Circulation, Vol 84, 2313-2317, Copyright © 1991 by American Heart Association
MC Hosking, LN Benson, N Musewe, JD Dyck and RM Freedom
BACKGROUND. Percutaneous closure of the persistently patent ductus
arteriosus with the Rashkind prosthesis is an established effective
therapeutic modality, although some patients are left with residual
shunting. To evaluate this, a retrospective study of the prevalence of
persistent shunting over a 40-month period in the first 190 patients was
undertaken. METHODS AND RESULTS. All patients (male 45, female 145; mean
age, 3.9 +/- 3.6 years; range, 5 months to 20 years) had serial clinical
and color-flow echocardiographic follow-up at 6-12-month intervals (range,
6-40 months). Four patients required surgical removal of an embolized
device, leaving a cohort of 186 patients in whom 196 procedures were
performed, resulting in successful placement of 195 devices (43 17-mm [22%]
and 152 12-mm [78%]). Complications occurred in seven of 195 procedures
(3.6%). Nine of 10 attempted reocclusions (all with 12-mm devices) were
successful. The prevalence of residual shunting was 38% at 1 year, 18% at 2
years, and 8% at 40 months. Patients with ductus measuring less than 4 mm
had a higher success of initial occlusion. Thirty-four patients were left
with residual shunting determined by color-flow Doppler study, but no
anatomic or echocardiographic features were found predictive for residual
shunting. All remain asymptomatic with 26 (76%) having no detectable
murmur, two (6%) a continuous murmur, and six (18%) a systolic murmur.
CONCLUSIONS. Catheter occlusion will obviate the need for surgery in the
majority of patients presenting with persistently patent ductus arteriosus.
Reocclusion has been found feasible in those with continuous murmurs (nine
of nine) and should be offered early because it is unlikely for spontaneous
closure to occur in this group. It appears prudent to follow those with
small residual shunting because further spontaneous closure can occur.
ARTICLES
Transcatheter occlusion of the persistently patent ductus arteriosus. Forty-month follow-up and prevalence of residual shunting
Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
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