Catheter occlusion of the persistently patent ductus arteriosus.
Catheter occlusion of a persistently patent ductus arteriosus was attempted in 40 patients (11 men and 29 women, mean age 7.2 +/- 8.3 years, range 244 days to 40 years), using a transvenously placed Rashkind umbrella occluder (USCI). Thirty-one 12-mm and six 17-mm diameter devices were successfully placed in the ductus (internal diameter average 3.9 mm, range 2 to 9 mm). One procedure was abandoned when fluoroscopy failed to visualize the device. There were 2 immediate embolizations subjected to surgical recovery. A residual shunt was present on the immediate postocclusion ventriculogram in 12 of 37 procedures (32%). Twenty-eight patients (75%) have had at least a follow-up at 3 months with Doppler study and 6 (21%) continued to have shunting into the pulmonary artery. Three of 4 patients have undergone successful placement of a second device and 1 patient's shunting spontaneously resolved at 1 year postimplant, leaving only 2 patients (7%) with persistent shunts. There has been 1 episode of probable prosthetic endarteritis and 1 patient has developed mild narrowing of the left pulmonary artery related to device placement. Catheter occlusion of the patent ductus arteriosus using the Rashkind umbrella appears to be a safe and effective method of non-surgical management.
Dyck
J D
JD
Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
Benson
L N
LN
Smallhorn
J F
JF
McLaughlin
P R
PR
Freedom
R M
RM
Rowe
R D
RD
D000328:Adult; D002404:Catheterization / Q000379:methods; D002648:Child; D004374:Ductus Arteriosus, Patent / Q000628:therapy*; D015150:Echocardiography, Doppler; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male