The off-label use of the Amplatzer muscular VSD occluder for large patent ductus arteriosus: a case report and review
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CASE REPORT
The off-label use of the Amplatzer muscular VSD occluder for large patent ductus arteriosus: a case report and review Roberto J. Cubeddu • Ivan Babin • Ignacio Inglessis
Received: 30 April 2013 / Accepted: 20 October 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract A percutaneous approach to the closure of patent ductus arteriosus (PDA) is the preferred procedure in the majority of cases. However, there is little experience with percutaneous closure of unusually large PDA. We report the case of a 28-year-old female with moderate left ventricular dilation and pulmonary hypertension resulting from a large 16 mm PDA. Percutaneous closure was successfully performed using an off-label Amplatzer muscular ventricular septal defect occluder after intravascular ultrasound assessment. Technical challenges, including accurate assessment of defect size and device selection are exemplified along with a comprehensive overview of the available literature. Keywords occluder
PDA Amplatzer muscular VSD
Introduction PDA closure techniques have been in use for over 70 years, beginning with surgical ligation by Gross and Hubbard in 1939 [1, 2]. In 1967, Portsmann et al. were the first to utilize a transcatheter approach for a patent ductus arteriosus (PDA) closure [3]. At present, transcatheter closure— using coils, wire mesh Amplatzer duct occluders, foldingR. J. Cubeddu I. Babin Aventura Hospital and Medical Center, Miami, FL, USA R. J. Cubeddu I. Inglessis Massachusetts General Hospital, Boston, MA, USA I. Babin (&) 21097 NE 27th Ct #480, Aventura, FL 33180, USA e-mail: [email protected]
plug buttoned devices, umbrellas, or wireless patches—is the preferred method for closure [2, 4, 5]. However, in the US the currently available Amplatzer duct occluders are designed for closure of PDA defects of up to 8 mm in diameter, and are thus inadequate for larger defects. In such instances, the off-label use of other septal occluders such as the Amplatzer muscular ventricular septal defect device may be considered [6–10]. Case description A 28-year-old woman from Kenya, Africa, was diagnosed with a PDA shortly after birth but was lost to follow-up. After moving to the United States she sought medical attention. At the time of her evaluation she complained of mild dyspnea on exertion. On physical examination she had a prominent left ventricular impulse along with a loud continuous murmur that was best appreciated over the second intercostal space and the left posterior parascapular region. No clicks, rubs or gallops were appreciated. There was no evidence of jugular venous distension, cyanosis, clubbing, or peripheral edema. Two-dimensional echocardiography revealed a moderately enlarged left atrium and ventricular chamber with preserved systolic function and moderate-to severe pulmonary hypertension. A large PDA was clearly distinguishable on color flow Doppler velocities in high parasternal axis view. The 12-lead electrocardiogram revealed normal sinus rhythm with normal QRS wi
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