Single‐center experience in percutaneous closure of arterial duct with Amplatzer duct Occluder II additional sizes

• Published in: Catheterization and cardiovascular interventions 2017-05, Vol.89 (6), p.1045-1050
• Main Authors: Mahmoud, Heba Talat, Santoro, Giuseppe, Gaio, Gianpiero, D'Aiello, Fabio Angelo, Capogrosso, Cristina, Palladino, Maria Teresa, Russo, Maria Giovanna
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aorta; Aortography; ASD/PDA/PFO; Body weight; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Child; Child, Preschool; closure; congenital heart disease; Ductus Arteriosus, Patent - diagnostic imaging; Ductus Arteriosus, Patent - physiopathology; Ductus Arteriosus, Patent - therapy; Female; Humans; Infant; Infant, Newborn; Italy; Male; Medical instruments; Mercury; Middle Aged; Morbidity; Neurodegenerative diseases; Occlusion; pediatric intervention; pediatrics; Pressure; Pressure ratio; Prosthesis Design; Pulmonary arteries; Pulmonary artery; Septal Occluder Device; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26860

Objectives This study aimed to report a large, single‐center experience of percutaneous arterial duct (AD) closure using Amplatzer Duct Occluder II Additional Sizes device (ADO II‐AS)(St. Jude Medical Corp, St. Paul, MN, USA). Background Transcatheter closure of AD remains challenging in low body weight patients and those who have a persisting shunt following a previous attempt at interventional closure. Recent technical advances in device design may address these issues. Methods From May 2011 to April 2016, 109 patients underwent attempted percutaneous closure of AD with ADO II‐AS at our Institution. Mean age and weight were 4.8 ± 8.1 years (range 0‐48) and 21.4 ± 20.6 kg (range 3‐93), respectively. Fifteen patients (13.8%) were ≤6 kg (age 3.5 ± 2.0 months; weight 4.7 ± 1.1 kg). Arterial duct morphology was type A in 62 (57%), type B in 1 (1%), type C in 32 (29%), type D in 7 (6%) and type E in 6 patients (6%), respectively. Arterial approach was used to negotiate and deploy the occluding device in 103 patients (94.5%). Results AD diameter was 2.2 ± 0.6 (range 1.5–4.5) resulting in QP/QS of 1.9 ± 0.7 (range 1‐3.3). Mean pulmonary artery pressure and PA/aortic pressure ratio were 19.3 ± 5.0 mm Hg (range 12‐38) and 0.34 ± 0.14 (range 0.14‐0.95), respectively. Successful device deployment was achieved in 107 patients (98.2%). Neither procedural morbidity nor mortality was recorded. Immediate, 24h and mid‐term (30 ± 17 months) complete occlusion was recorded in 71%, 98.1%, and 100% of patients, respectively. Conclusion In our experience, trans‐catheter closure of AD of different sizes and morphologies using ADO II‐AS is highly feasible, safe and effective also in challenging anatomic/clinical settings. © 2016 Wiley Periodicals, Inc.