Conclusions-It appears feasible to close interatrial communications and atrial septal defects up to 26 mm stretched diameter safely with the Amplatzer septal occluder. Short term results confirm an early high occlusion rate with no major complications. Careful selection of cases based on the echocardiographic morphology of the ASD and accurate assessment of their stretched diameter is of utmost importance. Further experience with the larger devices and longer term results are required before a firm conclusion regarding its use can be made. (Heart 1999;82:300-306)

Objective-To assess the possibility of maintaining ductal patency in neonates with complex pulmonary atresia by percutaneous implantation of balloon expandable stents.Patients-Two duct-dependent neonates with long segment pulmonary atresia, right sided aortic arch, and left sided arterial duct.Results-Stents with final diameter of 3 5 or 4 mm and initial length of 7 or 15 mm were successfully positioned in the arterial duct. Two stents were required in one child and four in the other in order to stent the entire length of the duct. After dependent congenital heart disease has not, however, been attempted. We report the successful maintenance of ductal patency by implantation of expandable stainless steel stents. The technical procedure (performed in each case under general anaesthesia), its potential complications, and its very considerable future promise in the palliation of duct dependent congenital heart disease are discussed. Patients and methods CASE 1A 2-6 kg boy presented with cyanosis and a soft continuous murmur when he was four hours old. He had an extensive cleft lip and palate and a bifid right thumb. Echocardiography and later cardiac catheterisation and angiography showed severe hypoplasia of the right ventricle and tricuspid valve with an intact ventricular septum, right ventricular sinusoids, long segment pulmonary atresia, small but confluent pulmonary arteries, a right sided aortic arch, and a left sided arterial duct arising at the origin of the left subclavian artery. He was maintained on an infusion of prostaglandin E and at the age of five days underwent a Waterston aortopulmonary anastomosis. The right pulmonary artery was found to be approximately 2-5 mm in diameter behind the ascending aorta. Postoperatively the child remained duct dependent. Angiography showed that the shunt was completely occluded. In view of the failed attempt at surgical palliation and with informed consent from the child's parents, we believed the alternative approach of stenting the arterial duct was justified.