Transcatheter closure of a 16 mm hypertensive patent ductus arteriosus with the Amplatzer muscular VSD occluder

Abstract

There is little experience with transcatheter closure of very large, hypertensive patent ductus arteriosus. We present a case of successful closure of a 16 mm ductus with the Amplatzer VSD occluder, a device originally designed for transcatheter closure of congenital muscular ventricular septal defects. To our best knowledge this is the largest ductus ever closed by an interventional technique.

Transcatheter closure of hypertensive ductus with amplatzer post infarction muscular VSD occluder after percutaneous retrieval of embolized amplatzer duct occluder

“…Except for one large series[2] and another smaller one,[3] both from China, there are only anecdotal case reports. [4] Overall, embolization of the device is a rare complication — an incidence of only 0.5% being reported in the multicenter series of 439 patients mentioned earlier in this article. Factors predisposing to embolization include an inappropriately small device size, significant pulmonary hypertension, and ‘abnormally’ shaped ducts.…”

Transcatheter closure of a 22 mm patent ductus arteriosus with an Amplatzer atrial septal occluder

“…However, few cases of percutaneous closure of PDAs this size with off-label use of devices designed for closure of different congenital defects such as the Amplatzer muscular ventricular defect occluder have been described [4,5]. We report the successful transcatheter closure of a PDA measuring 22 mm in diameter using an Amplatzer ASO.…”

“…Based on manufacturer's recommendations, commonly used devices are capable to close ducts up to 14 mm in diameter. As a result, the majority of very large PDAs are surgically closed, although there have been a few cases in the literature describing closure of such large defects using transcatheter technique [4,5]. The following report describes a case of successful transcatheter closure of a PDA measuring 22 mm with off-label use of an Amplatzer atrial septal occluder (ASO).…”

Transcatheter closure of a non-restrictive patent ductus arteriosus with an Amplatzer muscular ventricular septal defect occluder

“…Some have used the Amplatzer muscular VSD occluder [4,5], others used an Amplatzer ASD occluder [6] to close large ducts. We favour the muscular VSD occluder for this purpose since its configuration seems more appropriate to fit into a PDA, without causing any pulmonary artery obstruction or protrusion into the aorta.…”