title: Percutaneous closure of patent ductus arteriosus in children using amplatzer duct occluder II: relationship between PDA type and risk of device protrusion into the descending aorta.
abstract: OBJECTIVE
  To compare the efficacy and safety of Amplatzer Duct Occluder II (ADOII) among the various patent ductus arteriosus (PDA) types, and to assess the association between development of aortic obstruction and the PDA type in terms of measurable parameters as the device angulation and distance of upper end protrusion into the aortic lumen.
  
  
  METHODS
  Retrospective cohort study involving 50 consecutive subjects who underwent ADO II device closure of PDA.
  
  
  RESULTS
  The median age and weight at intervention were 13 months (5.5 months to 18 years) and 11 (6-67) kg respectively. The median smallest ductal diameter by angiography was 3.2 (1.9-5.4) mm. Thirty two patients had type A PDA, 5 had type C, 5 had type D, and 8 had type E. Residual shunt was seen in only 1 patient who had a tubular PDA and resolved within 2 months of the procedure. No device embolization or pulmonary side protrusion were noted. There was a 16% aortic protrusion rate. The median distance of protrusion of the upper end of the device into the aortic lumen was 3.1 (0-9) mm and the median angle formed between the aortic end of the device and the PDA take-off was 10.4 (0-80.6) degrees. These latter parameters of aortic obstruction were significantly higher in the non-conical PDA group as compared to the conical PDA. Nevertheless, there was no significant coarctation due to aortic retention disc protrusion.
  
  
  CONCLUSIONS
  Device closure of PDA using the ADO II is a safe procedure for chosen types of PDA. We demonstrated a novel technique for objective assessment of device protrusion into the descending aorta based on measurable parameters. ADOII device closure of non-conical PDAs warrants closer follow ups.
authors.affiliation: Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon.
authors.forename: Samer
authors.initials: S
authors.lastname: Masri
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
authors.forename: Issam
authors.initials: I
authors.lastname: El Rassi
authors.affiliation: Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon.
authors.forename: Mariam
authors.initials: M
authors.lastname: Arabi
authors.affiliation: Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon.
authors.forename: Anas
authors.initials: A
authors.lastname: Tabbakh
authors.affiliation: Children's Heart Center, Division of Pediatric Cardiology, American University of Beirut-Medical Center, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: Bitar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: closure PDA; congenital heart disease; interventional devices; pediatric intervention