Early clinical experience with the new Amplatzer Ductal Occluder II for closure of the persistent arterial duct.
OBJECTIVE
To describe the early single-center clinical experience with the Amplatzer Ductal Occluder II (ADO II).


METHODS
All patients undergoing attempted transcatheter closure of persistent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters.


RESULTS
From March until September 2008, 29 procedures were undertaken in 27 patients (21 female). Median age was 1.4 years (range 0.4-76 years) with median weight 9.4 kg (range 4.7-108 kg). A transarterial approach was used in 2 patients. The median minimum ductal diameter was 2.7 mm (range 1.7-5). ADO II was released in 25 patients (92.5%). Two patients had significant residual shunting following deployment of ADO II and underwent closure with Amplatzer ductal occluder (ADO I). Postprocedural echocardiography identified one occluder had changed position with development of a significant leak and one occluder had embolized to the left pulmonary artery. Both occluders were retrieved successfully at a second catheter procedure. Complete occlusion was noted predischarge in 22 of the remaining 23 occluders (96%). One patient had mild flow acceleration in the left pulmonary artery which has resolved.


CONCLUSIONS
The ADO II is highly effective at providing rapid occlusion of morphologically varied PDAs. Occluder design allows closure with arterial or venous approach and delivery with 4 or 5 F delivery catheters. Stable occluder position is dependent on correct positioning of both aortic and pulmonary discs. A larger range of sizes and configurations of this occluder may be required to successfully occlude all ductal sizes and morphologies.
Bristol Congenital Heart Centre, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK.
Jonathan
J
Forsey
Damien
D
Kenny
Gareth
G
Morgan
Alison
A
Hayes
Mark
M
Turner
Andrew
A
Tometzki
Robin
R
Martin
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome; D014463:Ultrasonography