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Abstract
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Although surgery is still required in symptomatic neonates, the majority of older infants and children can undergo safe and effective transcatheter device closure on an out-patient basis. First described in 1967, over the past four decades, numerous devices have been specifically developed for this purpose. This article will review the current status of transcatheter therapy. The experience with each device is detailed and issues and controversies are reviewed.
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Affiliation(s)
- Jennifer M Rutledge
- Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Liang CD, Ko SF, Huang CF, Chien SJ, Lin YJ, Lin IC, Tiao MM. Immediate echocardiographic surveillance after transcatheter closure of a patent ductus arteriosus: a feasible method to assess residual shunt. Pediatr Neonatol 2010; 51:52-6. [PMID: 20225539 DOI: 10.1016/s1875-9572(10)60010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To evaluate the feasibility of echocardiography after transcatheter closure of patent ductus arteriosus (PDA) with coils. METHODS Between April 1998 and December 2006, 131 patients had transcatheter coil occlusion of their PDA using Gianturco coils. We hypothesized that post-procedural hemolysis would not occur if a residual shunt < 1 mm or if no continuous waveform was detected by echocardiography. Immediately after coil implantation, patients without and with a residual shunt as detected by echocardiography were designated to groups A and B, respectively. The clinical presentations, laboratory data and outcomes were compared between the two groups. RESULTS There were 101 patients in group A and 30 patients in group B. Patients in group B had larger ductal diameter (2.8 +/- 0.9 mm vs. 1.6 +/- 0.8 mm; p < 0.001), larger Qp/Qs (1.9 +/- 0 .9 vs. 1.3 +/- 0.4; p = 0.001), higher frequency of more than one coil used (14/30 vs. 11/101; p < 0.001), and female predominance (22/30 vs. 53/101; p = 0.043) compared with group A. Trivial residual shunt was noted in 6 patients in group A and 20 patients in group B on the day after embolization. All shunts spontaneously closed within 6 months in patients of group A, while five patients in group B had a persistent shunt at the 1-year follow-up and thereafter. Although the patients in group B had higher residual shunt rate than group A during follow-up (p < 0.001), none of these patients suffered from hemolysis. CONCLUSION Echocardiography is a feasible tool to assess residual shunt after PDA closure. If a residual shunt < 1 mm or if no continuous waveform is detected by echocardiography, the risk of developing hemolysis is low.
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Affiliation(s)
- Chi-Di Liang
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
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Smith PJ, Martin MWS. Transcatheter embolisation of patent ductus arteriosus using an Amplatzer vascular plug in six dogs. J Small Anim Pract 2007; 48:80-6. [PMID: 17286660 DOI: 10.1111/j.1748-5827.2006.00255.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to assess the feasibility of transcatheter embolisation of a patent ductus arteriosus using an Amplatzer vascular plug (Amplatzer Medical UK) in six dogs. METHODS The Amplatzer vascular plug is a self-expandable, cylindrical device attached to a delivery cable. In all the dogs, the device was delivered transvenously. Successful device implantation was defined as firm anchorage of the device squarely within the distal part of the ductus arteriosus with no intra- or postoperative dislodgement. Successful occlusion of the ductus arteriosus occurred if a disappearance of the continuous murmur was achieved 24 hours after placement of the Amplatzer vascular plug. RESULTS The age of the dogs ranged from 16 weeks to 7.5 years. Their weights ranged from 2.9 to 27.6 kg (median 6 kg). Two dogs had congestive heart failure before embolisation. Successful device implantation was achieved in all dogs. Successful occlusion of the ductus arteriosus was achieved in four of the six dogs. Complications included mild lameness, residual shunting, and bruising and pruritus around the surgical wound site. At follow-up, two dogs had a continuous murmur and one required treatment for congestive heart failure. CLINICAL SIGNIFICANCE This technique may represent a clinically effective and less expensive alternative to the use of an Amplatzer duct occluder (Amplatzer Medical UK) in dogs with medium-sized patent ductus arteriosus. Further investigations are required to fully evaluate its efficacy and safety in various sizes and types of patent ductus arteriosus, and to determine the optimal device size in relation to the size of the ductus.
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Affiliation(s)
- P J Smith
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk CB8 0UH, UK
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Gillor A, Perrey SE, Schnegg C. Soll ein silenter persistierender Ductus arteriosus Botalli verschlossen werden? Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1330-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Beck A, Birk E, Blieden LC, Bruckheimer E. Stent implantation for coarctation of aorta caused by a Rashkind patent ductus arteriosus umbrella. Catheter Cardiovasc Interv 2004; 63:80-2. [PMID: 15343573 DOI: 10.1002/ccd.20128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This case demonstrates a novel use of stent implantation for relief of coarctation of the aorta caused by protrusion of a Rashkind patent ductus arteriosus umbrella. Follow-up 3 years after stent implantation shows complete relief of obstruction.
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Affiliation(s)
- Avi Beck
- Department of Pediatric Cardiology, Schneider Children's Medical Center-Israel, Beilinson Campus, Tel Aviv University, Petach Tikva, Israel
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Liang CD, Ko SF, Huang SC, Huang CF, Niu CK. Vocal cord paralysis after transcatheter coil embolization of patent ductus arteriosus. Am Heart J 2003; 146:367-71. [PMID: 12891209 DOI: 10.1016/s0002-8703(03)00125-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In patients with patent ductus arteriosus (PDA) after Gianturco coil embolization, vocal cord paralysis (VCP) had not been previously described. This study investigates the risk factors of coil embolization associated with VCP. METHODS We reviewed the medical records of all patients who had undergone transcatheter closure of PDA with a Gianturco coil between March 1998 and May 2001, and 75 patients (age range, 6 months to 55 years; mean age, 5.5 years) were identified. The procedure was performed with local anesthesia and with sedation in some young children. No patient required general anesthesia or endotracheal intubation. RESULTS Three of the 75 patients had hoarseness caused by VCP after coil embolization. Patients with VCP had a longer ductus length (P <.01) and a smaller ductus diameter (P <.01) than patients without VCP. The pathogenesis of VCP may be caused by tense stretching and angulation of the ductus arteriosus induced by the implanted coil, which leads to compression injury of the adjacent left recurrent laryngeal nerve. CONCLUSIONS A long ductus length (> or =12 mm) and a small ductus diameter (<1 mm) are significant risk factors of VCP after coil embolization in children <1 year of age. We recommend that coil embolization be performed very carefully in patients with PDA.
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Affiliation(s)
- Chi Di Liang
- Department of Pediatrics, Chang Gung Children's Hospital, Kaohsiung, Taiwan.
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Stanley BJ, Luis-Fuentes V, Darke PGG. Comparison of the incidence of residual shunting between two surgical techniques used for ligation of patent ductus arteriosus in the dog. Vet Surg 2003; 32:231-7. [PMID: 12784199 DOI: 10.1053/jvet.2003.50025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the incidence of residual patent ductus arteriosus (PDA) flow after ligation using 2 different dissection techniques: a standard dissection and a method described by Jackson and Henderson. STUDY DESIGN A randomized, prospective study. ANIMALS Thirty-five dogs admitted for surgical correction of a left to right shunting PDA. METHODS Dogs were randomly assigned: 19 to a standard dissection technique (group S) and 16 to the Jackson and Henderson dissection group (group JH). RESULTS Gender ratio, age at surgery, and diameter of the ductus were not statistically different between groups. Breed distribution was also similar. Because 1 dog had fatal intraoperative hemorrhage, only 34 dogs were available for residual flow comparisons. Twenty-one percent of group S dogs had residual flow compared with 53% in group JH. Whereas no intraoperative complications occurred in group S, 3 were encountered in group JH. CONCLUSIONS The incidence of residual flow was higher when the Jackson and Henderson dissection was used for PDA ligation compared with a standard method of dissection. This was probably because of entrapment of loose connective tissue within the medial aspect of the ligature, impeding complete closure of the ductus. CLINICAL RELEVANCE Ideal PDA closure should result in no residual ductal flow to prevent possible adverse long-term sequelae, such as recanalization and infective endocarditis.
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Affiliation(s)
- Bryden J Stanley
- Department of Clinical Veterinary Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Edinburgh, Scotland
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Formigari R, Toscano A, Herraiz I, Bialkowski J, Donti A, Picchio FM, Bermudez-Cañete R, Ballerini L. Late follow-up of occlusion of the patent ductus arteriosus with the Rashkind device with emphasis on long-term efficacy and risk for infections. Am J Cardiol 2001; 88:586-8. [PMID: 11524079 DOI: 10.1016/s0002-9149(01)01749-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Formigari
- Pediatric Cardiology, University of Bologna, Policlinico S. Orsola, Bologna, Italy.
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Kong H, Gu X, Bass JL, Titus J, Urness M, Kim TH, Hunter DW. Experimental evaluation of a modified Amplatzer duct occluder. Catheter Cardiovasc Interv 2001; 53:571-6. [PMID: 11515016 DOI: 10.1002/ccd.1225] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to evaluate a new device specifically designed for patent ductus arteriosus (PDA) occlusion based on PDA anatomy. Percutaneous closure of aortopulmonary shunts was attempted in 10 dogs. Shunts were surgically created in the location and orientation of PDA. The occlusion prosthesis consisted of a cylindrical frame filled with polyester and a 32 degree angled retention disk. The delivery system of the device included a 6 Fr thin-walled Teflon introducing sheath, an antirotating delivery catheter, and cable. Complete occlusion of the shunt was obtained in nine animals. One animal died before device placement. Temporary hemolysis occurred in one dog after device placement. The disk of device was completely covered by smooth glistening neoendothelium at 1-3 months postmortem examination. None of the devices protruded into the lumen of the aorta. The device is an improvement over the standard Amplatzer duct occluder. The angled retention disk lies flatly against the aortic wall, avoiding turbulence or an aortic pressure gradient.
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Affiliation(s)
- H Kong
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Ananthasubramaniam K. Patent ductus arteriosus in elderly patients: clinical and echocardiographic features-a case-based review. J Am Soc Echocardiogr 2001; 14:321-4. [PMID: 11287900 DOI: 10.1067/mje.2001.109684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Congenital heart disease in adults is a rapidly growing field, with many operated and unoperated infants and children surviving into adulthood. Patent ductus arteriosus is an example of a congenital cardiac defect, which may enable patients to survive well into adulthood without prior recognition or correction before symptoms arise. This case illustrates the clinical and echocardiographic manifestations of patent ductus arteriosus with special emphasis on its 2-dimensional and Doppler findings. Management options for this condition are also briefly addressed.
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Janorkar S, Goh T, Wilkinson J. 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. Am Heart J 1999; 138:1176-83. [PMID: 10577450 DOI: 10.1016/s0002-8703(99)70085-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- S Janorkar
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
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Wang LH, Wang JK, Mullins CE. Eradicating acute hemolysis following transcatheter closure of ductus arteriosus by immediate deployment of a second device. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:295-7. [PMID: 9535367 DOI: 10.1002/(sici)1097-0304(199803)43:3<295::aid-ccd11>3.0.co;2-l] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Two patients who underwent transcatheter closure of patent ductus arteriosus, one with a Rashkind umbrella device and the other with a coil, suffered from acute hemolysis following the procedure. Hemolysis ceased after deployment of second device(s) within 48 hr without needing to retrieve the first devices in either patient. We conclude that immediate deployment of a second device(s) is an alternative to surgery when acute hemolysis occurs following transcatheter closure of ductus.
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Affiliation(s)
- L H Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei
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Alcibar J, Gochi R, Oñate A, Barrenetxea JI, Ramón Rumoroso J, Salazar H, Jiménez A, Rodrigo D, González-Liébana J, Peña N, Cembellín JC. [Late reopening of patent ductus arteriosus after complete closure with the Rashkind prosthesis. Possible traumatic origin]. Rev Esp Cardiol 1997; 50:133-6. [PMID: 9092001 DOI: 10.1016/s0300-8932(97)73192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the case of a symptomatic adult with an occluded persistent duct with a transcatheter proceeding using a Rashkind prosthesis. After a month of follow up the color-coded Doppler-flow echocardiogram did not show residual shunt, posteriorly the patient's symptoms disappeared and the left ventricular dimensions were reduced. At the thirteen month of follow-up, the patient had an accident while working, falling down from a scaffold. Afterwards, a ductal jet was observed in the echocardiogram with an increased size of the left ventricle, symptoms also appeared. A cardiac catheterism was then performed showing a pulmonary/systemic flow rate of 2 and a 3 mm flow jet at the superior border of the prosthesis. A second prosthesis was implanted with no residual shunts.
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Affiliation(s)
- J Alcibar
- Servicio de Cardiología, Hospital de Cruces, Vizcaya
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Galal O, Nehgme R, al-Fadley F, de Moor M, Abbag FI, al-Oufi SH, Williams E, Fawzy ME, al-Halees Z. The role of surgical ligation of patent ductus arteriosus in the era of the Rashkind device. Ann Thorac Surg 1997; 63:434-7. [PMID: 9033315 DOI: 10.1016/s0003-4975(96)00962-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The role of surgery in managing patent ductus arteriosus (PDA) was studied in the era of the Rashkind double-umbrella device. METHODS All 354 patients with PDA referred to our center in a 5-year period were included in this report. Of the 354 patients, 236 underwent cardiac catheterization with the intent of transcatheter PDA closure, and 118 had surgical intervention. RESULTS In 46 (19.5%) of the 236 patients having cardiac catheterization, the procedure either was abandoned or failed. Color Doppler echocardiography demonstrated total occlusion of the ductus after 24 hours in 97 patients (41%) in the cardiac catheterization group. An additional 20 patients had no residual leaks at follow-up. Twenty other patients underwent reocclusion because of a residual shunt. Thus, of the 236 patients, 137 (58%) had successful complete closure of the PDA. Surgical PDA ligation was performed in 118 patients as the initial procedure and in 26 of the 46 patients in whom transcatheter closure was abandoned. If the remaining 20 patients in whom transcatheter closure failed are added to the 144 patients who underwent PDA ligation, the percentage having surgical intervention versus transcatheter occlusion is higher than 46%. CONCLUSIONS Our data suggest that surgery plays a major role in the management of patients with PDA despite the advent of new interventional catheterization techniques.
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Affiliation(s)
- O Galal
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Hawkins JA, Minich LL, Tani LY, Sturtevant JE, Orsmond GS, McGough EC. Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus. J Thorac Cardiovasc Surg 1996; 112:1634-8; discussion 1638-9. [PMID: 8975855 DOI: 10.1016/s0022-5223(96)70022-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare cost and efficacy of surgical closure of patent ductus arteriosus using new critical pathway methods with outpatient transcatheter coil occlusion of patent ductus arteriosus. METHODS Surgical techniques included a transaxillary, muscle-sparing thoracotomy, triple ligation of the patent ductus arteriosus, no chest tube, and discharge from the hospital within 24 hours. Transcatheter coil occlusion of patent ductus arteriosus was done as an outpatient procedure. Costs were compared with inclusion of all hospital and professional charges. RESULTS From July 1994 until March 1996, 20 patients underwent coil occlusion of patent ductus arteriosus and 20 patients underwent surgical closure of patent ductus arteriosus. Duration of hospitalization was significantly less for the patients receiving coil occlusion (11 +/- 6 hours) as compared with that for the patients having surgical ligation (28 +/- 7 hours, p < 0.05). Total charges were similar for surgical ligation ($7101 +/- $408) as compared with those for coil occlusion ($7104 +/- $886, p > 0.05). Morbidity in coil occlusion included inability to occlude the patent ductus arteriosus in two patients (2/20, 10%) and residual patency in two patients (2/18, 11%). Morbidity in the surgical group included nausea and vomiting necessitating hospitalization for more than 36 hours in one patient (1/20, 5%), transient left recurrent laryngeal nerve palsy in one (1/20, 5%), and pneumothorax in two patients (2/20, 10%). There were no instances of residual patency in the surgical group. CONCLUSIONS Transaxillary thoracotomy without tube thoracostomy and with critical pathway methods allows safe and effective ligation of a patent ductus arteriosus with early hospital discharge. This surgical method has similar cost, higher efficacy rate, and applicability in all patients as compared with newer transcatheter coil occlusion techniques for closure of a patent ductus arteriosus.
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Affiliation(s)
- J A Hawkins
- Department of Surgery, Primary Children's Medical Center and the University of Utah, Salt Lake City 84113, USA
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de Moor M, Abbag F, al Fadley F, Galal O. Thrombosis on the Rashkind double umbrella device: a complication of PDA occlusion. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 38:186-8. [PMID: 8776527 DOI: 10.1002/(sici)1097-0304(199606)38:2<186::aid-ccd16>3.0.co;2-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 3-year-old child with a patent arterial duct underwent percutaneous transcatheter occlusion using Rashkind's "double umbrella" technique. The procedure, using a 17 mm device, was uncomplicated. An echocardiogram done 6 hr later showed a mobile 5 x 3 mm thrombus on the pulmonary aspect of the device. The thrombus resolved after 24 hr of intravenous heparin.
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Affiliation(s)
- M de Moor
- Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Piéchaud JF, Delogu A, Kachaner J, Iserin L, Aggoun Y, Giusti S, Bonnet D, Sidi D. [Percutaneous occlusion of patent ductus arteriosus by the Rashkind double-umbrella device]. Arch Pediatr 1995; 2:1149-55. [PMID: 8547994 DOI: 10.1016/0929-693x(96)89915-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The transcatheter option consisting of implanting and releasing an occlusive device designed as a double-umbrella is an interesting alternative to surgery aimed to close persistently patent ductus arteriosus. POPULATION AND METHODS Closure of a duct with the Rashkind device had been planned in 113 children. The procedure was abandoned in 12 with inadequately sized ducts (too large or too small). This study therefore included 101 attempts in patients aged 2.3 months to 18.5 years (m +/- 1 SD = 45.9 +/- 43.2 months) whose weights ranged from 3.3 to 87 kg (m +/- 1 SD = 15.7 +/- 11.7 kg). The narrowest dimension of the duct on the aortograms ranged from 1.2 to 6.2 mm (m +/- 1 SD = 2.9 +/- 0.9 mm). RESULTS The procedure failed in seven patients because of a too large and/or tubular vessel, causing removal of the device prior to release in five patients, or surgical extraction after it had embolized into a pulmonary artery branch in two patients. An early acute hemolysis requiring again the surgical removal of an instable device in a tubular duct was seen in one case. Two patients had femoral artery occlusion successfully treated with thrombolytic agents. Complete occlusion was immediately proven in 32 (35%) of the 92 successful and stable implantations. These figures raised to 64% (59 cases) prior to discharge. At final follow-up (0.3-59 months, m +/- 1 SD = 13.8 +/- 14.4 months), another 16 total occlusions were observed and one patient was successfully managed by a second implantation. The final occlusion rate was 83% (76 cases). Of the 16 residual shunts, five were surgically suppressed and the remaining were minimal. CONCLUSION Transcatheter occlusion of the patent ductus arteriosus is safe in children weighing more than 5 kg, having ducts with a narrowing ranging from 1 to 6 mm. It is efficient in five out of six cases and has less disadvantages than surgery.
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Affiliation(s)
- J F Piéchaud
- Service de cardiologie pédiatrique, hôpital Necker-Enfants-Malades, Paris, France
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Sievert H, Moor T, Ensslen R, Spies H, Scherer D. Transcatheter closure of oversized persistent ductus arteriosus by simultaneous delivery of two Rashkind umbrella devices. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:251-4. [PMID: 8542635 DOI: 10.1002/ccd.1810360313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Transcatheter closure of persistent ductus arteriosus (PDA) with a diameter of > 9 mm is considered to be impossible or at least difficult with the occlusion systems that are currently available. We report a simple technique for occluding oversized PDAs with two diameter of 13 mm was successfully occluded in a 40-year-old man. Complete closure without residual shunt was documented by echocardiogram and angiogram.
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Affiliation(s)
- H Sievert
- Bethanien Hospital, Department of Cardiology and Angiology, Frankfurt, Germany
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Abstract
This article reviews the current status of transcatheter technology, which has been applied to close the patent ductus arteriosus (PDA). Pioneering work in this field was performed by Porstmann in the 1960s and Rashkind in the 1970s. Devices which have been implanted in the PDA have basic designs as plugs, umbrellas, or coils. The experience reported with each type of device is detailed. Issues and controversies are examined. It appears that coils should be the preferred method for closing smaller PDAs (3-mm diameter or smaller), and Rashkind or similar devices, if available, should be reserved for larger PDAs (> 3-mm diameter). Surgery is necessary for neonatal and for rare large PDAs. Transcatheter technology is still evolving and may become more effective and cheaper.
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Affiliation(s)
- J W Moore
- Department of Cardiology, Children's Heart Institute, Children's Hospital, San Diego, California 92123, USA
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