[Catheter closure of open ductus arteriosus--the first 100 patients]
P G Bjørnstad1, J Westvik, R Rian
1Barneklinikken, Rikshospitalet, Oslo.
Insights
Catheter-based closure of patent ductus arteriosus (PDA) is effective, with high closure rates using devices like umbrellas, coils, and Amplatzer ductal occluders. This technique is now the preferred treatment over surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) treatment increasingly utilizes catheter-based techniques.
- This study reports outcomes for the first 100 patients treated with these methods by the end of 1998.
Purpose of the Study:
- To evaluate the efficacy and safety of catheter-based closure devices for PDA.
- To compare outcomes between different occluding devices.
Main Methods:
- 100 patients (0.6-31.4 years) were treated with Rashkind umbrellas (60), Cook PDA coils (31), or Amplatzer ductal occluders (10).
- Some patients required reintervention with the same or different devices.
Main Results:
- Overall complete closure rate was 90% after reinterventions.
- Primary closure rates: 100% for pegs, 85% for umbrellas, 97% for coils.
- One coil embolization (2.5%) occurred; no umbrella or peg embolizations were reported.
Conclusions:
- Catheter closure of PDA is a favorable alternative to surgery and is the established method of choice.
- The introduction of new devices like pegs removes upper size limits for PDA treatment.
Background:
Patent ductus arteriosus is increasingly treated with catheter based techniques. We present our results as by the end of 1998 of the first 100 patients given such treatment.
Material And Methods:
The 100 patients between 0.6 and 31.4 years were initially treated with one of these devices: The Rashkind umbrella (60 patients), Cook PDA coils (31 patients) or Amplatzer ductal occluders (ten patients). Seven umbrella patients were treated twice, one with an additional umbrella, six with coils; two coil patients twice, one with another coil and one--after embolisation--with a peg.
Results:
The overall complete closure rate for all groups was 90% after nine patients had been treated a second time. The primary complete closure rate in pegs was 100%, after reintervention 85% in umbrella and 97% in coil patients. Neither umbrellas nor pegs have embolised. One coil embolised in the course of implantation of 40 coils (2.5%). No other complication has occurred.
Interpretation:
The closure of the arterial duct with catheter techniques compares favorably with surgery and is now established as the method of choice. Following the investigational introduction of pegs there is no longer an upper limit in the size of ducts suitable for such treatment.
