TRANSCATHETER CLOSURE OF THE PATENT DUCTUS-ARTERIOSUS - A COMPARATIVE-STUDY BETWEEN OCCLUDING COILS AND THE RASHKIND UMBRELLA DEVICE

This study was performed to evaluate the efficacy of transcatheter coi l closure of the patent ductus arteriosus in comparison to our experie nce with the Rashkind umbrella device. Transcatheter coil closure of t he patent ductus arteriosus has been reported with encouraging results . We present our experience with ducti up to 5.0 mm in diameter and re port the short-term follow-up. We compare the results with our previou s experience with the Rashkind umbrella device. Seventy-one patients u nderwent transcatheter coil closure. Median age was 3.1 years, and med ian weight was 13.6 kg. Mean ductus diameter was 2.0 +/- 1.1 mm. These were compared with 105 patients who underwent transcatheter closure u sing a single Rashkind umbrella device. The median age was 3.2 years a nd the median weight was 14.0 kg. The mean ductus diameter for this gr oup was 2.1 +/- 0.6 mm. The ductus murmur in the coil group disappeare d in all patients. Immediate (less than or equal to 24 h), complete cl osure 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 umbr ella device group at the 6-12-month follow-up (P < 0.05). In almost al l patients requiring more than one coil, the ductus was crossed serial ly from the aortic end. All patients with ductus diameter greater than or equal to 3.0 mm required two or more coils. Eleven coils in six pa tients embolized to the pulmonary arteries. All coils except one were retrieved with subsequent successful coil placement. Sixty-seven patie nts (94%) in the coil group were discharged in less than or equal to 2 4 h. Transcatheter closure of the patent ductus arteriosus using multi ple coils is a more effective technique than the Rashkind umbrella clo sure and has excellent short-term results. This can be performed safel y as an outpatient procedure. (C) 1996 Wiley-Liss, Inc.