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[Ductus closure in adults with the Rashkind device: comparative results]
E Novo García1, R Bermúdez, I Herraiz
1Servicio de Cardiología, Hospital General Universitario, Guadalajara.
Insights
Transcatheter closure of the persistent ductus arteriosus using the Rashkind device is effective and safe in adults. This method shows excellent early results, with age being a key predictor of successful occlusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- The Rashkind device offers a transcatheter alternative to surgical closure for persistent ductus arteriosus (PDA), primarily demonstrated in pediatric cases.
- Limited data exists on the efficacy and safety of this method in adult patients with PDA.
Purpose of the Study:
- To evaluate the outcomes of transcatheter occlusion of PDA using the Rashkind device in adult patients.
- To compare the results in adults with those in children.
Main Methods:
- A retrospective study of 127 patients (105 children, 22 adults) who underwent PDA occlusion with the Rashkind device between 1990 and 1996.
- Analysis included immediate aortography and follow-up at 24 hours, 6 months, and 12 months using color-Doppler echocardiography.
Main Results:
- Adults presented more frequently with asymptomatic and silent PDA. Despite higher pulmonary pressures in children, ductal anatomy and diameter favored adults.
- Complication rates were significantly lower in adults (0% vs. 4.72% in children).
- Transcatheter closure was more effective in adults, with age identified as an independent predictor of complete occlusion.
Conclusions:
- Transcatheter occlusion of PDA with the Rashkind device is safe and effective in adults.
- Excellent early results were observed in adults, even with a higher incidence of silent, asymptomatic PDA.
- The study supports the use of the Rashkind device for PDA closure in adult populations.
Introduction:
Catheter occlusion of the persistent ductus arteriosus with Rashkind device is an alternative to the surgical closure demonstrated in children, 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 Raskind device. Two groups according age: 105 children (< 14 years) and 22 adults (> 14 years), were studied 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 incidence (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 children (12.50 +/- 2.97 vs 16.84 +/- 5.88 mmHg; p = 0.003). In group > 14 years the ductal anatomy favorable (Krichenko type A or B) was 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 frequently (91 vs 61%; p = 0.02). Absence complications (embolization, bacteremia, haemolysis, proximal stenosis of the left pulmonary artery) were found in adults against 4.72% in children. The occlusion were 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 ductus.