U. Aydogan et al., TRANSCATHETER CLOSURE OF THE DUCTUS-ARTERIOSUS IN CHILDREN AND YOUNG-ADULTS, Turkish Journal of Pediatrics, 37(2), 1995, pp. 103-109
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.