Protrusion of the Amplatzer duct occluder (ADO) II device into the aortic isthmus or the pulmonary artery causing obstruction and residual flow has been reported, but the same has not been widely studied in small children with a patent ductus arteriosus (PDA) anatomy not considered suitable for closure with the ADO I device. This study aimed to report the safety and efficacy of the ADO II device in children younger than 3 years with a tubular or elongated PDA and to analyze the possible reasons for residual flow in children with such a PDA. In this study, 17 children younger than 3 years (mean age, 10.3 ± 7 months; mean weight, 6 ± 3.6 kg) underwent attempted closure of a tubular or elongated PDA (mean diameter at the narrowest point, 4.1 ± 1.1 mm) with the ADO II device between July 2010 and July 2012. Of the 17 patients, 16 (2 boys and 14 girls) completed the follow-up evaluation. A complete echocardiographic evaluation was performed on all the patients before PDA closure and at the follow-up visit, and the results were compared with those of previous published studies. Of the 16 patients, the 15 who completed the follow-up evaluation had successful device closure (1 device embolization). Residual flow was present in six patients immediately after deployment, which was reduced to three patients at the last follow-up visit. Five of nine patients closed with a 6-mm-long device had residual flow compared with only one of seven patients closed with a 4-mm-long device. After device closure, significant elevations of the left and right pulmonary artery velocities occurred in three and two patients, respectively; in 12 patients, descending thoracic aortic (DTA) velocities increased mildly. There was trend toward a fall in the elevated pressures at the last follow-up visit, although one patient had an elevation in right pulmonary artery velocity at last the follow-up echocardiogram compared with the echocardiogram immediately after closure. Hence, in children younger than 3 years with or without pulmonary arterial hypertension, closure of a PDA not amenable to closure with the ADO I device is feasible using the ADO II device, with an increased incidence of clinically nonsignificant complications. Selection of device dimensions according to the manufacturer’s recommendation may not be the optimal strategy.
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Abadira S, Boudjemlineb Y, Reyc C et al (2009) Significant persistent ductus arteriosus in infants less or equal to 6 kg: percutaneous closure or surgery? Arch Cardiovasc Dis 102:533–540
Al Hamash SM, Wahab HA (2012) Transcatheter closure of patent ductus arteriosus using ADO device: retrospective study of 149 patients. Heart Views 13:1–6
Bhole V, Miller P, Mehta C, Stumper O, Reinhardt Z, De Giovanni JV (2009) Clinical evaluation of the new Amplatzer duct occluder II for patent arterial duct occlusion. Catheter Cardiovasc Interv 74:762–769
Bilkis AA, Alwi M, Hasri S et al (2001) The Amplatzer duct occluder experience in 209 patients. J Am Coll Cardiol 37:258–261
Brunetti MA, Ringel R, Owada C, Coulson J, Jennings JM, Hoyer MH, Everett AD (2010) Percutaneous closure of patent ductus arteriosus: a multiinstitutional registry comparing multiple devices. Catheter Cardiovasc Interv 76:696–702
Duke C, Chan KC (1999) Aortic obstruction caused by device occlusion of patent arterial duct. Heart 82:109–111
Forsey J, Kenny D, Morgan G, Hayes A et al (2009) Early clinical experience with the new Amplatzer Ductal Occluder II for closure of the persistent arterial duct. Catheter Cardiovasc Interv 74:615–623
Ghasemi A, Pandya S, Reddy SV, Turner DR, Du W, Navabi MA, Mirzaaghayan MR, Kiani A, Sloan K, Forbes TJ (2010) Transcatheter closure of patent ductus arteriosus: what is the best device? Catheter Cardiovasc Interv 76:687–695
Javois AJ, Husayni TS, Thoele D et al (2006) Inadvertent stenting of patent ductus arteriosus with Amplatzer vascular plug. Catheter Cardiovasc Interv 67:485–489
Krichenko A, Benson LN, Burrows P et al (1989) Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 67:877–880
Kuo HC, Ko SF, Wu YT, Huang CF, Chien SJ, Tiao MM, Liang CD (2005) Obstruction of the aorta and left pulmonary artery after Gianturco coil occlusion of patent ductus arteriosus. Cardiovasc Interv Radiol 28:124–126
Masura J, Gavora P, Podnar T (2003) Transcatheter occlusion of patent ductus arteriosus using a new angled Amplatzer duct occluder: initial clinical experience. Catheter Cardiovasc Interv 58:261–267
Morgan SG, Tometzki AJ, Martin RP (2009) Transcatheter closure of long tubular patent arterial ducts: the Amplatzer Duct Occluder II: a new and valuable tool. Catheter Cardiovasc Interv 73:576–580
Porstmann W, Wierny L, Warnke H, Gerstberger G, Romaniuk PA (1971) Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy. Radiol Clin North Am 9:203–218
Schwartz M, Glatz AC, Rome JJ, Gillespie MJ (2010) The Amplatzer vascular plug and Amplatzer vascular plug II for vascular occlusion procedures in 50 patients with congenital cardiovascular disease. Catheter Cardiovasc Interv 76:411–417
Thanopoulos BD, Eleftherakis N, Tzannos K, Stefanadis C (2008) Transcatheter closure of the patent ductus arteriosus using the new Amplatzer duct occluder: initial clinical applications in children. Am Heart J 156:917.e1–917.e6
Thanopoulos BV, Eleftherakis N, Tzannos K, Stefanadis C, Giannopoulos A (2010) Further experience with catheter closure of patent ductus arteriosus using the new Amplatzer duct occlude in children. Am J Cardiol 105:1005–1009
Venczelova Z, Tittel P, Masura J (2011) The new Amplatzer duct occluder II: when is its use advantageous? Cardiol Young 21:1–10
Wang JK, Hwang JJ, Chiang FT, Wu MH, Lin MT, Lee WL, Lue HC (2006) A strategic approach to transcatheter closure of patent ductus: Gianturco coils for small-to-moderate ductus and Amplatzer duct occluder for large ductus. Int J Cardiol 106:10–15
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Kumar, S.M., Subramanian, V., Bijulal, S. et al. Percutaneous Closure of a Moderate to Large Tubular or Elongated Patent Ductus Arteriosus in Children Younger Than 3 Years: Is the ADO II Appropriate?. Pediatr Cardiol 34, 1661–1667 (2013) doi:10.1007/s00246-013-0700-x
- ADO II device
- DTA obstruction
- LPA obstruction
- Tubular PDA