Frequent Oversizing during Amplatzer Device Deployment for Percutaneous PDA Closures

Background- Transcatheter closure of small to moderate patent ductus arteriosus (PDA) has been well established during this last decade. The Amplatzer device occluder (ADO) is a selfexpandable device with ease of delivery and a rapid learning curve. The aim of the study was to access the optimum sizing of ADO in regard to maximum efficacy with respect to shunt occlusion without oversizing and reducing bulk and potential protrusions. Methods- From April 2007 to July 2008, a total of twenty-four adult PDA closures were reviewed. Occlusion was achieved via antegrade venous approach. Our primary objective was an evaluation of optimum ADO sizing for PDA closures. We retrospectively compared the patients with a theoretical optimum size as regards complications and residual shunts. Results- PDA size determination was based on the smallest diameter at pulmonary artery (PA) side. Based on specific criteria, undersizing was not observed in our cases, while oversizing was noted in 42% of cases. Oversizing did not lead to a decrease in residual shunts (37.5% vs. 36%, p=NS). Although no short-term complications were observed in the oversized group, oversizing resulted in a characteristic mushroom deformity due to unnecessary tension applied to our device. The Chinese device also performed well in terms of deployment and short-term complications with no significant difference in comparison to its American counterpart (p=NS). Conclusion- An acceptable rate of acute complications was obtained; nonetheless, we were frequently oversizing, leading to mild device deformation and protrusion. Although not previously described in the literature, the terminal ballooning of the ADO should alert us of such a complication