TRANSCATHETER CLOSURE OF THE DUCTUS-ARTERIOSUS IN CHILDREN AND YOUNG-ADULTS

Transcatheter occlusion of persistent patent ductus arteriosus (PDA) w as attempted in 32 patients (22 female and 10 male, mean age 5.12 +/- 3.98 years, range 9 months to 19.2 years) using Rashkind's occluder de vice (USCI). Implantation of a second occluder device was attempted in three of the patients. Device embolization to a pulmonary artery occu rred in three patients, all with the 12 mm occluder device; two of the se devices were retrieved by grabber catheter and the last with thorac otomy without adverse sequelae. Embolization to the right atrium occur red in another patient during a second device implantation attempt bec ause of fluoroscopy problems; this patient required open-heart surgery with sequala of 2 (+) tricuspid insufficiency. In another patient wit h a significant shunt after the implantation of a 17 mm occluder devic e, mechanical hemolysis developed, but surgical intervention was not r equired. The overall complication rate was five out of 35 implantation procedures (14.3%). Besides these, sublingual nifedipine was required for two patients whose systolic blood pressure exceeded 160 mmHg just after the implantation procedure. Sixteen 12 mm and fifteen 17 mm occ luder devices were successfully and uneventfully implanted in the firs t procedure, except for two patients in whom a 17 mm occluder device w as Implanted after retrieval of an embolized 12 mm occluder. Overall e arly and mid-term complete occlusion was achieved in 24 patients (75%) . Complete occlusion of PDA in the first days after the procedure was achieved in all patients, with the narrowest ductal diameter of less-t han 3 mm with the 12 mm occluder device, and less than 6 mm with the 1 7 mm occluder device. Catheter occlusion of the PDA using Rashkind's u mbrella appears to be a safe and effective method of nonsurgical manag ement. However, good fluoroscopy, an experienced team, careful monitor ing of systemic blood pressure, a good patient selection and a prefere nce for the 17 mm occluder device when possible is highly recommended.