Off-label use of Amplatzer Duct Occluder II additional sizes

OBJECTIVE: To report our experience on novel, off-label use of Amplatzer Duct Occluder type II additional sizes (ADO II-AS) device (St. Jude Medical, Inc.; St. Paul, Minnesota, USA) to manage nonduct shunt lesions. METHODS AND RESULTS: Among the 114 patients submitted to ADO II-AS implantation at our institution, 12 received this device as off-label treatment of paravalvular leak (n = 5), sinus of Valsalva fissuration (n = 2), accessory atrial septal defect (n = 2), muscular ventricular septal defect (n = 1), bleeding bronchial artery aneurysm (n = 1) and reverse shunt due to abnormal origin of left subclavian artery from pulmonary artery (n = 1). Age and body weight of these patients ranged from 3 to 74 years and from 15 to 80 kg, respectively. All procedures were completed without anatomical, functional or ECG complications and without residual shunt. In one patient with mitral paravalvular leak, mild restriction of the posterior disc excursion after device deployment was recorded. CONCLUSION: In our case series, ADO II-AS was well tolerated, versatile and cost-effective in treatment of different types of nonduct shunt lesions, mainly in young children and in older patients with comorbidities.