title: Further experience with transcatheter closure of the patent ductus arteriosus using the Amplatzer duct occluder.
abstract: OBJECTIVE
  The aim of this study was to report further experience with transcatheter closure of the patent ductus arteriosus (PDA) using the Amplatzer duct occluder (ADO).
  
  
  BACKGROUND
  The design of previously used devices is not ideal for this purpose, and their use has been associated with several drawbacks, especially in large PDAs.
  
  
  METHODS
  Forty-three patients, aged 0.3 to 33 years (mean 6.4+/-6.7 years), with a moderate to large, type A to E PDA, underwent attempted transcatheter closure using the ADO. The device is a plug-shaped repositionable occluder made of 0.004-in. nitinol wire mesh. It is delivered through a 5F to 6F long sheath. The mean PDA diameter (at the pulmonary end) was 3.9+/-1.2 mm (range 2.2 to 8 mm). All patients had color flow echocardiographic follow-up (6 to 24 months) at 24 h, 1 and 3 months after closure, and at 6-month intervals thereafter.
  
  
  RESULTS
  The mean ADO diameter was 6.1+/-1.4 mm (range 4 to 10 mm). Complete angiographic closure was seen in 40 of 43 patients (93%; 95% confidence interval [CI] 85.4% to 100%). The remaining three patients had a trivial angiographic shunt through the ADO. At 24 h, color flow mapping revealed no shunt in all patients. A 9F long sheath was required for repositioning of a misplaced 8-mm device into the pulmonary artery. The mean fluoroscopy time was 7.9+/-1.6 min (range 4.6 to 12 min). There were no complications. No obstruction of the descending aorta or the pulmonary artery branches was noted on Doppler follow-up studies. Neither thromboembolization nor hemolysis or device failure was encountered.
  
  
  CONCLUSIONS
  Transcatheter closure using the ADO is an effective and safe therapy for the majority of patients with patency of the arterial duct. Further studies are required to establish long-term results in a larger patient population.
authors.affiliation: Department of Pediatric Cardiology, Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: B D
authors.initials: BD
authors.lastname: Thanopoulos
authors.forename: F A
authors.initials: FA
authors.lastname: Hakim
authors.forename: A
authors.initials: A
authors.lastname: Hiari
authors.forename: Y
authors.initials: Y
authors.lastname: Goussous
authors.forename: E
authors.initials: E
authors.lastname: Basta
authors.forename: A A
authors.initials: AA
authors.lastname: Zarayelyan
authors.forename: G S
authors.initials: GS
authors.lastname: Tsaousis
mesh_terms: D000293:Adolescent; D000328:Adult; D000497:Alloys; D001027:Aortography; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019233:Retreatment
chemical_list: D000497:Alloys; C013616:nitinol