Transcatheter closure of patent ductus arteriosus (PDA) by Amplatzer duct occluder is the treatment of choice. However, closure of very large ducts in infants with low weight is a challenge for the interventionalist because a large device may obstruct the aorta or left pulmonary artery. Difficulty is also encountered in advancing the device around the curve of the right ventricular outflow tract toward the pulmonary artery; this curve is tight, more or less at a right angle in infants, leading to kinking of the sheath, which increases fluoroscopic time. This is the first reported case of a very large PDA (8.7 mm), larger than the aorta (8.2 mm), successfully closed by an Amplatzer angled duct occluder in an infant weighing 5 kg.
T RANSCATHETER OCCLUSION OF SMALL ARTERIAL ducts, of less than 4 millimetres in diameter, and closure of larger ducts with devices, have now become accepted as attractive alternatives to surgery. Indeed, interventional closure has become the treatment of choice in most of the patients now born with patency of the arterial duct. 1,2 Despite the tremendous improvements in technique and hardware available, closing large ducts in very sick and underweight infants remains a challenge for paediatric interventionists. This is because bigger devices require larger delivery sheaths, and carry the risk of possible obstruction to aorta and left pulmonary artery. 3,4 Moreover, negotiating a large device around the curve of the right ventricular outflow tract and through the pulmonary trunk, which is very tight and at right angles in infants, is difficult or impossible, the sheath becoming kinked and thereby increasing the procedural and fluoroscopic time. This subset of patients with very large tubular ducts, typically weighing less than 5 kilograms, in left ventricular Initial clinical experience in transcatheter closure of large patent arterial ducts in infants using the modified and angled Amplatzer duct occluder
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