TRANSCATHETER OCCLUSION OF PATENT DUCTUS-ARTERIOSUS IN ADULTS

This study examines whether transcatheter closure of a patent ductus a rteriosus (PDA) using a Rashkind PDA occluder device is safe and effec tive in adults, or if adults have complications not sited in children owing to prolonged aorticopulmonary communication, high surgical risks or calcified PDAs. Fifteen patients aged 22 to 76 years (mean 42 +/- 14) were referred for transcatheter PDA occlusion. Exercise intoleranc e was the most frequent clinical manifestation. Eleven of 15 patients had surgical risk factors that included left ventricular failure (n = 10), biventricular failure (n = 1), elevated pulmonary pressures (n = 1), and a calcified PDA (n = 5). Twelve millimeter devices were placed in 4 PDAs less-than-or-equal-to 3 mm in diameter; 17 mm devices were placed in 11 PDAs 3 to 6 mm in diameter. Seven (47%) were occluded ang iographically shortly after device placement; another 5 PDAs (33%) wer e occluded echocardiographically within 24 hours of the procedure. Com pleted occlusion in this time interval was more likely to occur in PDA s < 5 mm in diameter (p = 0.0009). Of the 3 remaining PDAs with follow -up ranging from 9 to 38 months, 2 have demonstrated gradual diminutio n of shunting and have trivial leaks by color/Doppler flow. The other patient with a residual PDA has no ductal flow after placement of a se cond device. No complications related to device implantation or closur e of the PDA occurred in any patient. No complications were reported i n the follow-up patients who received evaluation (14 of 15 patients; r ange 1 to 38 months). All patients with exercise intolerance had impro vement, usual beginning within 1 day of their procedure.