title: Closure of large patent ductus arteriosus using the Amplatzer Septal Occluder.
abstract: BACKGROUND
  Percutaneous closure of patent ductus arteriosus has become the treatment of choice in many centres. In patients with large ducts and pulmonary hypertension, transcatheter closure has been achieved with success using the Amplatzer Duct Occluder or even the Amplatzer Muscular Ventricular Septal Defect Occluder.
  
  
  METHODS
  We present a series of 17 patients with large and hypertensive ductus arteriosus who were treated with an Amplatzer Septal Occluder. The group had 11 female patients (64.7%) and a mean age of 18.6±12.1 years.
  
  
  RESULTS
  The haemodynamic and anatomical data are as follows: pulmonary artery systolic pressure 71.3±31.8 mmHg, pulmonary to systemic flow ratio 3.14±1.36, ductal diameter at the pulmonary end 12.5±3.8 mm, and at the aortic end 20.2±7.7 mm; 14 cases (82.3%) had type A ducts. In 11 patients, we began the procedure using a different device - six with duct occluder and five with ventricular septal occluder - and it was changed because of device embolisation in six (35.3%). All septal occluders were delivered successfully. Residual shunt was moderate in six patients (35.3%), mild in eight (47%), trivial in two (11.8%), and no shunt in one (5.9%). Pulmonary systolic pressure decreased to 48.9±10.8 mmHg after occlusion (p=0.0015). Follow-up in 15 patients (88.2%) for 28.4±14.4 months showed complete closure in all cases but one, and continuous decrease of the pulmonary systolic pressure to 31.4±10.5 mmHg. No complications at follow-up have been reported.
  
  
  CONCLUSIONS
  The Amplatzer Septal Occluder is a good alternative to percutaneously treat large and hypertensive ductus arteriosus.
authors.affiliation: 1Department of Interventional Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: José A
authors.initials: JA
authors.lastname: García-Montes
authors.affiliation: 1Department of Interventional Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: Anahí
authors.initials: A
authors.lastname: Camacho-Castro
authors.affiliation: 1Department of Interventional Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Sandoval-Jones
authors.affiliation: 2Department of Pediatric Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Buendía-Hernández
authors.affiliation: 2Department of Pediatric Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Calderón-Colmenero
authors.affiliation: 2Department of Pediatric Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: Emilia
authors.initials: E
authors.lastname: Patiño-Bahena
authors.affiliation: 1Department of Interventional Cardiology,National Institute of Cardiology "Ignacio Chavez",Mexico City,Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zabal
mesh_terms: D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000628:therapy*; D008297:Male; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult
keywords: pulmonary arterial hypertension