Transcatheter closure of patent ductus arteriosus with the Rashkind occluder: Acute results and angiographic follow-up in adults

Abstract

We performed catheter closure of a patent ductus arteriosus with a Rashkind occluder in 51 adult patients (aged 14 to 76 years). The diameter of the ductus ranged from 2 to 13 mm (mean 4.5 +/- 2.0 mm), QP:QS from 1.0 to 2.6 (mean 1.6 +/- 0.3). The procedure was successful in 50/51 patients, in one of them at a second attempt. In one patient, the ductus could not be closed even with additional occluders. This patient was sent for surgery. In two patients with a large ductus, two Rashkind umbrellas were implanted simultaneously. Immediately after ductus closure, there was a residual shunt in 40/50 patients decreasing to 26/50 after 20 min. Two of the patients with a residual shunt suffered from haemolysis. In 16 patients, the residual shunt disappeared spontaneously within some months. In 15 patients, additional occluders (a second occluder in 12, a third occluder in one, and a fourth and fifth occluder in another) were implanted during the initial procedure or during follow-up. All patients were followed until angiography proved complete closure of the ductus. At the time of the last follow-up angiogram, the ductus was occluded in 49/50 patients; one patient refused a follow-up angiogram. Ductus occlusion with the Rashkind umbrella can be considered a technique with a high success rate and low rate of complications in adults. However, a residual shunt is not uncommon. Additional occluders have to be implanted in many patients.

Asymptomatic patent ductus arteriosus in a 41-year-old woman

“…Surgical or percutaneous techniques may be used for the closure of PDA. Transcatheter techniques include percutaneous coil occlusion, Amplatzer duct occluder (ADO), and Rashkind occluder [6,7]. For small and intermediate sized PDAs, single or multiple steel coils are appropriate.…”

Angeborene Herzfehler und erworbene Herzklappenfehler in der Schwangerschaft

“…Chirurgische Interventionen während der Schwangerschaft sind heute kaum noch erforderlich. In den sehr seltenen Fällen einer medikamentös nicht beherrrschbaren Dekompensation des linksventrikulären Myokards ist der katheterinterventive Ductusverschluss Therapie der Wahl [60].…”

Patent ductus arteriosus

“…Device closure obviates the need for general anesthesia and a surgical incision and eliminates postoperative pain, long convalescence, and lifelong scarring. Over the past 20 years, the efficacy and safety of transcatheter device closure of PDA in adults has been established [1][2][3][4][5]. Even though the immediate success rate is lower with transcatheter device closure than with surgical closure, transcatheter reintervention for residual clinical shunts is very effective at abolishing residual leaks.…”

“…Since the first report of transcatheter PDA closure appeared in 1967 [11], various devices have been used with varying results [1][2][3][4][5][12][13][14][15][16][17][18][19][20][21]. The greatest experience in the adult population has been with the Rashkind device, the efficacy and safety of which are well documented [1][2][3][4][5]. Use of the Rashkind device avoids general anesthesia, thoracotomy, postoperative pain, and prolonged convalescence; thus, it is a very attractive option.…”

“…Immediate clinical closure, defined as the absence of murmur after surgery, is achieved in more than 99% of patients, and reoperation is rarely needed. Functional class improvement is seen in most symptomatic patients after successful closure [5,26]. The incidence of silent residual leaks on echocardiography at 4 months' follow-up is surprisingly high-23% [27]-but decreases to 6% [28] at 3 years, presumably as a result of late spontaneous closure.…”