Comparison of the Efficacy of Different-Sized Amplatzer Duct Occluders (I, II, and II AS) in Children Weighing Less Than 10 kg

Abstract

The transcatheter closure of patent ductus arteriosus (PDA) may cause more complications in small children. Amplatzer (St. Jude Medical, Plymouth, MN) has produces three types of devices for ductal occlusion: the Amplatzer duct occluder I (ADO I) and II (ADO II) and the recently introduced ADO II additional sizes (ADO II AS). We performed this study to determine the efficacy and complication rates in children who weigh <10 kg for the three types of devices used in our clinic. Between February 2007 and March 2012, 77 patients weighing <10 kg had their PDAs occluded with ADOs. The mean age of the patients was 0.76 ± 0.44 years (range 17 days-2 years), and their mean weight was 6.73 ± 2.05 (range 1.2-9.9) kg. In total, 54 girls (70.1 %) and 23 boys (29.9 %) with a mean pulmonary ductus diameter of 2.55 ± 1.0 (1.08-5.94) mm were included in the study. The ADO I was used in 26 patients (33.8 %); the ADO II was used in 43 patients (55.8 %); and the ADO II AS was used in 8 patients (10.4 %). The mean ages of patients with the ADO I, ADO II, and ADO II AS were 1.07 ± 0.48, 0.66 ± 0.31, and 0.28 ± 0.17 years (p < 0.05), respectively. Their mean weights were 7.86 ± 1.45, 6.50 ± 1.85, and 4.36 ± 2.49 kg (p < 0.05), respectively. Their mean narrowest ductal diameters were 3.11 ± 0.96, 2.25 ± 1.06, and 2.33 ± 1.01 mm (p < 0.05), respectively. The use of the ADO II and ADO II AS was found to be more common in type C defects. One patient with the ADO I and 5 patients with the ADO II (7.8 %) developed varying degrees of left pulmonary artery stenosis or iatrogenic aortic coarctation. In 1 patient, the ADO II AS was replaced with the ADO II due to a significant residual shunt observed during the procedure. Each of the ADOs has its own advantages and disadvantages. Although the ADO I is convenient for medium- and large-sized defects, the ADO II and ADO II AS can be used both anterogradely and retrogradely. The ADO II AS is safe and efficient to use in small infants.

Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients

“…[212223] The Liddy group reported an occlusion rate of 98% after 6 months. [22] In our study, we noted a lower immediate occlusion rate (85.7%), and this rate remained the same after 3 months.…”

Early clinical experience with the new Amplatzer Ductal Occluder II for closure of the persistent arterial duct

“…Transcatheter closure procedures have been performed with high success rates both in children and adults [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Due to advances in diagnostic and therapeutic modalities diagnosis and treatment of PDA can be accomplished at a relatively early age [5][6][7] .…”

“…The ADO2 device provides a solution for the closure of small to moderate-sized PDAs in children 13,14 . We have demonstrated that percutaneous treatment with ADO2 can be realized with lower complication and residual shunt rates.…”

Tratamento percutâneo vs. cirúrgico da persistência do canal arterial em crianças e adolescentes

“…7 Estenose da artéria pulmonar esquerda ou coarctação da aorta, secundárias à protrusão do dispositivo, podem ser observadas em pequenos lactentes com canais de grande diâmetro que requerem o uso de próteses de maior tamanho. 16 Apesar de não termos manejado pacientes com essas características, eles teriam sido encaminhados a tratamento cirúrgico neste estudo. A ocorrência de pneumotórax em um paciente do grupo percutâneo pode ser considerada mais como complicação anestésica, não estando diretamente associada ao cateterismo.…”