Background .– Percutaneous closure of huge and tubular (type C) patent ductus arteriosus remain challenging or unsuccessful in small infants.

Aim .– To evaluate the usefulness and safety of Amplatzer vascular plug II and IV for percutaneous closure of very large ductus arteriosus under 6 kg.

Methods .– Single-center retrospective study including all consecutive unselected patients (≤ 6 kg, large symptomatic ductus arteriosus) referred to our institution over a 4 years period for percutaneous closure and treated with plug II or IV. No patient was excluded and there was no failure or surgery within the weight limit to consider percutaneous closure (> 2.5 kg).

Results .– Seven patients were successfully treated using vascular plug II and IV without any residual shunt. Six plug II were implanted (mean patients weight 4.3 ± 0.8 kg, mean ductus diameter 6 ± 1.8 mm, mean device size 8.6 mm (6–14), fluoroscopy time 14.8 ± 6.3 min, occlusion rate 100%, mean follow-up 6 ± 2 months) including huge type C (5) and one type E (1) ductus. Mean pulmonary artery pressure dropped from 25 ± 7 (17–38) mm of Hg to normal value in all cases and there was no aortic protrusion or embolization. One patient experienced severe but reversible pulmonary hypertension crisis in the catheter lab requiring blood transfusion. A 6 mm Amplatzer vascular plug IV was also implanted in a 4.2 kg patient (4.8 mm type D ductus, fluoroscopy 10 min, uneventful 8 months follow-up).

Conclusion .– Percutaneous closure of very large ductus arteriosus is safe and effective under 6 kg. In our experience, the vascular plug II profile allows with acceptable risk to extend indication to infants below 4 kg with huge tubular forms. This might contribute to reduce surgical indications and in hospital morbidities and to improve cost effectiveness. We believe that plug II could also be proposed in the near future for closure of conical shape (type A) with similar results.