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Transcatheter closure of patent ductus arteriosus in pediatric patients
L A Latson1, P J Hofschire, J D Kugler
1Department of Pediatrics, University of Nebraska Medical Center, Omaha 68105.
Insights
Transcatheter closure of patent ductus arteriosus (PDA) using the Rashkind occluder is feasible in most children. This minimally invasive procedure offers a shorter hospital stay and is preferred by families over surgical ligation.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect in infants and children.
- Traditional surgical ligation is effective but invasive.
- Transcatheter device closure offers a less invasive alternative.
Purpose of the Study:
- To evaluate the feasibility and efficacy of the Rashkind PDA occluder system for transcatheter closure of PDA.
- To assess procedural success rates, clinical outcomes, and patient/family preference.
Main Methods:
- A retrospective analysis of 37 infants and children (excluding premature neonates) with isolated PDA.
- Use of the "double disk" Rashkind PDA occluder system for transcatheter closure.
- Assessment of procedural success, residual shunts via echocardiography and Doppler, and hospitalization duration.
Main Results:
- The Rashkind occluder was suitable for 78% of patients and successfully placed in 25 out of 27 procedures.
- Only one patient required device removal due to a significant residual shunt.
- No clinical evidence of residual PDA was observed; hospitalization was <24 hours for most procedures.
- Echocardiography showed normal chamber dimensions, with minor residual leaks in three patients detected by Doppler.
Conclusions:
- Transcatheter closure of PDA with the Rashkind occluder is a feasible and effective option for the majority of pediatric patients.
- The procedure is associated with high success rates, minimal residual shunting, short hospital stays, and strong family preference over surgery.
Abstract:
A "double disk" occlusion device (Rashkind PDA occluder system) has been designed to allow transcatheter closure of patent ductus arteriosus (PDA). During a 3-year period, we examined 37 infants and children (not premature neonates) with PDA as their only significant cardiovascular defect. Seventy-eight percent of these patients were considered potential candidates for the use of the PDA occlusion device, and it was successfully placed in all but 2 of 27 patients who underwent cardiac catheterization (PDA too small in one and too large in one). Only one of the remaining 25 patients had a significant residual shunt after placement of the device, which therefore was removed in the catheterization laboratory before surgical ligation of the PDA. There was no clinical evidence of a residual PDA in any patient. The duration of hospitalization was less than 24 hours for each of the last 20 procedures. Echocardiography demonstrated return to normal chamber dimensions in all patients, but a tiny, clinically undetectable residual leak around the device was found in three patients by Doppler evaluation. The transcatheter procedure was preferred over surgery by more than 90% of families and can be completed with a much shorter hospitalization than surgical ligation. We conclude that transcatheter closure of patent ductus arteriosus is feasible in the majority of children with PDA.