Transcatheter closure of patent ductus arteriosus with the Amplatzer Duct Occluder.

Background and methods: Percutaneous closure of a moderate-to-large sized p atent ductus arteriosus using multiple coils or a Rashkind double-umbrella may be technically demanding and raises a significant rate of embolization and residual shunting. This is why we tried a new self-expandable device ca lled Amplatzer Duct Occluder to close transvenously large ductuses in eight een patients at a median age of 2.8 years (range: 0.7 to 34). They had a pa tent ductus arteriosus with a minimal diameter >3 mm (mean: 5+/-2 mm). The device had a mean diameter of 9+/-2 mm and was delivered through a 6F venou s sheath. Aortography was done 5 to 10 minutes after the release and follow -up evaluation was performed with color Doppler echocardiography within 24 h, 1 and 3 to 6 months after the procedure. Results: Placement was successful in all but the first patient (95%). Compl ete closure was achieved immediately in 4/17 patients (24%) and in 13/17 (7 6%) 24 h later, live patients were lost for follow-up. Complete closure was confirmed in 14 of the 15 (93%) reviewed patients at 1 and 3 months. In al l patients with a ductal diameter less than or equal to 7.5 mm the closure was complete at 1 month. Embolization occurred in one patient with a 9.7 mm duct and surgery was undertaken. A mild and transient hematuria was observ ed in one patient. No pulmonary artery stenosis nor aortic obstruction were observed on follow-up. Conclusion: The Amplatzer Duct Occluder device offers a safe and effective option to treat patients with a ductus arteriosus which minimal diameter is up to 7.5 mm.