Transcatheter closure of patent ductus arteriosus with the Rashkind occluder: Acute results and angiographic follow-up in adults

We performed catheter closure of a patent ductus arteriosuswith a Rashkind occluder in 51 adult patients (aged 14 to 76years). The diameter of the ductus ranged from 2 to 13 mm (mean4·5±2·0 mm), Q_P:Q_S from 1·0 to 2·6(mean 1·6±0·3). The procedure was successful in 50/51 patients, in one of themat a second attempt. In one patient, the ductus could not beclosed even with additional occluders. This patient was sentfor surgery. In two patients with a large ductus, two Rashkindumbrellas were implanted simultaneously. Immediately after ductusclosure, there was a residual shunt in 40/50 patients decreasingto 26/50 after 20 min. Two of the patients with a residual shuntsuffered from haemolysis. In 16 patients, the residual shuntdisappeared spontaneously within some months. In 15 patients,additional occluders (a second occluder in 12, a third occluderin one, and a fourth and fifth occluder in another) were implantedduring the initial procedure or during follow-up. All patientswere followed until angiography proved complete closure of theductus. At the time of the last follow-up angiogram, the ductuswas occluded in 49/50 patients; one patient refused a follow-upangiogram. Ductus occlusion with the Rashkind umbrella can be considereda technique with a high success rate and low rate of complicationsin adults. However, a residual shunt is not uncommon. Additionaloccluders have to be implanted in many patients.