title: Transcatheter closure of the patent ductus arteriosus: a comparative study between occluding coils and the Rashkind umbrella device.
abstract: This study was performed to evaluate the efficacy of transcatheter coil closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Transcatheter coil closure of the patent ductus arteriosus has been reported with encouraging results. We present our experience with ducti up to 5.0 mm in diameter and report the short-term follow-up. We compare the results with our previous experience with the Rashkind umbrella device. Seventy-one patients underwent transcatheter coil closure. Median age was 3.1 years, and median weight was 13.6 kg. Mean ductus diameter was 2.0 +/- 1.1 mm. These were compared with 105 patients who underwent transcatheter closure using a single Rashkind umbrella device. The median age was 3.2 years and the median weight was 14.0 kg. The mean ductus diameter for this group was 2.1 +/- 0.6 mm. The ductus murmur in the coil group disappeared in all patients. Immediate (< or = 24h), complete closure was achieved in 89% of the coil group as compared to 71% for the Rashkind umbrella device group (P < 0.005). Closure rate for the coil group was 97% at the 6-month follow-up, vs. 82% for the Rashkind umbrella device group at the 6-12 month follow-up (P < 0.05). In almost all patients requiring more than one coil, the ductus was crossed serially from the aortic end. All patients with ductus diameter > or = 3.0 mm required two or more coils. Eleven coils in six patients embolized to the pulmonary arteries. All coils except one were retrieved with subsequent successful foil placement. Sixty-seven patients (94%) in the coil group were discharged in < or = 24 h. Transcatheter closure of the patent ductus arteriosus using multiple coils is a more effective technique than the Rashkind umbrella closure and has excellent short-term results. This can be performed safely as an outpatient procedure.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA.
authors.forename: Z R
authors.initials: ZR
authors.lastname: Bulbul
authors.forename: J T
authors.initials: JT
authors.lastname: Fahey
authors.forename: T P
authors.initials: TP
authors.lastname: Doyle
authors.forename: Z M
authors.initials: ZM
authors.lastname: Hijazi
authors.forename: W E
authors.initials: WE
authors.lastname: Hellenbrand
mesh_terms: D000293:Adolescent; D000328:Adult; D001027:Aortography; D002404:Catheterization / Q000379:methods; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D004867:Equipment Design; D006801:Humans; D007223:Infant; D008875:Middle Aged; D019736:Prostheses and Implants / Q000706:statistics & numerical data