Lázaro CJL, Munayer CJ, Aldana PT, San LMR, Maza JG, Ramírez RH, Arias ML, Campos GA, Amaya HA

Language: Spanish
References: 9
Page: 167-172
PDF size: 234.25 Kb.

ABSTRACT

This study was performed to evaluate the efficacy of transcatheter Coil and Grifka closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Ninety seven patients (36 male and 61 females) underwent occlusion of the PDA. The following variables were compared: age, sex, ductus diameter, morphology, device, occlusion time, residual shunt, multiple device and complications. Data obtained were compared using the Student’s test and Chi². Median patient age was 7.82 ± 6.89, forty five patients underwent transcatheter Rashkind-17 closure, 19 patients with Rashkind-12, 18 patients with Coil and 13 patients with Grifka device, in two patients the closure could not be performed. There were diferences between the morphology and device used (p = 0.008), between the ductus diameter and device used (p ‹ 0.001). There was immediate closure in 26.7% in the Rashkind-17 group compared with, 57.9% for the Rashkind-12 group, 83.3% for Coil group and of 91.7% for Grifka group. The occlusion within 24 hrs of implantation was 60% with Rashkind-17, 78.9% with Rashkind-12, 94.4% with Coil and 100% with Grifka. Residual shunt persisted for more than a year in 7 patients with Rashkind-17 and 1 with Rashkind 12, (p = 0.001), in 4 patients two devices wore placed. The complications were, 15.5% for Rashkind-17, 26.3% for Rashkind-12, 5.2% for Coil and 30% for Grifka, (p = 0.004), one coil and one Grifka embolized. Transcatheter Coil and Grifka occlusion are more effective in achieving immediate closure than the Rashkind device. The indication to use each device is made according to the morphology and size of the ductus.

REFERENCES

1. Porstmann W, Wierny L, Warnke H: Closure of the persistent ductus arteriosus without thoracotomy. Ger Med Mon 1967; 12: 259-261.

2. Porstmann W, Wierny L, Warnke H, Gerstberger G, Romaniuk PA: Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy. Radiol Clin North Am 1971; 9:203-18.

3. Rashkind WJ, Mullins CE, Hellenbrand WE, Tait MA: Non-surgical closure of patent ductus, arteriosus: Clinical application of the Rashkind PDA occluder system. Circulation 1987; 75: 583-92.

4. Lloyd TR, Fedderly R, Mendelsohn AM, Sandhu SK, Beekman RH: Transcatheter occlusion of patent ductus arteriosus with Gianturco coils. Circulation 1993; 88(4): 1412-20.

5. Grifka RG, Miller MW, Frischmeyer KJ, Mullins CE: Transcatheter occlusion of a patent ductus arteriosus in a Newfoundland puppy using the Gianturco-Grifka vascular occlusion device. J Vet Intern Med 1996;10(1): 42-4.

6. Grifka RG, Vincent JA, Nihill MR, Ing FF, Mullins CE: Transcatheter patent ductus arteriosus closure in an infant using the Gianturco-Grifka Vascular Occlusion Device. Am J Cardiol 1996; 78 (6): 721-3

7. Krichenko A, Benson LN, Burrows P, Moes CAF, McLaughlin P, Freedom R: Angiographic Classification of the Isolated, Persistently Patent ductus arteriosus and implications for Percutaneous Catheter Occlusion. Am J Cardiol 1989; 63: 877-80.

8. Ali Khan MA, Yousef S, Mullins CE, Sawyer W: Experience with 205 procedures of transcatheter closure of ductus arteriosus in 182 patients, with special reference to residual shunts and long-term follow up. J Thorac Cardiovasc Surg 1992; 104(6): 1721-7.

9. Bulbul ZR, Fahey JT, Doyle TP, Hijazi ZM, Hellenbrand WE: Transcatheter closure of the patent ductus arteriosus a comparative study between occluding coils and the Rashkind umbrella device. Cathet Cardiovasc Diag 1996; 39(4): 355-63.