TRANSCATHETER OCCLUSION OF THE DUCTUS-ART ERIOSUS WITH THE RASHKIND UMBRELLA DEVICE

Background. - The transcatheter option consisting of implanting and re leasing an occlusive device designed as a double-umbrella is an intere sting alternative to surgery aimed to close persistently patent ductus arteriosus. Population and methods. - Closure of a duct with the Rash kind device had been planned in 113 children. The procedure was abando ned in 12 with inadequately sized ducts (too large or too small). This study therefore included 101 attempts in patients aged 2.3 months to 18.5 years (in +/- 1 SD = 45.9 +/- 43.2 months) whose weights ranged f rom 3.3 to 87 kg (m +/- 1 SD = 15.7 +/- 11.7 kg). The narrowest dimens ion of the duct on the aortograms ranged from 1.2 to 6.2 mm (m +/- 1 S D = 2.9 +/- 0.9 mm). Results. - The procedure failed in sev en patient s because of a too large and/or tubular vessel, causing removal of the device prior to release in five patients, or surgical extraction afte r it had embolized into a pulmonary artery branch in two patients. An early acute hemolysis requiring again the surgical removal of an insta ble device in a tubular duct was seen in one case. Two patients had fe moral artery occlusion successfully treated with thrombolytic agents. Complete occlusion was immediately proven in 32 (35%) of the 92 succes sful and stable implantations. These figures raised to 64% (59 cases) prior to discharge. At final follow-up (0.3-59 months, m +/- 1 SD = 13 .8 +/- 14.4 months), another 16 total occlusions were observed and one patient was successfully managed by a second implantation. The final occlusion rate was 83% (76 cases). Of the 16 residual shunts, five wer e surgically suppressed and the remaining were minimal. Conclusion. - Transcatheter occlusion of the patent ductus arteriosus is safe in chi ldren weighing more than 5 kg, having ducts with a narrowing ranging f rom 1 to 6 mm. It is efficient in five out of six cases and has less d isadvantages than surgery.