Ductal closure by Rashkind device in adults: Comparative results

Introduction. Catheter occlusion of the persistent ductus arteriosus with R ashkind device is an alternative to the surgical closure demostrated in chi ldren, however a few results have been reported of occlusion in adults. Method From 1990 to 1996 in 127 patients with persistent ductus arteriosus undergoing occlusion by Rasking device. Two groups according age: 105 child ren (< 14 years) and 22 adults (> 14 years), were estudied retrospectively. The results were analysed by immediate aortogram and follow-up at 24 hours , 6 and 12 months by color-Doppler echocardiograms. Results. The adults were frequently asymptomatic (86%) and with high incide nce (59%) of silent ductus. Similar QP/QS (1.61 +/- 0.47 in adults vs 1.49 +/- 0.51) was calculated although pulmonary pressure was superior in childr en (12.60 +/- 2.97 vs 16.84 +/- 5.88 mmHg; p = 0.003). In group > 14 years the ductal anatomy favorable (Krichenko type A or B) mas more frequent (91% vs 73%; p = 0.06) and ductal diameter significantly higher (3.03 +/- 1.50 vs 2.41 +/- 0.96 mm; p = 0.009). In adults 17 mm umbrella were used more fr equenly (91 vs 61%; p = 0.02). Absence complications (embolization, bactere mia, haemolysis, proximal stenosis of the left pulmonary artery) were found in adults against 4.72% in children. The occlusion mere more effective in adults specially in early controls: 55% vs 34%, (p = 0.09), 82% vs 69%, 91% vs 77 % and 95% vs 83% (p > 0.10). Multivariate analysis identified age as an independent predictor of complete occlusion. Conclusion. Our experience in transcatheter occlusion of persistent ductus arteriosus with Rashkind device in adults support the efficacy, safety and excellent early results despite higher incidence of silent asymptomatic duc tus.