title: Treatment of congenital non-ductal shunt lesions with the amplatzer duct occluder II.
abstract: Amplatzer Duct Occluder II (ADO II) is especially designed for closing long ducts in infants. The experience with off-label use of ADO II in non-ductal positions is limited.
  
  
  OBJECTIVE
  To evaluate feasibility of use of ADO II in non-ductal positions, incidence of complete heart block (CHB), advantages and disadvantages.
  
  
  RESULTS
  Out of 79 defects closed with ADO II, 61 had perimembranous, 12 apical/mid-muscular ventricular septal defects (VSD), 4 Gerbode defects, one each of coronary arterio-venous fistula and aorto-right ventricular tunnel. Age ranged from 8 months to 21 years (mean 8.9 ± 4.02 years, median 9 years). The mean fluoroscopy time was 5.2 ± 1.1 min with range 4.2-9.2 min. Complete closure was achieved in all. Three cases developed transient junctional bradycardia, treated with steroids. One patient who developed CHB (1.3%) needed temporary pacing.
  
  
  CONCLUSIONS
  ADO II is a low profile device. It can be easily delivered through a 5F guiding catheter and needs very short fluoroscopic time as arteriovenous loop is not needed. The cost is 1/3 of regular ventricular septal occluders. The CHB that is a major challenge for closure of VSDs is less common with soft, specially designed ADO II, which does not compress the conducting system.
  
  
  CONCLUSIONS
  Use of the ADO II in non-ductal positions can be achieved with high success and low complication rates, especially CHB; its use is also associated with significantly reduced procedure time and device cost. Device size availability restricts use of the ADO II to defects up to 6 mm in diameter. © 2013 Wiley Periodicals, Inc.
authors.affiliation: Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
authors.forename: I B
authors.initials: IB
authors.lastname: Vijayalakshmi
authors.affiliation: Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
authors.forename: Chitra
authors.initials: C
authors.lastname: Narasimhan
authors.affiliation: Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Singh
authors.affiliation: Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
authors.forename: C N
authors.initials: CN
authors.lastname: Manjunath
mesh_terms: D000293:Adolescent; D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D005260:Female; D006327:Heart Block / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D012307:Risk Factors; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult
keywords: ADO II; Swiss cheese; VSDs; complete heart block; dextrocardia; noncompaction