RASHKIND-PDA-OCCLUDER AND DETACHABLE META L COIL FOR THE INTERVENTIONAL OCCLUSION OF THE PERSISTENTLY PATENT DUCTUS-ARTERIOSUS

The intention of this study was to determine the efficacy and complica tion rate of the interventional duct occlusion. Furthermore, we wanted to compare the meanwhile well-known Rashkind-PDA-Occluder system (ROS ) with the results of the considerably cheaper detachable duct occlude coils (PDA-S). For this purpose, we analyzed the data of 53 consecuti ve patients who received a total of 28 ROS and 25 PDA-S. The ROS was i mplanted in the slightly larger ducts (phi 3.1 +/- 0.6 mm), the PDA-S in the smaller ones (phi 2.2 +/- 0.6 mm). The rate of residual shuntin g was 20 % in the ROS-group (follow-up: 104 to 1099 days, mean 580 +/- 300 days) and 7.7 % in the PDA-S-group (follow-up: 90 to 384 days, me an 161 +/- 101 days). One patient after ROS showed a significant resid ual shunting and received 2.5 years after the first procedure a PDA-S which eliminated the shunt. In a second patient the attempt of implant ing two coils in a 4 mm duct resulted in the embolization of the first coil into the right pulmonary artery. The coil could not be retrieved and was left in the pulmonary artery without sequelae. All other pati ents received only one ROS or one PDA-S. There were no further complic ations. The complication rate for all interventional duct occlusions t herefore was 1.9 % (0 % for the ROS-group; 4.0 % for the PDA-S-group). In comparison with the Gianturco coils that have been introduced sinc e 1975, the new detachable coils can be manipulated much more easily b ecause they remain fixed at the delivery wire until an ideal position is achieved. Then the coil is set free by unscrewing it from the deliv ery wire. For small ducts with a diameter up to 3 mm the detachable co il is an effective and cheap alternative which can be handled easily. Because of the smaller delivery systems in comparison to the ROS (4-5 F versus 8 F or 11 F) the PDA-S is also suitable for small children an d infants. Larger ducts should be closed with the ROS.