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

Lee, Hyoung Doo

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.