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Editorial: late-term displacement of Amplatzer Duct Occluder II device following percutaneous closure of patent ductus arteriosus in an adult.

We read the encoraging article of Saliba et al.1 on the closure of patent ductus arteriosus (PDA) with the novel Amplatzer Ductal Occluder (ADO) II device (AGA Medical Corporation, MN, USA). Although the experience with this device is relatively limited and largely belongs to pediatric age group, it can also be used in proper adult cases. Being adult cardiologists we have experience with five cases with ADO II device and we would like to share a case of a patient in whom the ADO II device displaced in the late term. A 21-year-old male referred to our hospital for continuous murmur in the second left intercostal space. Echocardiography revealed a PDA and a borderline rise in pulmonary artery systolic pressure. Left ventricle function and dimensions were in normal limits. Cardiac catheterization confirmed the presence of PDA with a Qp/Qs of 1.5 and pulmonary artery systolic pressure of 32 mmHg. After an informed consent was taken from the patient, we decided to close the defect with an ADO II device. The diameter and the length of the ductus were 3.6 mm and 6 mm, respectively and we preferred a device with a waist diameter of 5 mm, disc diameter of 11 mm, and waist length of 6 mm. Unfractioned heparin was used in order to keep the ACT above 200 seconds during the entire procedure. Using a 6 Fr JR4 guiding catheter and a 0.035’ hydrophilic wire (Terumo Radiofocus Guidewire; Terumo, Somerset, NJ, USA) we