RESIDUAL SHUNT AFTER PERCUTANEOUS OCCLUSI ON OF PATENT DUCTUS-ARTERIOSUS WITH THE RASHKIND DEVICE - ECHOCARDIOGRAPHIC APPEARANCES, OUTCOME,PROGNOSTIC FACTORS AND MANAGEMENT

Percutaneous occlusion of patent ductus arteriosus with the double umb rella Rashkind prosthesis is an alternative to surgery. The authors re port the results of a series of 40 patients aged 16 to 203 months, who underwent transcatheter occlusion of patent ductus arteriosus between January 1989 and March 1993. These children were followed up regularl y, clinically and by echocardiography to determine the presence or abs ence of a residual shunt. Immediately after implantation, angiography showed a residual shunt in 75 % of cases. However, the shunt progressi vely regressed during follow-up. Three types of shunt were described u sing colour Doppler based on the diameter of the transductal jet at it s origin and its extension in the pulmonary artery : type I, a wide je t (> 3 mm), type II, or minimal shunt, with a jet diameter of 2 to 3 m m and an extension to the pulmonary valve (flame-like), and finally th e type III, or punctiform shunt with a jet diameter < 2 mm and extensi on in the main pulmonary artery < 1.5 cm. During follow-up, a transiti on between the 3 types was observed in 37 % of cases. Kaplan-Meier act uarial analysis showed a residual shunt rate of 33 % at one year and 1 9 % at 2 years after implantation. The search for predictive factors o f residual shunt showed that very young patients at the time of cathet erisation was the only indicator of a residual shunt (p = 0.03). Occlu sion of a patent ductus arteriosus with a Rashkind device is a reliabl e method which gives good results. The essential problem remains that of a residual shunt but this disappears in 3/4 of patients during foll ow-up. When the shunt persists, a 1 to 2 year interval is advised befo re considering implantation of a second occluder.