Front-loading of double-umbrella devices, a new technique for umbrella delivery for closing cardiovascular defects.

In all, 22 defects (6 atrial septal, 13 ventricular septal, 2 patent ductus arteriosus and 1 coronary artery fistula) in 17 patients were closed with double umbrella using a new delivery technique, front-loading. The umbrella was loaded in the sheath outside the body and then advanced with-out use of the rigid pod to the defect. The defect was successfully closed in all 17 patients, including 5 in whom standard delivery techniques were unsuccessful. Front-loading enables the double umbrella to be delivered through a smaller long sheath than does the standard technique, and enables the flexible umbrella rather than the rigid pod to be advanced through curves in the sheath, and may improve delivery of double-umbrella devices to inaccessible parts of the circulation.