Jesus Barbosa - Academia.edu (original) (raw)

Papers by Jesus Barbosa

Echocardiography, 2004

ABSTRACT Background: Follow-up in closing atrial septal defects (ASD) by transcatheter device, wi... more ABSTRACT Background: Follow-up in closing atrial septal defects (ASD) by transcatheter device, with TEE guidance.Methodology: In 137 patients with ASD ostium secundum (os) the mean (X) age of the patients was 8.78 years (range from 2 to 50 years). 120 patients with isolated defects, 12 with other small ASDs, 2 with fenestrated ASDs (fASD),1 patients had patent ductus arteriosus, 2 had ventricular Septal Defects (VSD). Following a routine hemodynamic evaluation in the catheter laboratory a TEE was conducted to measure in millimeters the location and size of the defect, as well as the distance from the defect to the upper pulmonary vein (upv), the tricuspid (TV) and mitral (MV) valves, and the superior (SVC) and inferior (IVC) cava veins. The residual shunt as well as complications were evaluated.Statistical Analysis: Statistical significance p < 0.05.Results: The ASD measured by TEE in short axis: X: 14.4 ± 4.53 mm (range: 7.4 ± 32), in 4-chamber view: X: 14.77 ± 5 mm (range: 6.5–33), in sagittal, at level of cava veins: X: 17.49 ± 10,29 mm (range: 6.5–38); balloon sizing: 18.3 ± 5.39 mm (range: 10–38); mean size of the device: 18.11 ± 5.57 mm (range 10–38). The distance from the upper edge to the upper pulmonary vein (upv): X: 9.11 ± 2.44 mm (range: 5.3–15); to tricuspid valve (T.V): X: 13.35 ± 3.17 mm (range: 6.5–19), mitral valve (M.V): X: 11.26 ± 2.36 (range: 7–14.4), left superior vena cava (SVC): X: 11.21 ± 2.83 mm (range: 6.2–16.9) and inferior vena cava (IVC): X: 10.21 ± 3.12 mm (range: 7–17.7). The Qp/Qs: 1.97 ± 0.45 (range: 1.25–3.5), pressure in RA: 5.79 ± 3 mmhg (range: 2–12), in LA: 7.42 ± 3.19 mmhg (range: 2–12); in RV: 33.82 ± 6.73 mmhg (24–50) and in pulmonary artery: 29.5 ± 5.92 mmhg (range 20–60), the wedge pressure X: 13.76 ± 3.92 mmhg (range: 9–25). The closure was effective in 137 of 134 cases (97.8 %); there were three embolizations: two defects with size in upper limit, and 1 accidental. These three were operated and the device was recovered, 1 died at 48 hours post-surgery. Residual shunts were found in 16 patients: 12 trivial, 4 light. Four remained permeable to another small ASD (3mm); 1patient had progressive mitral regurgitation and required mitral replacement. Ten patients had arrhythmia (2 with complete branch block, 2 with second degree block, 3 with supraventricular arrythmia, and 1 with sinusal tachycardia).Conclusion: Closure with the Amplatzer device was an effective procedure in 97.8% of the cases (137/134). During the procedure dangerous complications could take place (3 embolizations). The arrhythmias were not frequently in later evolution (10/137). Mortality was 0.72%. We still require further experience to be able to determine which procedure is best in each case.

Revista Argentina de Cardioangiología Intervencionista, 2016

Revista Argentina de Cardioangiología Intervencionista, 2012

La arteritis de Takayasu tiene diferentes formas de presentación con comorbilidades asociadas. Pr... more La arteritis de Takayasu tiene diferentes formas de presentación con comorbilidades asociadas. Presentamos el caso de una paciente con severa hipertensión arterial en miembros superiores que presentaba un síndrome de aorta media con coartación de aorta abdominal. Se realizó tratamiento con esteroides e inmunosupresores y para reducir la hipertensión se indicaron 3 antihipertensivos: enalapril, amlodipina y atenolol. Debido a que la hipertensión no podía ser controlada, se decidió realizar angioplastia de la coartación de aorta con colocación de un CP stent forrado con PTFE (politetrafl uoroetileno expandido). En la evolución a los 6 meses, la paciente redujo la hipertensión y continúa solo con atenolol. Palabras clave: arteritis de Takayasu, síndrome de aorta media, angioplastia con CP stent forrado, coartación de aorta abdominal.

World Journal for Pediatric and Congenital Heart Surgery, 2019

Patients with functionally single ventricle and interrupted inferior vena cava may develop progre... more Patients with functionally single ventricle and interrupted inferior vena cava may develop progressive cyanosis soon after the Kawashima operation. Therefore, early redirection of the hepatic venous return to the pulmonary circulation is recommended. To avoid performing an early redo sternotomy, we propose to prepare these patients for the interventional Fontan-Kreutzer at the time of the Kawashima operation using a technical modification of the approach reported by Prabhu and coworkers in 2017. The technique described here uses an expanded polytetrafluoroethylene conduit interposed between the hepatic veins and the right pulmonary artery. This graft is everted and divided into two portions with a pericardial patch. The lower one is widely opened and anastomosed side-to-side to the atrium. A few months after the operation, percutaneous Fontan-Kreutzer completion can easily be performed using covered stents to open the patch and at the same time close the opening between the conduit ...

Revista de la Facultad de Ciencias Medicas, 2020

Introducción: La hipertensión arterial (HTA) es una comorbilidad importante en niños con coartaci... more Introducción: La hipertensión arterial (HTA) es una comorbilidad importante en niños con coartación de aorta (COAO) y el monitoreo ambulatorio de presión arterial de 24horas (MAPA) permite un diagnóstico preciso. Objetivo: Describir la prevalencia de HTA por presión arterial (PA) en consultorio y su recategorización con MAPA Material y método: Estudio descriptivo, observacional, retrospectivo; incluyó niños entre 4y18 años con COAO que realizaron MAPA. Se registró PA en consultorio y MAPA, ecocardiograma y medicación. Resultados: 33 pacientes, 26 varones, edad 10,2 ± 3,8 años, Por PA en consultorio: 22 normotensos; 8 HTA controlada; 2 preHTA; 1 HTA no medicado. Con 32 registros completos de MAPA, se recategorizaron: normotensos 11, preHTA 7, HTA nocturna 3, HTA enmascarada 4; HTA controlada 3; HTA no controlada 3 y 1 HTA. Conclusión: La prevalencia de HTA en esta población en consultorio fue baja. El MAPA recategorizó y detectó HTA nocturna e HTA enmascarada.

Revista de ecocardiografía práctica y otras técnicas de imagen cardíaca, 2021

El canal atrioventricular disbalanceado puede ser una patología desafiante al momento de tomar un... more El canal atrioventricular disbalanceado puede ser una patología desafiante al momento de tomar una decisión quirúrgica, especialmente en los pacientes con moderada hipoplasia del ventrículo izquierdo. Es por ello que su abordaje es complejo y deben evaluarse anatómica y hemodinámicamente en forma completa y posiblemente con una modalidad multi-imagen. El presente trabajo brinda una actualización ecocardiográfica para la valoración del canal atrioventricular disbalanceado derecho, con el objetivo de dar al cardiólogo una herramienta para la toma de decisiones quirúrgicas frente a esta compleja patología.

World Journal for Pediatric and Congenital Heart Surgery, 2017

Scimitar syndrome repair represents a challenge due to the high incidence of postoperative pulmon... more Scimitar syndrome repair represents a challenge due to the high incidence of postoperative pulmonary venous obstruction associated with classic surgical strategies. In situ pericardial rerouting technique has been considered a promising alternative approach due to its simplicity and excellent midterm results. Access to the left atrium can be difficult in young patients with severe dextrocardia and hypoplastic right lung. We describe a modification of the original rerouting technique in which the atrial septum is repositioned in order to create a wide opening in the lateral aspect of the left atrium and ensure an adequate size of the reconstructed pathway.

Journal of Structural Heart Disease, 2018

Revista Argentina De Cardiologia, Jun 1, 2011

Catheterization and Cardiovascular Interventions, 2015

Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using con... more Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The Nit-Occlud(®) PDA-R trial can close a PDA up to 8 mm in diameter. We sought to report procedural and six-month efficacy and safety results of the multicenter Nit-Occlud(®) PDA-R trial. Methods: From June 2010 to February 2011, 43 patients were enrolled in 3 centers from Argentina. Median age was 4.5 (range 1.4 to 18.4 years) years old at catheterization, 70% were females and weight was 17.7 (range 10 to 67 kg). Results: PDAs mean diameter was 2.98±1.03 and ranged from 2 to 6.19 mm. 11.6% were large (≥4 mm), whereas 32.6% were <2.5 mm. Median pulmonary artery mean pressure was 17 mm Hg (range 9 to 26 mm Hg). The device was implanted successfully in all patients. By echocardiography, trivial residual shunt was observed in 42 % at the end of the procedure, in 28% at 24 hours, in 12.1% at one week and none at three-months. There was one case of embolization (due to undersizing), that was treated successfully with a larger study device. There were no major short or long-term complications. Conclusions: PDAs ranging from 2-6 mm can be effectively and safely closed using the Nit-Occlud(®) PDA-R device, with good procedural and six-month results. The Nit-Occlud(®) PDA-R emerges as an optimal alternative for closure of small to moderate PDAs. © 2013 Wiley Periodicals, Inc.

Argentine Journal of Cardiology, Sep 28, 2011

Cantrell s syndrome is characterized by: 1) Omphalocele 2) Sternal cleft 3) Anterior diaphragmati... more Cantrell s syndrome is characterized by: 1) Omphalocele 2) Sternal cleft 3) Anterior diaphragmatic hernia 4) Ectopia cordis 5) Intracardiac defects With an incidence of 5 to 8 cases per million of newborn babies, this syndrome is caused by mesodermal defects in early stages of the embrionary period. There are two ways of presentation: complete and incomplete. The incomplete way is when the heart is covered by skin, pericardium or both of them. In the complete way, the sternum is absent or it has a wide defect. There is no parietal pericardium and the heart is totally out of the thorax with its apex upwards and there is an important reduction in the size of the thoracic cavity. Generally, with omphalocele. 80% of the cases with incomplete way present congenital heart defect and in the complete way this percentage is 100%. Truncoconal abnormalities are the most usual. The studied case had interventricular communication (IVC) and the emergence of the great vessels was difficult to observe.

World Journal for Pediatric and Congenital Heart Surgery, 2021

Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approa... more Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.

Revista Brasileira de Fruticultura, 2014

Revista argentina de cardiología, 2011

Catheterization and Cardiovascular Interventions, 2013

Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using con... more Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The Nit-Occlud(®) PDA-R trial can close a PDA up to 8 mm in diameter. We sought to report procedural and six-month efficacy and safety results of the multicenter Nit-Occlud(®) PDA-R trial. Methods: From June 2010 to February 2011, 43 patients were enrolled in 3 centers from Argentina. Median age was 4.5 (range 1.4 to 18.4 years) years old at catheterization, 70% were females and weight was 17.7 (range 10 to 67 kg). Results: PDAs mean diameter was 2.98±1.03 and ranged from 2 to 6.19 mm. 11.6% were large (≥4 mm), whereas 32.6% were <2.5 mm. Median pulmonary artery mean pressure was 17 mm Hg (range 9 to 26 mm Hg). The device was implanted successfully in all patients. By echocardiography, trivial residual shunt was observed in 42 % at the end of the procedure, in 28% at 24 hours, in 12.1% at one week and none at three-months. There was one case of embolization (due to undersizing), that was treated successfully with a larger study device. There were no major short or long-term complications. Conclusions: PDAs ranging from 2-6 mm can be effectively and safely closed using the Nit-Occlud(®) PDA-R device, with good procedural and six-month results. The Nit-Occlud(®) PDA-R emerges as an optimal alternative for closure of small to moderate PDAs. © 2013 Wiley Periodicals, Inc.

Echocardiography, 2004

ABSTRACT Background: Follow-up in closing atrial septal defects (ASD) by transcatheter device, wi... more ABSTRACT Background: Follow-up in closing atrial septal defects (ASD) by transcatheter device, with TEE guidance.Methodology: In 137 patients with ASD ostium secundum (os) the mean (X) age of the patients was 8.78 years (range from 2 to 50 years). 120 patients with isolated defects, 12 with other small ASDs, 2 with fenestrated ASDs (fASD),1 patients had patent ductus arteriosus, 2 had ventricular Septal Defects (VSD). Following a routine hemodynamic evaluation in the catheter laboratory a TEE was conducted to measure in millimeters the location and size of the defect, as well as the distance from the defect to the upper pulmonary vein (upv), the tricuspid (TV) and mitral (MV) valves, and the superior (SVC) and inferior (IVC) cava veins. The residual shunt as well as complications were evaluated.Statistical Analysis: Statistical significance p < 0.05.Results: The ASD measured by TEE in short axis: X: 14.4 ± 4.53 mm (range: 7.4 ± 32), in 4-chamber view: X: 14.77 ± 5 mm (range: 6.5–33), in sagittal, at level of cava veins: X: 17.49 ± 10,29 mm (range: 6.5–38); balloon sizing: 18.3 ± 5.39 mm (range: 10–38); mean size of the device: 18.11 ± 5.57 mm (range 10–38). The distance from the upper edge to the upper pulmonary vein (upv): X: 9.11 ± 2.44 mm (range: 5.3–15); to tricuspid valve (T.V): X: 13.35 ± 3.17 mm (range: 6.5–19), mitral valve (M.V): X: 11.26 ± 2.36 (range: 7–14.4), left superior vena cava (SVC): X: 11.21 ± 2.83 mm (range: 6.2–16.9) and inferior vena cava (IVC): X: 10.21 ± 3.12 mm (range: 7–17.7). The Qp/Qs: 1.97 ± 0.45 (range: 1.25–3.5), pressure in RA: 5.79 ± 3 mmhg (range: 2–12), in LA: 7.42 ± 3.19 mmhg (range: 2–12); in RV: 33.82 ± 6.73 mmhg (24–50) and in pulmonary artery: 29.5 ± 5.92 mmhg (range 20–60), the wedge pressure X: 13.76 ± 3.92 mmhg (range: 9–25). The closure was effective in 137 of 134 cases (97.8 %); there were three embolizations: two defects with size in upper limit, and 1 accidental. These three were operated and the device was recovered, 1 died at 48 hours post-surgery. Residual shunts were found in 16 patients: 12 trivial, 4 light. Four remained permeable to another small ASD (3mm); 1patient had progressive mitral regurgitation and required mitral replacement. Ten patients had arrhythmia (2 with complete branch block, 2 with second degree block, 3 with supraventricular arrythmia, and 1 with sinusal tachycardia).Conclusion: Closure with the Amplatzer device was an effective procedure in 97.8% of the cases (137/134). During the procedure dangerous complications could take place (3 embolizations). The arrhythmias were not frequently in later evolution (10/137). Mortality was 0.72%. We still require further experience to be able to determine which procedure is best in each case.

Revista Argentina de Cardioangiología Intervencionista, 2016

Revista Argentina de Cardioangiología Intervencionista, 2012

La arteritis de Takayasu tiene diferentes formas de presentación con comorbilidades asociadas. Pr... more La arteritis de Takayasu tiene diferentes formas de presentación con comorbilidades asociadas. Presentamos el caso de una paciente con severa hipertensión arterial en miembros superiores que presentaba un síndrome de aorta media con coartación de aorta abdominal. Se realizó tratamiento con esteroides e inmunosupresores y para reducir la hipertensión se indicaron 3 antihipertensivos: enalapril, amlodipina y atenolol. Debido a que la hipertensión no podía ser controlada, se decidió realizar angioplastia de la coartación de aorta con colocación de un CP stent forrado con PTFE (politetrafl uoroetileno expandido). En la evolución a los 6 meses, la paciente redujo la hipertensión y continúa solo con atenolol. Palabras clave: arteritis de Takayasu, síndrome de aorta media, angioplastia con CP stent forrado, coartación de aorta abdominal.

World Journal for Pediatric and Congenital Heart Surgery, 2019

Patients with functionally single ventricle and interrupted inferior vena cava may develop progre... more Patients with functionally single ventricle and interrupted inferior vena cava may develop progressive cyanosis soon after the Kawashima operation. Therefore, early redirection of the hepatic venous return to the pulmonary circulation is recommended. To avoid performing an early redo sternotomy, we propose to prepare these patients for the interventional Fontan-Kreutzer at the time of the Kawashima operation using a technical modification of the approach reported by Prabhu and coworkers in 2017. The technique described here uses an expanded polytetrafluoroethylene conduit interposed between the hepatic veins and the right pulmonary artery. This graft is everted and divided into two portions with a pericardial patch. The lower one is widely opened and anastomosed side-to-side to the atrium. A few months after the operation, percutaneous Fontan-Kreutzer completion can easily be performed using covered stents to open the patch and at the same time close the opening between the conduit ...

Revista de la Facultad de Ciencias Medicas, 2020

Introducción: La hipertensión arterial (HTA) es una comorbilidad importante en niños con coartaci... more Introducción: La hipertensión arterial (HTA) es una comorbilidad importante en niños con coartación de aorta (COAO) y el monitoreo ambulatorio de presión arterial de 24horas (MAPA) permite un diagnóstico preciso. Objetivo: Describir la prevalencia de HTA por presión arterial (PA) en consultorio y su recategorización con MAPA Material y método: Estudio descriptivo, observacional, retrospectivo; incluyó niños entre 4y18 años con COAO que realizaron MAPA. Se registró PA en consultorio y MAPA, ecocardiograma y medicación. Resultados: 33 pacientes, 26 varones, edad 10,2 ± 3,8 años, Por PA en consultorio: 22 normotensos; 8 HTA controlada; 2 preHTA; 1 HTA no medicado. Con 32 registros completos de MAPA, se recategorizaron: normotensos 11, preHTA 7, HTA nocturna 3, HTA enmascarada 4; HTA controlada 3; HTA no controlada 3 y 1 HTA. Conclusión: La prevalencia de HTA en esta población en consultorio fue baja. El MAPA recategorizó y detectó HTA nocturna e HTA enmascarada.

Revista de ecocardiografía práctica y otras técnicas de imagen cardíaca, 2021

El canal atrioventricular disbalanceado puede ser una patología desafiante al momento de tomar un... more El canal atrioventricular disbalanceado puede ser una patología desafiante al momento de tomar una decisión quirúrgica, especialmente en los pacientes con moderada hipoplasia del ventrículo izquierdo. Es por ello que su abordaje es complejo y deben evaluarse anatómica y hemodinámicamente en forma completa y posiblemente con una modalidad multi-imagen. El presente trabajo brinda una actualización ecocardiográfica para la valoración del canal atrioventricular disbalanceado derecho, con el objetivo de dar al cardiólogo una herramienta para la toma de decisiones quirúrgicas frente a esta compleja patología.

World Journal for Pediatric and Congenital Heart Surgery, 2017

Scimitar syndrome repair represents a challenge due to the high incidence of postoperative pulmon... more Scimitar syndrome repair represents a challenge due to the high incidence of postoperative pulmonary venous obstruction associated with classic surgical strategies. In situ pericardial rerouting technique has been considered a promising alternative approach due to its simplicity and excellent midterm results. Access to the left atrium can be difficult in young patients with severe dextrocardia and hypoplastic right lung. We describe a modification of the original rerouting technique in which the atrial septum is repositioned in order to create a wide opening in the lateral aspect of the left atrium and ensure an adequate size of the reconstructed pathway.

Journal of Structural Heart Disease, 2018

Revista Argentina De Cardiologia, Jun 1, 2011

Catheterization and Cardiovascular Interventions, 2015

Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using con... more Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The Nit-Occlud(®) PDA-R trial can close a PDA up to 8 mm in diameter. We sought to report procedural and six-month efficacy and safety results of the multicenter Nit-Occlud(®) PDA-R trial. Methods: From June 2010 to February 2011, 43 patients were enrolled in 3 centers from Argentina. Median age was 4.5 (range 1.4 to 18.4 years) years old at catheterization, 70% were females and weight was 17.7 (range 10 to 67 kg). Results: PDAs mean diameter was 2.98±1.03 and ranged from 2 to 6.19 mm. 11.6% were large (≥4 mm), whereas 32.6% were <2.5 mm. Median pulmonary artery mean pressure was 17 mm Hg (range 9 to 26 mm Hg). The device was implanted successfully in all patients. By echocardiography, trivial residual shunt was observed in 42 % at the end of the procedure, in 28% at 24 hours, in 12.1% at one week and none at three-months. There was one case of embolization (due to undersizing), that was treated successfully with a larger study device. There were no major short or long-term complications. Conclusions: PDAs ranging from 2-6 mm can be effectively and safely closed using the Nit-Occlud(®) PDA-R device, with good procedural and six-month results. The Nit-Occlud(®) PDA-R emerges as an optimal alternative for closure of small to moderate PDAs. © 2013 Wiley Periodicals, Inc.

Argentine Journal of Cardiology, Sep 28, 2011

Cantrell s syndrome is characterized by: 1) Omphalocele 2) Sternal cleft 3) Anterior diaphragmati... more Cantrell s syndrome is characterized by: 1) Omphalocele 2) Sternal cleft 3) Anterior diaphragmatic hernia 4) Ectopia cordis 5) Intracardiac defects With an incidence of 5 to 8 cases per million of newborn babies, this syndrome is caused by mesodermal defects in early stages of the embrionary period. There are two ways of presentation: complete and incomplete. The incomplete way is when the heart is covered by skin, pericardium or both of them. In the complete way, the sternum is absent or it has a wide defect. There is no parietal pericardium and the heart is totally out of the thorax with its apex upwards and there is an important reduction in the size of the thoracic cavity. Generally, with omphalocele. 80% of the cases with incomplete way present congenital heart defect and in the complete way this percentage is 100%. Truncoconal abnormalities are the most usual. The studied case had interventricular communication (IVC) and the emergence of the great vessels was difficult to observe.

World Journal for Pediatric and Congenital Heart Surgery, 2021

Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approa... more Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.

Revista Brasileira de Fruticultura, 2014

Revista argentina de cardiología, 2011

Catheterization and Cardiovascular Interventions, 2013

Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using con... more Background: Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The Nit-Occlud(®) PDA-R trial can close a PDA up to 8 mm in diameter. We sought to report procedural and six-month efficacy and safety results of the multicenter Nit-Occlud(®) PDA-R trial. Methods: From June 2010 to February 2011, 43 patients were enrolled in 3 centers from Argentina. Median age was 4.5 (range 1.4 to 18.4 years) years old at catheterization, 70% were females and weight was 17.7 (range 10 to 67 kg). Results: PDAs mean diameter was 2.98±1.03 and ranged from 2 to 6.19 mm. 11.6% were large (≥4 mm), whereas 32.6% were <2.5 mm. Median pulmonary artery mean pressure was 17 mm Hg (range 9 to 26 mm Hg). The device was implanted successfully in all patients. By echocardiography, trivial residual shunt was observed in 42 % at the end of the procedure, in 28% at 24 hours, in 12.1% at one week and none at three-months. There was one case of embolization (due to undersizing), that was treated successfully with a larger study device. There were no major short or long-term complications. Conclusions: PDAs ranging from 2-6 mm can be effectively and safely closed using the Nit-Occlud(®) PDA-R device, with good procedural and six-month results. The Nit-Occlud(®) PDA-R emerges as an optimal alternative for closure of small to moderate PDAs. © 2013 Wiley Periodicals, Inc.