Transcatheter closure of residual patent ductus arteriosus shunting after the Rashkind occluder device using single or multiple Gianturco coils

Transcatheter closure of residual patent ductus arteriosus

INTRODUCTION

Residual patent ductus arteriosus (rPDAs) can occur following surgical or transcatheter treatment, and are indicated for closure because of the risks of infective endarteritis and hemolysis in addition to the hemodynamic effect of the residual left-to-right shunt.

METHODS

This retrospective descriptive study describes our experience at two Egyptian centers (Cairo University Children's Hospital & Tanta University Hospital) with transcatheter treatment of rPDAs, from January 2009 to October 2017.

RESULTS

Twenty cases were treated: 17/20 postsurgical and 3/20 post-transcatheter, at a mean period of 13.4 ± 9.3 months from the initial procedure. The median rPDA size was 2 mm (range2-3.5 mm). Most common ductal anatomy was the conical shape. All rPDAs were successfully closed with either coils (13/20) or devices (6/20), except one case where the residual flow was within the device mesh material. Coils could be deployed from the antegrade or the retrograde approaches although the latter was associated with a higher incidence of late shunt occlusion. One case with a malpositioned device required simultaneous device and LPA stent deployment.

CONCLUSION

Transcatheter closure of rPDAs is feasible in most cases, but may be technically challenging.

Closure of prosthetic paravalvular mitral regurgitation with the Gianturco-Grifka vascular occlusion device

Paravalvular regurgitation associated with prothetic mitral valves is often a consequence of infectious endocarditis. The condition is usually treated with debridement and repeat surgical valve replacement. However, repeated operations are associated with high risk. This report describes a case of successful transcatheter treatment of severe paravalvular mitral regurgitation and pulmonary edema in a patient in whom repeat mitral valve replacement was not believed possible.

Transcatheter closure of patent ductus arteriosus with the use of Rashkind occluders and/or Gianturco coils: long-term follow-up in 123 patients and special reference to comparison, residual shunts, complications, and technique

BACKGROUND

This report describes the long-term follow-up of transcatheter closure of patent ductus arteriosus (PDA) with 2 different modalities in 123 patients of diverse ages.

METHODS AND RESULTS

Between October 1990 and August 1997, 123 patients underwent transcatheter PDA (1.9 to 7.5 mm) closure at a mean age of 6.8 +/- 8.9 years (range 0.06 to 52) and mean weight of 20.9 +/- 17. 6 kg (range 2.7 to 83). In the initial procedure, the Rashkind device was used in 60, the Gianturco coil(s) in 60, and the Rashkind device with a coil in 3 patients. Six-month closure rate for the Rashkind group was 77% versus 90% for the coil group. The second procedure was carried out for residual shunt in 19 (14 in the Rashkind group and 5 in the coil group) and a third procedure in 1 patient from the Rashkind group. A balloon wedge catheter was used in 50 of 78 coil procedures to prevent coil embolization. One device and 11 coils (8 without balloon aid) embolized to the pulmonary arteries. The device and all coils except 2 were retrieved successfully. Overall, 122 (99%) patients showed complete PDA closure. The mean uneventful follow-up period was 44.11 +/- 23.77 months (range 8.7 to 90.28).

CONCLUSIONS

Transcatheter closure of PDA is feasible in infants as well as in patients >50 years of age without significant complications. The coils are easy to implant, less expensive, and multiple coils may be used in moderately large (>3.5 mm) ducts more effectively than with the Rashkind device. The use of a balloon wedge catheter prevents immediate coil embolization. Multiple procedures are feasible and safe to achieve complete closure.

Long-term outcome of transcatheter coil closure of small to large patent ductus arteriosus

Coil closure of patent ductus arteriosus (PDA) has become an accepted alternative to surgical closure in most pediatric cardiac centers. However, little is known about the mid-to long-term outcome of this procedure. Therefore, we evaluated the immediate, short-, and long-term outcome of transcatheter coil closure (TCC) of PDA using single or multiple Gianturco coils or the Gianturco-Grifka Vascular Occlusive Device (GGVOD). One hundred forty-nine patients underwent an attempt at TCC of their PDAs at a median age of 2.4 years (2 weeks to 55 years) and median weight of 13.5 kg (2.3-87 kg). There were 33 patients < 1 year of age. The median PDA minimal diameter was 2 mm (0.4-7 mm) with 26 patients whose PDA minimal diameter was > 4 mm. A 4 Fr catheter was used for coil deployment in 136 patients, a 3 Fr in 4, and an 8 Fr in 4 patients who received the GGVOD. A single coil was used in 77 patients and multiple coils (2-6) were used in 66 patients. One hundred forty-six patients had successful closure (142 had immediate complete closure and 4 had residual shunt), 3 patients failed the initial attempt (2 underwent surgical ligation and 1 had a successful second attempt a year later). Of the four patients with residual shunt, three underwent a second procedure with implantation of 1-3 coils resulting in complete closure in all and one patient had spontaneous resolution of the residual shunt. Complications were encountered in nine patients: six had coil migration with successful retrieval in four; two had left pulmonary artery stenosis (2.4 kg and 6.3 kg infants), and one patient had loss of femoral arterial pulse. The median fluoroscopy time was 16 min (2-152 min). One hundred forty-two patients had the procedure as an outpatient, five patients stayed greater than 24 hr, and two of these patients were in hospital for 1 month for noncardiac reasons. At a median follow-up interval of 3.0 years (1 month to 5.1 years), there were no episodes of delayed coil migration, delayed recanalization, thromboembolic episodes, or bacterial endocarditis. Lung perfusion scans performed at a median follow-up interval of 1.6 years in 31 patients who received multiple coils revealed 45% +/- 5% blood flow to the left lung. Long-term follow-up of coil closure of PDA indicates that the technique is safe and effective for most patients with PDA up to a diameter of 7 mm.

Combined use of detachable coil against persistent mechanical hemolysis after transcatheter occlusion using Rashkind umbrella device in adult patient with patent ductus arteriosus

Mechanical hemolysis after transcatheter occlusion of the patent ductus arteriosus using the Rashkind umbrella device has been postulated as a rare, but serious complication, even necessitating surgical repair. A rare, case of an adult patient with massive hemolytic anemia, successfully controlled by the combined use of several detachable coil devices is reported. The use of coil devices might be considered as a therapeutic option in such cases.