title: Initial experience and sizing considerations using the three lobed amplatzer ductal occluder.
abstract: BACKGROUND
  The recently released Amplatzer Ductal Occluder 2 (ADO2) was designed specifically for use in small children with moderate-sized shunts and larger children with small patent ductus arterioses (PDA). We report our initial experience with this device.
  
  
  METHODS
  Patients referred with PDA underwent occlusion using the ADO2. This is a fabric-free nitinol wire 3-lobed device. All cases underwent pre-, intra- and post-procedural echocardiography, with follow up at 1 day and one month. Device sizing for device waist diameter and width was based on aortography.
  
  
  RESULTS
  Seven patients with a median age of 3 years and 4 months (range 7 months-23 years) and a median weight of 12 kg (range 7-56 kg) underwent successful PDA closure. The median ductal diameter was 1.5 mm (range 0.4-4 mm). Both transpulmonary (6/7) and transaortic approaches (1/7) were used. Recurrent patency at 24 hours with complete occlusion at 1 month was noted in a single case. A specific device-based length assessment applied resulted in shorter than recommended device selection.
  
  
  CONCLUSIONS
  The ADO2 broadens the spectrum of PDAs that can be simply and safely treated with devices. The flexibility of the articulations, coupled with the alternative deployment techniques, allow for increased ease of treatment in a range of small patients and specific ductal anatomies. An alternative device-specific length measurement of the duct length may result in less retaining disc protrusion. Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.
authors.affiliation: Director of Experimental Cardiology, Shaare Zedek Medical Center, POB 3235, Jerusalem, Israel. meerkin@SZMC.org.il
authors.forename: David
authors.initials: D
authors.lastname: Meerkin
authors.forename: Benjamin
authors.initials: B
authors.lastname: Farber
authors.forename: Amiram
authors.initials: A
authors.lastname: Nir
mesh_terms: D000497:Alloys; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000601:surgery*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012008:Recurrence; D019233:Retreatment; D055989:Septal Occluder Device; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000497:Alloys; C013616:nitinol