TRANSVENOUS TRANSCATHETER CLOSURE OF A PE RSISTENT DUCTUS-ARTERIOSUS WITH AN IVALON(R) PLUG

Objective: To assess a new transvenous transcatheter method of closing a persistent ductus arteriosus, combining advantages of the Porstmann and Rashkind techniques. Patients and methods: Five patients (three m en, two women, mean age 36.2 [19-56] years) underwent the procedure. T he diameter of the duct was 3-6 mm. A compressed lvalon(R) (polyvinyl- alcohol) foam plug, introduced and held by a modified biopsy forceps, was placed into the duct via a percutaneously and transvenously placed catheter sheath. Small titanium legs attached to the plug at the aort ic and pulmonary ends unfolded once the plug was correctly placed, ens uring safe fixation. Results: Closure was achieved in all five patient s and no shunt demonstrated immediately afterwards in four. In one pat ient a small shunt briefly persisted but was not longer present the da y after. One patient had a fever of up to 39 degrees C for several wee ks that required no treatment and was thought to have been a foreign-b ody reaction. Follow-up examination after 5-19 months confirmed comple te closure. Conclusion: The described method appears to be safe and su perior to the Porstmann and Rashkind techniques, but the results must be tested on a larger number of patients with longer followup.