The Amplatzer Duct Occluder II: a new device for percutaneous ductus arteriosus closure.
OBJECTIVE
Study the new Amplatzer Duct Occluder II (ADO II). Limitations were encountered with the preexisting devices in nonconical ducts, large ducts, or in small infants. These include failure, residual shunts, protrusion, migration, and vascular damage.


METHODS
Between June 2008 and March 2009, 20 consecutive patients were enrolled. In cases where different devices were applicable, we favored the use of the ADO II to maximize our experience with this device and prove its superiority. No coils were required in these 20 patients.


RESULTS
There were 15 females and 5 males (median age 2 years). ADO II group (n = 16): Immediate complete closure in 75% of the patients, rising to 93.7% at 24 hours. A residual shunt persisted at 3 months in one child. Aortic narrowing from device protrusion was noted in two type E ducts, without any significant gradient, however. ADO I group (n = 4): In two adolescents and in one adult patient, the duct was successfully closed. In a 2-year-old patient with a 6.6 mm type B duct, the ADO I totally obstructed the aortic flow and was retrieved before releasing. The child was sent for surgery.


CONCLUSIONS
Even though we did not compare the ADO II to other devices, we feel that it has the capacity to substitute most of the coils, and some of the original ADO I indications. Arterial access was sufficient in most patients, but venous delivery is advised in small infants with large or long ducts, to avoid aortic protrusion and residual shunts.
Saliba
Zakhia
Z
From the Saint Joseph University, Hotel-Dieu de France Hospital, Pediatric Cardiology & Cardiac Surgery, Beirut, Lebanon.
El-Rassi
Issam
I
Abi-Warde
Marie-Thérèse
MT
Chehab
Ghassan
G
Daou
Linda
L
Khater
Daniele
D
Gerbaka
Bernard
B
Jebara
Victor
V
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000601:surgery / Q000628:therapy*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D055989:Septal Occluder Device; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
D000925:Anticoagulants; D006493:Heparin