Case report
Use of an Amplatzer Vascular Plug type II to occlude elongated patent ductus arteriosus in adult patient

Patent ductus arteriosus (PDA) is one of the most prevalent congenital heart diseases. Transcatheter closure of PDA is the treatment method of choice. In spite of recent advances in transcatheter management, the occlusion of certain anatomical types of PDA remains a challenge. The aim of the study was to report novel use of the Amplatzer Vascular Plug type II (AVPII) for closure of large elongated type of PDA (type E according to Krichenko classification) in a 19-year-old man. In clinical examination a soft continuous murmur was heard in the 2-3 left intercostal space. Echocardiography confirmed left to right shunt through the PDA. Left ventricle and left atrium were at the upper limit for body weight. In angiography the duct was 20 mm long, 7 mm wide with 3 mm narrowing at the pulmonary end. For the procedure we applied a 12 mm AVPII. The AVPII is a self-expanding, nitinol wire mesh occluder dedicated for arterial and venous occlusion in the peripheral circulation. It was delivered through a 6 F catheter retrogradely. The distal disc and medial part of the AVPII were opened inside the duct, and the proximal disc in the pulmonary artery. Complete closure of the PDA was confirmed in angiography. No complications during the procedure or 3-month follow-up were observed. Application of the AVPII is a safe and effective method of treatment for adult patients with elongated type of PDA.