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Closure of a large ductus arteriosus in a preterm infant using the ADO II AS device
  1. Gabriella Agnoletti,
  2. Roberto Bordese,
  3. Fulvio Gabbarini
  1. Department of Paediatric Cardiology, O.I.R.M - S. Anna Hospital, Turin, Italy
  1. Correspondence to Dr Gabriella Agnoletti, Servizio di Cardiologia Pediatrica, piazza Polonia 90, 10124 Torino, Italy; gabriella.agnoletti{at}oirmsantanna.piemonte.it

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Current catheter technology is not designed for closure of large patent ductus arteriosus (PDA) in low-weight infants. Percutaneous coil occlusion of PDA was previously attempted in a sick premature baby with multiple malformations.1 The new miniaturised device, ADO II AS (Amplatzer Duct Occluder II Additional Size), might avoid the risk of surgical closure of PDA in preterm babies.2

A male child was born with a weight of 1050 g; he had a large PDA resistant to ibuprofen. The baby was eventually weaned from mechanical ventilation but developed severe congestive heart failure. At age 2 months, his weight was 2010 g. Echocardiography showed a long (6.6 mm) tubular PDA which had a diameter of 3 mm (figure 1). The left ventricle measured 20 mm and there was a severe mitral regurgitation. Percutaneous closure of the PDA was planned via an antegrade approach using a 4F catheter. Aortography, performed with a 3F catheter, allowed to verify the correct positioning of the device. Fluoroscopy and procedural time were 5 min and 45 min, respectively. The occlusion was complete (figure 2). The favourable outcome of the intervention was confirmed at echocardiography (figure 1). The baby was discharged 2 days after the intervention. Medication was discontinued 1 week later.

Figure 1

Echocardiography shows a large tubular patent ductus arteriosus, which has the same size as the left pulmonary artery (LPA) (A), and prompts an abundant shunt (B). After closure, there is correct positioning of the device (*) and no residual shunt. There is a laminar flow through the aortic isthmus (Ao) and the left pulmonary artery (C).

Figure 2

Aortography shows a long patent ductus arteriosus (*) (A). At the end of the procedure there is no residual shunt, or device protrusion through the aortic isthmus (B).

The advantages of this device are the absence of protrusion in the vessel lumen, the capability of closing the PDA without major tension on vascular structures and its efficacy in abolishing the shunt. It might be a preferable alternative for closure of moderate to large PDAs in low-weight infants.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by OIRM Ethics Committee.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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