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[Closure of patent ductus arteriosus using interventional catheterization]
V Verin1, B Friedli, I Oberhänsli
1Centre de cardiologie, Hôpital cantonal universitaire de Genève.
Insights
The Rashkind technique effectively closes patent ductus arteriosus (PDA) in adults and children, avoiding surgery. This percutaneous method shows high efficacy and safety, with most patients achieving complete closure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Surgical closure (thoracotomy) is the traditional treatment but carries risks.
- Percutaneous closure offers a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of the Rashkind technique for percutaneous PDA closure.
- To assess outcomes in a cohort of patients treated since 1989.
Main Methods:
- Retrospective analysis of 16 patients undergoing percutaneous PDA closure using the Rashkind umbrella device.
- Procedures performed via transvenous femoral or transarterial approach.
- Device size (12 mm or 17 mm) selected based on ductus diameter.
Main Results:
- Successful closure achieved in all patients, with 8 showing total occlusion and 8 partial closure initially.
- No mortality or morbidity reported.
- Complete closure confirmed by follow-up Doppler in 13 patients, eliminating the need for endocarditis prophylaxis.
Conclusions:
- The Rashkind technique is an effective and safe method for percutaneous PDA closure, avoiding thoracotomy in most cases.
- The procedure is well-tolerated across a wide age range.
- Further device miniaturization could enable application in neonates.
Abstract:
Percutaneous closure of patent ductus arteriosus can be performed with the Rashkind technique. This procedure has been performed in 16 patients in Geneva since 1989. The age of the patients varied from 2 to 44 years (4 boys, 7 girls, and 5 women). Pulmonary hypertension was present in only 1 child. A 12 mm Rashkind umbrella was used in 11 patients with ductus of < or = 4 mm inner diameter, while a 17 mm umbrella was used in 5 cases for larger ducts. Ductus closure was carried out through a transvenous femoral approach in 15 cases, while in 1 patient a transarterial approach was employed because of impossibility of passing the ductus from the pulmonary artery. There was neither mortality nor morbidity in this series. The aortography performed just after device placement showed total ductus occlusion in 8 patients and partial closure in 8 others. The follow-up by color Doppler showed disappearance of the residual shunt in 4 of these 8 patients. Prophylaxis of bacterial endocarditis is therefore no longer necessary in 13 patients with complete ductus closure. Our experience with this technique confirms its efficacy and the possibility it offers of avoiding thoracotomy in the vast majority of patients with a patent ductus arteriosus. Further miniaturization of the device and delivery system should make it applicable in the neonatal period.