Use of the Amplatzer Vascular Plug II Device to Occlude Different Types of Patent Ductus Arteriosus in Pediatric Patients

Abstract

IntroductionTranscatheter patent ductus arteriosus (PDA) closure is difficult in small patients in part due to the diverse PDA morphology. We describe a multicenter pediatric experience using the Amplatzer Vascular Plug II device (AVP II) to occlude PDA.

MethodsAll patients undergoing transcatheter closure of PDA with AVP II from April 2008 until May 2012 were included. Clinical, angiographic, and echocardiographic data were collected.

ResultsOne hundred and seventy-seven procedures were performed. Median age was 14 months (2-180) with median weight 9.7kg (4.7-68). The morphological PDA classification was Type A in 66 (37.1%), Type C in 27 (15.3%), Type D in 17 (9.6%), and Type E in 67 (37.9%). The median minimum PDA diameter was 2.6mm (1.2-7.7mm). The implanted device sizes were: 4mm in 17 patients (9.6%), 6mm in 81 (45.8%), 8mm in 56 (31.6%), 10mm in 18 (10.2%), and 12mm in 5 (2.8%). The implanted device was mean of 2.6+0.7 times the ductus narrowest diameter and mean of 1+0.5 times the ductus largest diameter. Complications included: one severe left pulmonary artery stenosis and one device embolization. No aortic obstruction occurred. Closure was complete in the 175 remaining patients.

ConclusionsThe AVP II is an effective and safe device for PDA closure. It is particularly useful when dealing with nontypical PDA shapes and in small infants where it eliminated the risk of device-related aortic obstruction. The AVPII is an addition to the PDA device closure armamentarium in pediatric patients.