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Two-dimensional echocardiographic and color flow Doppler evaluation of ductal occlusion with the Rashkind prosthesis
N N Musewe1, L N Benson, J F Smallhorn
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Rashkind prosthesis occlusion for patent ductus arteriosus shows higher initial residual shunting than surgical ligation. However, residual shunting decreases over time with spontaneous resolution and reocclusion, indicating effectiveness.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Both surgical ligation and device occlusion are used to treat PDA.
- Understanding the long-term efficacy and residual shunting rates of different PDA closure methods is crucial.
Purpose of the Study:
- To evaluate the outcomes of ductal occlusion using the Rashkind prosthesis in children with PDA.
- To compare the prevalence of residual ductal shunting after Rashkind prosthesis occlusion versus surgical ligation.
- To assess pulmonary arterial flow patterns post-occlusion.
Main Methods:
- Retrospective evaluation of 78 children (Group 1) who underwent Rashkind prosthesis occlusion for PDA.
- Comparison with 30 children (Group 2) who had surgical PDA ligation.
- Assessment using pulsed and color flow Doppler at various follow-up intervals (9 +/- 7 months post-occlusion, 44 +/- 58 months post-ligation).
Main Results:
- Initial residual ductal shunting in Group 1 was 38%, decreasing to 19.7% at 1 year or more.
- Residual shunting rate in Group 2 (ligation) was significantly lower at 6% compared to Group 1 at 1 year (p < 0.001).
- Successful reocclusion in a subset of Group 1 patients further reduced residual shunting.
Conclusions:
- Residual ductal shunting is more common after Rashkind prosthesis occlusion than surgical ligation.
- However, residual shunting after Rashkind prosthesis occlusion demonstrates a trend of decrease over time.
- Spontaneous shunt resolution and successful reocclusion contribute to improved outcomes with Rashkind prosthesis.
Abstract:
To evaluate the results of ductal occlusion with the Rashkind prosthesis, 78 children (group 1, 19 boys and 59 girls; mean age at occlusion, 4.5 +/- 4.0 years) with isolated patent ductus arteriosus (n = 73) or in association with other lesions (n = 5) were evaluated by pulsed and color flow Doppler 9 +/- 7 months (range, 2-26 months) after occlusion. Thirty children who had undergone patent ductus arteriosus ligation (group 2, 9 boys and 21 girls; mean age at study, 5.7 +/- 4.9 years; mean follow-up after ligation, 44 +/- 58 months) were evaluated in the same way. The prevalence of residual ductal shunting and the main pulmonary arterial flow patterns were recorded. Residual ductal shunting in group 1 was 38% on day 1, decreasing slowly to 31% at 3 months, 27% at 6 months, and 19.7% at 1 year or more due to further spontaneous shunt resolution. The residual shunting rate in group 2 (6%) was significantly lower than that at 1 year or more in group 1 (p less than 0.001). Successful reocclusion in 5 of 6 in a subset of patients in group 1 followed for 1 year or less reduced further the prevalence of residual shunting. Residual shunting after patent ductus arteriosus occlusion is more common than after ligation, but continues to decrease during follow-up.