[Rashkind PDA occluder and detachable metal spiral for interventional occlusion of the ductus arteriosus Botalli. Indications, outcome and complications].
The intention of this study was to determine the efficacy and complication rate of the interventional duct occlusion. Furthermore, we wanted to compare the meanwhile well-known Rashkind-PDA-Occluder system (ROS) with the results of the considerably cheaper detachable duct occlude coils (PDA-S). For this purpose, we analyzed the data of 53 consecutive patients who received a total of 28 ROS and 25 PDA-S. The ROS was implanted in the slightly larger ducts (O 3.1 +/- 0.6 mm), the PDA-S in the smaller ones (O 2.2 +/- 0.6 mm). The rate of residual shunting was 20% in the ROS-group (follow-up: 104 to 1099 days, mean 580 +/- 300 days) and 7.7% in the PDA-S-group (follow-up: 90 to 384 days, mean 161 +/- 101 days). One patient after ROS showed a significant residual shunting and received 2.5 years after the first procedure a PDA-S which eliminated the shunt. In a second patient the attempt of implanting two coils in a 4 mm duct resulted in the embolization of the first coil into the right pulmonary artery. The coil could not be retrieved and was left in the pulmonary artery without sequelae. All other patients received only one ROS or one PDA-S. There were no further complications. The complication rate for all interventional duct occlusions therefore was 1.9% (0% for the ROS-group; 4.0% for the PDA-S-group). In comparison with the Gianturco coils that have been introduced since 1975, the new detachable coils can be manipulated much more easily, because they remain fixed at the delivery wire until an ideal position is achieved. Then the coil is set free by unscrewing it from the delivery wire. For small ducts with a diameter up to 3 mm the detachable coil is an effective and cheap alternative which can be handled easily. Because of the smaller delivery systems in comparison to the ROS (4-5 F versus 8 F or 11 F) the PDA-S is also suitable for small children and infants. larger ducts should be closed with the ROS.
Buheitel
G
G
Abteilung für Pädiatrische Kardiologie, Jugendliche der Friedrich-Alexander-Universität Erlangen-Nürnberg.
Hofbeck
M
M
Leipold
G
G
Tenbrink
U
U
Singer
H
H
D000800:Angioplasty, Balloon / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome