[The percutaneous closure of the ductus arteriosus in adults]

From May 1990 to June 1998, 116 patients were submitted to percutaneous closure of patent ductus arteriosus. There were 18 adult patients, aged 18 to 61 years. Two patients had residual ductus after an attempted surgical ligation and two other patients had a calcified ductus. A device was not implanted in three patients, two of whom because of pulmonary hypertension being considered irreversible. Another patient, with a very large duct, underwent attempted occlusion, but the device embolized to the pulmonary artery and was retrieved percutaneously in the same session. This patient was operated later. Complete duct occlusion, confirmed by color Doppler echocardiography, was achieved in 14 of the remaining 15 patients (93%; 95% CL: 81-100). This was performed with a single catheterization in 12 cases, with implantation of one or more detachable coils in 8 patients; with a Rashkind device in 3, and a combination of a Rashkind device and coils in 1. In two cases complete duct occlusion required a second catheterization for implantation of additional detachable coils, including one patient with intravascular hemolysis in whom resolution of this problem was achieved with additional coils. In recent years, we have preferentially used detachable coils implanted through 5 Fr catheters, with a controlled release mechanism. This is a safer and less expensive device. Patients with pulmonary hypertension can be submitted to a trial occlusion of the duct with a balloon catheter to evaluate the response of pulmonary artery pressures. Percutaneous closure of the patent ductus arteriosus can be performed with excellent results in adults. Complete occlusion was achieved in 14 of the 15 patients (93%) without pulmonary hypertension or extremely large ductus. This is similar to our results in the pediatric population.