TOTAL UK MULTICENTER EXPERIENCE WITH A NOVEL ARTERIAL-OCCLUSION DEVICE (DUCT OCCLUD PFM)

Objective-To report the total UK multicentre experience of a novel art erial occlusion device (Duct Occlud pfm). Design-Descriptive study of selected non-randomised paediatric patients with a variety of aortopul monary connections. Setting-Five UK tertiary referral centres for cong enital heart disease. Patients and methods-Between March 1994 and Febr uary 1995, 57 children aged 2 weeks to 14 years (median 50 months) und erwent attempted closure of their aortopulmonary connection. Fifty one had persistent arterial ducts and 9 of them had had a Rashkind umbrel la device implanted. Five patients had superfluous modified Blalock-Ta ussig shunts (mBTS). in one there was also a native major aortopulmona ry collateral artery (MAPCA). Another patient had a native major aorto pulmonary connection (APC). Transcatheter occlusion was attempted in a ll cases through a 4 F delivery catheter. Results-Devices were success fully deployed in 49/57 (86%) patients. Seven of 51 cases with persist ent arterial ducts were judged too large for the device and a Rashkind umbrella was used. 40 (91%) of the 43 in whom the detachable coil dev ice was used had complete occlusion at 24 hours on colour flow Doppler echocardiography. Devices were successfully deployed in all 6 remaini ng patients (4 mBTS, 1 mBTS + MAPCA, and 1 APC). Embolisation of a dev ice occurred on 4 occasions. Two devices were not retrieved but caused no apparent clinical problems. Conclusion-This novel detachable coil type occlusion system compares favourably with other methods of transc atheter occlusion of native, residual, or surgically created aortopulm onary shunts. The delivery system allows its use in small children.