Nonsurgical Treatment for Severe Hemolysis Following Transcatheter Closure of the Patent Ductus Arteriosus Using the Rashkind Umbrella Device / 대한내과학회지

Transcatheter occlusion of the patent ductus arteriosus(PDA) using the Rashkind double umbrella device has become an accepted practice as an effective alternative to surgical ligation in many centers. We experienced three cases of medically refractory severe mechanical hemolysis following transcatheter closure of PDA due to residual shunt. Hemolysis resolved rapidly and completely after deployment of second or more Rashkind umbrellas without surgical correction of the residual shunt. In conclusion, reinsertion of the Rashkind umbrella is a useful modality for treatment of severe hemolysis developed after transcatheter closure of the PDA.

Transcatheter Closure of Patent Ductus Arteriosus in Adults

BACKGROUND: Transcatheter closure of patent ductus arteriosus, using the Rashkind double umbrella occluder system, had been attempted in mulitcenter since non-surgical closure of patent ductus arteriosus by Rashkind. METHODS: Between July 1991 and June 1993, transcatheter closure of patent ductus arterious was attempted in 20 adult patients(21 trials). RESULTS: Seventeen female and 3 male patients was consisted of the study. The patient age ranged from 17 to 54 years(mean 30+/-9 years). Mean pulmonary artery pressure before closure was 18.5+/-6.0mmHg(range from 10mmHg to 30mmHg). The diameter of ductus ranged from 3.5mm to 8.0mm(mean 5.2+/-1.5mm), as determined by contrast injection through 11F Mullin sheath or 7F catheter. There was significant decrease of Qp/Qs from 2.6+/-1.1 to 1.5+/-0.4 immediately after transcatheter closure of ductus(p<0.01). There was significant decrease of left ventricular end-diastolic dimension by echocardiogram from 58.7+/-7.6mm to 53.6+/-6.5mm after transcatheter closure of ductus(p<0.01). Among the 21 cases, 16 cases(76.2%) had the clinical improvement without the support of surgical closure. One 17mm Rashkind umbrella was retrieved because of position and problem of deployment. There was no device embolic experience in 21 cases. There were 2 cases of hemolytic anemia during the follow-up period ; one case was surgically ligated and another 17mm device was implanted in the other case. CONCLUSIONS: Transcatheter closure of patent ductus arteriosus in adult patients can replace the surgical correction in selected patients.