Garcia, EN; Bermudez, R; Herraiz, I; Salgado, A; Balaguer, J; Moya, JL; Pinto, J

Hosp Ramon y Cajal, Serv Cardiol Pediat, E-28034 Madrid, Spain; Hosp Ramon y Cajal, Serv Cardiol Adultos, E-28034 Madrid, Spain; Hosp Ramon y Cajal, Serv Anestesia & Reanimac, E-28034 Madrid, Spain; Hosp Gen Univ, Serv Cardiol, Guadalajara, Spain

Introduction. Catheter occlusion of the persistent ductus arteriosus with Rashkind device is an alternative to the surgical closure demostrated in children, however a few results have been reported of occlusion in adults. Method From 1990 to 1996 in 127 patients with persistent ductus arteriosus undergoing occlusion by Rasking device. Two groups according age: 105 children (< 14 years) and 22 adults (> 14 years), were estudied retrospectively. The results were analysed by immediate aortogram and follow-up at 24 hours, 6 and 12 months by color-Doppler echocardiograms. Results. The adults were frequently asymptomatic (86%) and with high incidence (59%) of silent ductus. Similar QP/QS (1.61 +/- 0.47 in adults vs 1.49 +/- 0.51) was calculated although pulmonary pressure was superior in children (12.60 +/- 2.97 vs 16.84 +/- 5.88 mmHg; p = 0.003). In group > 14 years the ductal anatomy favorable (Krichenko type A or B) mas more frequent (91% vs 73%; p = 0.06) and ductal diameter significantly higher (3.03 +/- 1.50 vs 2.41 +/- 0.96 mm; p = 0.009). In adults 17 mm umbrella were used more frequenly (91 vs 61%; p = 0.02). Absence complications (embolization, bacteremia, haemolysis, proximal stenosis of the left pulmonary artery) were found in adults against 4.72% in children. The occlusion mere more effective in adults specially in early controls: 55% vs 34%, (p = 0.09), 82% vs 69%, 91% vs 77 % and 95% vs 83% (p > 0.10). Multivariate analysis identified age as an independent predictor of complete occlusion. Conclusion. Our experience in transcatheter occlusion of persistent ductus arteriosus with Rashkind device in adults support the efficacy, safety and excellent early results despite higher incidence of silent asymptomatic ductus.