case_images: PMC5965010_01
case_images: (a) Left lateral 90  view showing the "end-on" orientation and improper profiling of the patent ductus arteriosus. (b) Right anterior oblique 40  view showing the separation of the patent ductus arteriosus from the aortic shadow. (c) Right anterior oblique 40  view showing the Tiger  catheter hooking the aortic end of patent ductus arteriosus. (d) Anteroposterior view showing the exchange length Terumo wire which was snared from the venous side. (e and f) Right anterior oblique 40  view in which a 6 mm x 8 mm Cocoon duct occluder was placed antegradely and released
case_images: HV-19-20-g001.jpg
case_images: PMC5965010_01_HV-19-20-g001.jpg
case_images: F1
case_images: The patent ductus arteriosus was foreshortened because of the "end-on" orientation in the left lateral 90  view [Figure 1a]. However, the right anterior oblique 40  view [Figure 1b] was helpful in separating the patent ductus arteriosus from the aortic shadow and thus, proper profiling of the patent ductus arteriosus. We opted for the retrograde approach where in the right anterior oblique 40  view, following failed attempts with a Judkins right 3.5, a multipurpose catheter, left internal mammary catheter, Amplatz left and right catheters, we used an Optitorque TIG catheter; Tiger  catheter (Terumo, Japan) to hook the aortic end of patent ductus arteriosus [Figure 1c]. In the anteroposterior view, 0.035" exchange length Terumo wire was snared from the venous side with a Gooseneck snare [Figure 1d]. There seemed to be a significant protrusion of the device into the aorta. The right anterior oblique 40  view [Figure 1e and 1f] revealed a more assured position of the device and the device was released in the same view.