Transcatheter interruption of large residual flow after device closure of "Type A" patent ductus arteriosus

We report a case of 3-year-old girl who had persistence of large residual flow following transcatheter closure of a 6 mm 'Type A' patent ductus arteriosus using a 12 × 10 mm duct occluder. Angiography revealed a large left-to-right shunt coursing through and exiting around the implanted device. Near total abolition of the residual shunt was achieved by initial implantation of an embolization coil within the duct occluder and subsequently an Amplatzer duct occluder (ADO II) adjacent to the duct occluder. This challenging case describes an additional technique of abolishing a large residual flow in and around a Nitinol duct occluder device.