Transcatheter Closure of Patent Ductus Arteriosus with the Rashkind PDA Occluder System

ABSTRACT

PURPOSE: This study was perfomed to evaluate the success rate and complications of transcatheter closure of patent ductus arteriosus with the Rashkind PDA Occluder System (USCI). METHODS: Between February 1993 and January 1996, 24 patients (6 men and 18 women, median age 4 years, range 10 months to 51 years) were treated with the Rashkind PDA Occluder System for occlusion of patent ductus arteriosus at Dong-A University Hospital. The rate of presence of residual shunt and complications associated with the ductus occlusions in these patients were investigated. RESULTS: At pre-occlusion cardiac catheterization, mean Qp/Qs was 1.49+/-0.48 and mean pulmonary artery pressure was 18.1+/-4.93mmHg. The narrowest diameters of ductus ranged from 1.2mm to 6mm (mean 2.8+/-1.3mm). The most frequently encountered ductal shape was Krichenko type A (16 patients, 66.6%). Three patients required dilatation of ductus with 3mm balloon catheter to cross with 8Fr long sheath. Seventeen 12mm and seven 17mm devices were successfully placed in twenty-four patients. Mean pulse pressure was decreased from 45.5+/-7.11mmHg to 38.8+/-8.98mmHg (p<0.05). After occlusion, the continuous murmurs were disappeared from all but one. From the immediate (20 minute) postocclusion aortogram, 12 of 24 patients (50%) had evidence of residual left to right shunt through the ductus. Four of these 24 patients (17%) demonstrated residual shunt by echocardiogram which performed within 2 weeks after the procedure. Of 20 patients with 3 patients who had residual shunt at previous study, having returned for follow up echocardiogram at 6 months after occlusion, only one (5%) had residual shunt. There were no significant differences in incidence of residual shunt according to size of devices or ductal shape. In 2 patients, Doppler study revealed mild pressure gradient at origin of left pulmonary artery. CONCLUSIONS: In selective candidates, transcatheter closure of the patent ductus arteriosus using the Rashkind PDA Occluder System is a safe and effective method in the nonsurgical management of patent ductus arteriosus.