BACKGROUND: Several devices have been used for transcatheter closure of Patent Ductus Arteriosus (PDA), with varying degrees of success. Among them, the Amplatzer Duct OccluderTM (ADO) is now widely used due to ease of use, safety and efficacy to close almost all types of PDAs. The authors present their experience with this device and discuss its features, technical aspects of the implant and results obtained. METHODS: From April 1999 to December 2006, 116 patients were subsequently submitted to transcatheter occlusion. Out of those, 91 (64F:27M) were selected for occlusion with the ADO. Implants were performed as described elsewhere, in most cases. Pulmonary extremity was dilated with coronary balloon catheters in smallest ductuses. All cases were selected based on previous transthoracic echos with color flow mapping (TTE). Follow-up was carried out through immediate, 1m, 3m, 6m and 12m TTE. RESULTS: Ages ranged from 2 to 600 months (87.0±116.4mo) and weight from 4 to 88 kg (23.8±19.1 kg). Mean PDA diameter was 3.0 ± 1.8mm (ranging 0.5 to 11mm). Morphology of PDA was assessed, according to Krichenko's classification, and was of type A in 58 patients (64%), type C in 6 patients (7%), type D in 2 patients (2%) and type E in 25 patients (27%). No type B PDAs were found in our series. Devices were successfully implanted in 90 patients. Type of devices used were PDA occluder 5-4 in 4 cases (4%), 6-4 in 34 cases (37%), 8-6 in 33 cases (36%), 10-8 in 16 cases (18%), 12-10 in 3 cases (3%). In a 50 year-old female patient with severe pulmonary hypertension, a 12mm Muscular VSD Occluder device was successfully implanted. In only one patient the implant was not achieved because of defective screwing mechanism that caused inadvertent release of the device in the descending aorta. Defect was closed and the device retrieved surgically, with no further complications. There was total occlusion in all other cases, as of 1-month follow-up TTE. All ductuses remained closed thereafter. No major complications or procedure-related deaths were observed. CONCLUSIONS: The Amplatzer Duct Occluder has proven to be user-friendly, safe and effective for transcatheter PDA closure. Based on our own experience and that of others, we suggest that it should become the method of choice for percutaneous PDA occlusion in ductuses of suitable anatomy.
Ductus arteriosus, patent; Heart catheterization; Prostheses and implants; Heart defects, congenital
