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[The midterm evolution in the percutaneous closure of ductus arteriosus with the Rashkind prosthesis]
J I Zabala Argüelles1, J García Fernández, J L Zunzunegui Martínez
1Departamento de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
Percutaneous patent ductus arteriosus (PDA) occlusion using a Rashkind device is a safe and effective alternative to surgery for all age groups. This minimally invasive procedure achieved high occlusion rates, even in infants, with good long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Percutaneous patent ductus arteriosus (PDA) occlusion is an alternative to surgical closure.
- This study evaluated the safety and efficacy of percutaneous PDA occlusion in different age groups.
Purpose of the Study:
- To assess the outcomes of percutaneous PDA occlusion using Rashkind devices.
- To compare results between pediatric patients younger than 18 months (Group I) and older patients (Group II).
Main Methods:
- 44 patients underwent percutaneous PDA occlusion between April 1990 and July 1994.
- Patients were divided into two groups based on age: Group I (<18 months) and Group II (>18 months).
- Color Doppler was used to assess residual shunt; device embolization and removal were documented.
Main Results:
- Overall occlusion rates were 75% (Group I) and 64.5% (Group II) immediately after implantation.
- At 6 months, occlusion rates improved to 83% (Group I) and 84% (Group II).
- After a second device implantation, occlusion rates reached 100% (Group I) and 97% (Group II) with minimal residual shunt.
Conclusions:
- Percutaneous PDA occlusion with Rashkind devices is a valid therapeutic option for all age groups.
- The procedure demonstrated high success rates and acceptable complication profiles.
- This technique offers a viable alternative to surgical closure for patent ductus arteriosus.
Abstract:
Background percutaneous PDA occlusion has been proposed as a valid therapeutic alternative to surgical closure. Between April 1990 and July 1994, 44 patients underwent percutaneous PDA occlusion. Thirteen patients were less than 18 months old and weighed 8.7 +/- 3.2 Kg (Group I). Thirty-one patients, older than 18 months of age, had a mean weight of 36.8 +/- 20.6 Kg (Group II). Four patients in group I and two in group II had associated cardiac anomalies Residual shunt after percutaneous occlusion was studied by color Doppler. Fifty-one occluding devices were used. Forty-nine were implanted and there were two device embolizations. Twelve devices were implanted in group I. One device needed surgical removal from the right ventricle where it had embolized. In group II, 31 devices were implanted and one embolized to the descending aorta and was percutaneously removed through the femoral artery sheath. In two patients of group I and four of group II, a second device was implanted. The total occlusion rate immediately after implantation at 24 hours and at 6 months was 75%, 83% and 83% in group I and 64.5%, 77% and 84% in group II. After implantation of a second device the total occlusion rate without residual shunt reached 100% in group I (after 16 +/- 12 months follow-up) and 97% in group II (after 23 +/- 16 months of follow-up). We conclude that percutaneous ductal occlusion with a Rashkind device is a valid therapeutic alternative to surgical closure in all age groups.