PMC8254156_01
Case 1: (a) Aortogram showing 4 mm patent ductus arteriosus; (b) venogram showing interrupted inferior vena cava; (c) patent ductus arteriosus crossed via azygous route from the femoral venous access; (d) lifetech 8 mm x 6 mm patent ductus arteriosus device deployed
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F1
A 3-year-old male child weighing 14 kg with 4 mm PDA [Figure 1a] was taken up for device closure. 5Fr Femoral Arterial and Venous Access were taken. Venous angiogram via the femoral route showed the azygous continuation of IVC [Figure 1b]. AmplatzerR extra-stiff 0.035" wire (AGA Medical Corporation, USA) which was parked in descending aorta [Figure 1c]. This caused transient bradycardia and hypotension due to the stretch, which resolved on withdrawal of Amplatzer wire. An 8 mm x 6 mm Cera  duct occluder device (Lifetech Scientific Inc., China) was deployed successfully [Figure 1d] over a 6-Fr SteerEase  sheath (Lifetech Scientific Inc., China). The post deployment angiogram showed no residual flow across the device.
PMC8254156_02
Case 2: (a) Aortogram showing 4 mm patent ductus arteriosus; (b) Amplatzer Duct Occluder I device 8 mm x 6 mm via femoral venous route; (c) device (White arrow) embolized into right pulmonary artery; (d) embolized device snared; (e) Snared device stuck at superior vena cava-azygous junction; (f) device retrieved via 2nd snare via internal jugular vein access; (g) device in internal jugular vein; (h) cocoon 6 mm muscular device closure of patent ductus arteriosus via femoral arterial route
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F2
A 2-year-old female child weighing 11 kg with 4 mm PDA [Figure 2a] was taken up for device closure. Amplatzer Duct Occluder (ADO) I (AGA Medical Corporation, USA) device [Figure 2b]. As soon as the cable was released, the device embolised into the right pulmonary artery (PA) probably because of the rebound force of the extra loop-tension of the cable device [Figure 2c]. The device was snared and retrieved from the right PA [Figure 2d]. It could be pulled into the superior vena cava (SVC) but could not be retrieved into the azygous vein [Figure 2e]. Hence a second snare was introduced from the internal jugular vein (IJV) access and the device was fed to the second snare from the first snare in the SVC [Figure 2e and f]. IJV [Figure 2g] and retrieved by surgical cut down on the table. In the same sitting, a 6 mm Cocoon muscular VSD device (Vascular Innovations, Thailand) was used successfully to close from the aortic end via the femoral route [Figure 2h].
PMC8254156_03
(a) Case 3: 3 mm patent ductus arteriosus closed with 8 mm x 6 mm Amplatzer Duct Occluder I device via femoral venous route; (b) Case 4: 2 mm patent ductus arteriosus closed with 5 mm x 4 mm Gianturco coil via femoral arterial route
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F3
PMC8254156_04
(a) Case 3: 3 mm patent ductus arteriosus closed with 8 mm x 6 mm Amplatzer Duct Occluder I device via femoral venous route; (b) Case 4: 2 mm patent ductus arteriosus closed with 5 mm x 4 mm Gianturco coil via femoral arterial route
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F3