93, 862-868DOI: (10.1016/j.athoracsur.2011.12.017) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 After release, the device stay suture was tied down with the pursestring sutures to avoid dislocation of the device to the descending aorta. The Annals of Thoracic Surgery 2012 93, 862-868DOI: (10.1016/j.athoracsur.2011.12.017) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions