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Paper text:
since the first case of transcatheter closure of patent ductus arteriosus ( pda ) by porstmann in 1967,1 device closure has become a mainstream form of intervention for this lesion with a wide variety of devices.2 
  the amplatzer pda occluder is a self - expanding nitinol double - disk device and consists of two disks of varying sizes with the larger disk positioned at the aortic end of the duct .
since its introduction , this device remains , to date , the device of choice for the transcatheter occlusion of large ( > 3 mm ) pdas,3 and the exact technique for device deployment has been previously described.4 
  we report one child who required device closure of pda with two amplatzer pda devices on two separate occasions .
our patient was born in march 2001 and a murmur was noted shortly after birth .
echocardiography eventually showed a large pda , and followup did not reveal signs of pulmonary hypertension .
an amplatzer pda device ( 8 by 6 mm ) was implanted at almost 3 years of age ( figure 1 ) .
repeat cardiac catheterization showed a significant residual shunt ( figures 2 and 3 ) and a second device ( 10 by 8 mm ) was implanted at 4 years and 3 months of age , 1 years after the first device was implanted ( figures 4 and 5 ) , with little residual shunting .
the amplatzer ductal occluder is a safe device and has been utilized extensively with few complications in competent hands.5 closure rates of > 99% have been documented,5 and follow - up has not revealed any episodes of delayed device migration , endocarditis , thromboembolism , or wire fracture / device disruption.6 our patient is unusual in that despite standard placement of an appropriately sized amplatzer device in the usual position , significant residual shunting necessitated the placement of a second device .
it is accepted practice to close large patent arterial ducts ( pda ) with amplatzer duct occluder devices , with extremely low rates of residual pda . 
 we report a child who required device closure of pda with two amplatzer pda devices on two separate occasions , despite the first device deployment being a standard placement of an appropriately sized amplatzer device in the usual position .