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[Patent ductal arteriosus occlusion by Rashkind umbrella and by detachable coil]
M N Mahayni1, M Pépin-Donat, D Saillant
1Unité de cardiologie pédiatrique, service de pédiatrie, hôpital Clocheville, 49, bd Béranger, 37044 Tours.
Insights
Detachable coils offer a faster and more effective closure for patent ductus arteriosus (PDA) compared to Rashkind umbrellas, resulting in a significantly lower rate of residual shunts. This interventional catheterization technique provides a superior long-term outcome for patients with PDA.
Area of Science:
- Interventional Cardiology
- Pediatric Cardiac Catheterization
- Congenital Heart Disease
Context:
- Patent ductus arteriosus (PDA) is a common congenital heart defect requiring closure.
- Interventional catheterization offers a less invasive alternative to surgical repair.
- Comparing closure devices is crucial for optimizing treatment strategies.
Purpose:
- To compare the efficacy and outcomes of Rashkind umbrella versus detachable coil closure for PDA.
- To evaluate medium-term results using clinical assessment and color Doppler echocardiography.
- To analyze rates of residual shunt, spontaneous closure, and need for re-intervention.
Summary:
- A retrospective study of 69 patients (10 months-18 years) undergoing PDA closure with Rashkind umbrellas (n=29) or detachable coils (n=40).
- Initial residual shunt rates were comparable, but detachable coils showed significantly lower rates at 6 and 12 months (3.3% vs. 39%).
- Spontaneous shunt disappearance was faster with coils, and fewer patients required re-intervention, indicating better long-term outcomes.
Impact:
- Detachable coils represent a more effective interventional method for PDA closure.
- This technique leads to faster resolution of residual shunts and improved patient outcomes.
- Findings support the use of detachable coils as a preferred device for PDA interventional closure.
Unlabelled:
The objective of this study is to report all of our experience of patent ductus arteriosus closure by interventional catheterisation, comparing two systems used successively: Rashkind umbrella and detachable coil.
Method:
Between January 1991 and July 2001, 72 patients underwent cardiac catheterisation in order to occlude patent ductus arteriosus (PDA). In 3 patients closure was not attempted (n = 1) or aborted (n = 2). The 69 patients in whom one or several prostheses were implanted are the object of this retrospective study. The patients were between 10 months and 18 years old (median 4 years), weighing between 6.7 and 54 kg (median 17 kg). The narrowest average angiographic diameter of the PDA was 2.2 mm (1 to 4 mm), type A in the Krichenko classification in 59 cases. The PDA was occluded by an umbrella in 29 patients (group 1), and from 1997 coils were used in 40 patients (group II). The medium term results were evaluated clinically and by colour doppler echocardiography.
Results:
The age, weight, size and type of PDA were similar in the 2 groups. Group 1: 28 patients were treated with a single umbrella and one patient received 2 umbrellas. Systemic embolisation occurred in one case. The average period of follow-up was from 4 years to 10 years (average 6.5 years). The rate of residual shunt at 24 h, 6 months, and 12 months was 43%, 43%, and 39% respectively. A second implant was necessary in 2 children after 7 months and 30 months. The spontaneous disappearance of residual shunt was observed in 8 patients after between 1 month and 54 months (average 33.5 months). A slight residual shunt persisted in 4 patients (13.7%), 4.5 to 8.5 years after placing one or two umbrellas. The patients with a residual shunt were younger: 37 months versus 73 months (p < 0.05). Group II: 34 patients received a single coil and 6 patients several coils. Two cases of embolic migration and two cases of haemolysis were observed. The follow-up extended from 4 months to 4.5 years (average 2.2 years). The rate of residual shunt at 24 h, 6 months, and 1 year respectively was 35%, 10.5%, and 3.3%. At 6 and 12 months this rate was significantly less in group I (p < 0.01). Implantation of supplementary coils was necessary in 2 children at 24 h and at 9 months. Spontaneous disappearance of residual shunt occurred in 10 children out of 14 with an average interval of 5.5 months. A weak residual shunt remained detectable in 2 patients (5%) at 6 months and 36 months.
Conclusion:
The rate of initial residual shunt is comparable using both techniques. Spontaneous disappearance of residual shunts was observed in the majority of cases, but with the detachable coils this outcome is faster and the final rate for residual shunt is very low.