CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
AFRICA
207
PDA that measured 6.2 mm, which was 0.7 mm more than the
recommended upper limit. In favour of percutaneous closure in
this patient was the shape of the PDA, which was more conical
with a larger ampulla of 15.4 mm. This patient also had a small
left-to-right shunt of 1.46:1. This may have been due to the fact
that the patient had significant pulmonary hypertension with a
pulmonary artery mean of 37 mmHg, thus limiting left-to-right
shunting across the PDA. The duct was amenable to percutaneous
closure though, as the Rp was high-normal at 2.8 Wood units.
The mean screening time of 23.4 (
±
16.66) min was longer
than in other studies.
17,22
Limitations to the use of this device
would include inability to close a very large PDA, as the largest
size is 6
×
6 mm, with a retention disk of 12 mm; and inability
to occlude a duct with a shallow ampula and a small aorta
or pulmonary artery, as closure in such patients might cause
significant aortic coarctation or left pulmonary artery stenosis.
The introduction of ADO II additional sizes and the use of
an Amplatzer vascular plug II for ductal closure, which has a
much smaller profile with smaller retention disks, has offered
hope for closure of PDAs in much smaller infants, including
newborns.
21,25,26
The major limitation of this study was that this was a
retrospective analysis of records. There was no direct comparison
between this device and other devices used for percutaneous
ductal occlusion, including the ADO I.
Conclusion
The Amplatzer duct occluder II is able to close all types of PDAs
in very small infants (
<
6 kg). The device may be utilised to close
PDAs historically closed using coils. Its ability to be delivered
via both pulmonary and aortic approaches expands its use,
including patients whose anatomy is difficult to approach either
through the pulmonary side or the aorta.
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