Long-term clinical experience with amplatzer ductal occluder II for closure of the persistent arterial duct in children

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Abstract

Objectives:

To describe the long-term clinical experience and follow-up with the Amplatzer Ductal Occluder II (ADO II) in children.

Methods:

All patients undergoing attempted transcatheter closure of patent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters.

Results:

From March 2008 until March 2013, 62 patients with a median age of 1.2 years (range 0.43–11.1 years) and median weight of 9 kg (range 4.7–31.4 kg) underwent the procedure. The median measurement for minimal ductal diameter was 2.7 mm (range 1.3–5 mm). An ADO II was implanted in 60 patients (96.8%). Two patients had significant residual shunting following deployment of the ADO II and underwent closure with the Amplatzer ductal occluder I (ADO I) during the same procedure. In six patients, the initial ADO II was unsatisfactory, and after recapture a different size ADO II was deployed. Device embolization of the ADO II to the pulmonary artery occurred in 6.7% of patients. Of these, one underwent surgical closure and three were closed with an ADO I. Complete occlusion on echocardiography was noted prior to discharge in 87.5% of the deployed occluders and 100% at first follow-up. Five year follow-up (n = 25) revealed a 100% occlusion rate. There were three cases of persistent mild left pulmonary artery stenosis at long-term follow-up.

Conclusions:

The ADO II is effective for occlusion of PDA with variable anatomy from either arterial or venous approaches with a low profile delivery system. Stable occluder position is highly dependent on accurate device sizing, good quality imaging to visualize device configuration after deployment and operator experience. © 2014 Wiley Periodicals, Inc.

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