Treatment of congenital non-ductal shunt lesions with the amplatzer duct occluder II

Catheter Cardiovasc Interv. 2017 May;89(6):E185-E193. doi: 10.1002/ccd.25250. Epub 2013 Nov 18.


Amplatzer Duct Occluder II (ADO II) is especially designed for closing long ducts in infants. The experience with off-label use of ADO II in non-ductal positions is limited.

Aim: To evaluate feasibility of use of ADO II in non-ductal positions, incidence of complete heart block (CHB), advantages and disadvantages.

Material and results: Out of 79 defects closed with ADO II, 61 had perimembranous, 12 apical/mid-muscular ventricular septal defects (VSD), 4 Gerbode defects, one each of coronary arterio-venous fistula and aorto-right ventricular tunnel. Age ranged from 8 months to 21 years (mean 8.9 ± 4.02 years, median 9 years). The mean fluoroscopy time was 5.2 ± 1.1 min with range 4.2-9.2 min. Complete closure was achieved in all. Three cases developed transient junctional bradycardia, treated with steroids. One patient who developed CHB (1.3%) needed temporary pacing.

Discussion: ADO II is a low profile device. It can be easily delivered through a 5F guiding catheter and needs very short fluoroscopic time as arteriovenous loop is not needed. The cost is 1/3 of regular ventricular septal occluders. The CHB that is a major challenge for closure of VSDs is less common with soft, specially designed ADO II, which does not compress the conducting system.

Conclusions: Use of the ADO II in non-ductal positions can be achieved with high success and low complication rates, especially CHB; its use is also associated with significantly reduced procedure time and device cost. Device size availability restricts use of the ADO II to defects up to 6 mm in diameter. © 2013 Wiley Periodicals, Inc.

Keywords: ADO II; Swiss cheese; VSDs; complete heart block; dextrocardia; noncompaction.

MeSH terms

  • Adolescent
  • Aortography
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation*
  • Child
  • Child, Preschool
  • Coronary Angiography
  • Echocardiography, Doppler, Color
  • Feasibility Studies
  • Female
  • Heart Block / etiology
  • Heart Septal Defects, Ventricular / diagnostic imaging
  • Heart Septal Defects, Ventricular / therapy*
  • Humans
  • Infant
  • Male
  • Prosthesis Design
  • Risk Factors
  • Septal Occluder Device*
  • Treatment Outcome
  • Young Adult