How Your Doctor Will Implant the Duct Occluder

What to expect before, during and after the procedure will vary. Discuss any questions or concerns you have with your doctor.

1. The procedure will be performed in the heart catheterization laboratory, or "cath lab." The patient lies on an x-ray table, and an x-ray camera will be used to see the area during the procedure. The staff will monitor heart function using an Electrocardiogram (ECG). During an ECG, electrical sensing devices, called electrodes or leads, are placed on the skin over the heart and at other sites on the chest and limbs. The Electrocardiogram is painless and there is no danger of electrical shock. The ECG helps to evaluate both the heart rate – the number of beats per minute – and the flow of electrical impulses through the heart muscle. The procedure should take about 1-2 hours.

2. The doctor will administer an anesthetic. It may be general or local. This will depend on the technique the doctor uses to place the device. There should not be significant discomfort.

3. Catheter introduction into the groin is most common and requires a small incision to be made on the inside of the upper thigh. This incision will allow an introducer sheath to be inserted into the femoral vein or artery. The doctor will then insert a guiding catheter into the introducer sheath and advance it until it reaches the PDA in the heart. Another option for catheter introduction is the arm (or brachial) approach. A small incision is made on the inside of the elbow. (Figure 1). The doctor will perform a procedure (angiogram) to visualize the PDA.

4. The doctor will then measure the pressure and oxygen content in different chambers of the heart and measure the size of the PDA.

5. The appropriate size AMPLATZER Duct Occluder is screwed onto an AMPLATZER Delivery Cable.

6. The Duct Occluder and the cable are put into a special catheter and advanced through the PDA. The PDA Occluder is partially expanded, then pulled back into the PDA. (Figure 2 and 3).

7. Your doctor will then push the device out of the catheter and implant the AMPLATZER Duct Occluder in the PDA (Figure 3).

8. Your doctor carefully studies the device's position in your heart. When your doctor is satisfied with the device position, the device is released by unscrewing the cable that was used to slide it through the catheter. The AMPLATZER Duct Occluder is now implanted in your heart. (Figure 4)

9. The catheter is removed and the procedure is completed.

What To Expect After The Procedure
After the procedure, blood pressure will be checked frequently, and the patient may be attached to an ECG monitor so that heart function can be monitored continuously. A nurse will check the site where the catheter was inserted as well as the pulses in the feet and arms.

After recovery from anesthesia and bed rest, you should be able to sit up and walk about. The patient may be able to go home that day or stay one night in the hospital. Before leaving the hospital, a chest x-ray and/or echocardiogram will be performed to make sure the device is still positioned properly.

Because the procedure is less invasive than open-heart surgery, recovery should be easier. An adhesive bandage on the catheter insertion site (groin or arm) may be in place for several days after the procedure.

Before leaving the hospital, the doctor will provide guidelines for activities and prescribe medications.

Aspirin will be required every day for the next 6 months. Antibiotics will also be required for prevention of heart infection ( endocarditis prophylaxis ) for certain medical procedures like dental work performed after the Occluder placement. Ask the doctor which procedures require you to take endocarditis prophylaxis. The decision to continue taking aspirin and endocarditis prophylaxis beyond 6 months is at the discretion of the doctor.

It is important to keep all follow-up appointments that are scheduled. Patients will return to the doctor for periodic follow-up visits over the next year.