Immediate aortic obstruction in young infants undergoing patent arterial duct closure with the duct occluder.

We report three young infants (118, 45, and 80 days; 3.5, 4.1, and 3.8 kg) with patent ductus arteriosus (PDA) who had a uniform pattern of immediate device displacement into the aorta after an apparently secure deployment of a duct occluder. All had aortic obstruction requiring urgent surgical relief. During the study period, 18 infants (<6 months) underwent PDA closure with the same device size (6-4 Lifetech duct occluder). The aortic diameter and PDA length were similar in cases versus the 15 controls with uneventful procedures. The percentage shortening screw to pin distance ratio, which indicates the degree of recoil of the device upon release, was significantly higher in the cases versus controls (14.00 [12-15] vs. 4.00 [2.30-7.50], P = 0.011). A combination of tissue pliability and exaggerated recoil can occasionally result in unforeseen device migration and resultant aortic obstruction in small young infants, meriting cautious assessment before deployment and immediately after release.