TRANSFEMORAL CLOSURE OF PATENT DUCTUS-ARTERIOSUS IN ADULT PATIENTS

Patent ductus arteriosus is an uncommon anomaly in adult patients. Sur gical closure of patent ductus arteriosus in this age group presents d ifficult problems to-the surgeon. We report our experience of 21 adult patients (19-62 years of age, mean 40 years) who underwent closure of the ductus by transfemoral implantation of a Rashkind double umbrella device. The patients came to light because of atrial fibrillation, co ngestive heart failure, residual flow after surgical ligation of the d uct or because of incidental diagnosis made during physical examinatio n or chest X-ray. In ten patients the pulmonary arterial pressure was normal (systolic pressure < 30 mmHg), in eleven it was elevated (systo lic pressure from 30 to 100 mmHg, mean 50 mmHg). In seven patients the duct was clearly calcified and the size of the duct varied from 3 to 9 mm (mean 4.3 mm). In 16 patients the ductus resulted perfectly close d after implantation of the first double umbrella device, two patients had minimal residual aortopulmonary flow, whereas in three patients t he residual shunt was significant; two of these also developed haemoly sis and went to surgery, in the latter the shunt was completely abolis hed after implantation of a second 17-mm device 16 months later. In co nclusion transcatheter closure of patent ductus arteriosus in adults i s feasible, even in the presence of calcifications and/or pulmonary hy pertension; taking into account the significant surgical risk, PDA umb rella closure should be considered the first choice procedure in this group of patients.