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HK J Paediatr (New Series)
Vol 1. No. 2,
1996
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HK J Paediatr (New Series) 1996;1:218
Proceedings of Clinical Meeting
Transcatheter Closure of Patent Ductus Arteriosus - A Comparison of Three Different Methods in Children
ZW Zhang, GH Zeng, YF Li, FS Wang, MY Qian ZW Zhang, GH Zeng, YF Li, FS Wang, MY Qian Guang Dong Cardiovascular Disease Institute, Guangzhou, PRC
| HK J Paediatr (new series) 1996;1:207-220 The First Joint Scientific Meeting of Hong Kong College of Paediatricians and Guangdong Pediatric Society of the Chinese Medical Association
May 25, 1996 | Background Non-surgical closure of patent ductus arteriosus (PDA) by an Ivalon plug (Porstmann) was first attempted in 1967. Subsequently, the duct was successfully occluded by a double umbrell device (Rashkind) and button device (Sideris) in 1979 and 1994, respectively. A comparison of the efficacy of the 3 methods of ductal closure has not been reported. Aim This study compared the efficacy of transcatheter closure of the PDA by the above 3 methods. Method Between March 1989 and December 1995, occlusion of PDA were attempted in 82 patients at the Guang Dong Cardiovascular Disease Institute. The procedure was initially limited to the Porstmann's technique. Since 1993, the other 2 methods of closure were introduced into the unit. For the 3 methods of occlusion, we compared the success rate of implanting the device, the age and weight of the patients, size and morphology of the duct closed, time for each procedure and the rates of residual shunt and major complications. Result | | Porstmann | Rashkind | Sideris | P Values | | P1 | P2 | P3 | | Age (years) | 10±2.4 | 5.3±3.1 | 4.8±2.3 | <0.01 | NS | <0.01 | | Weight (kg) | 28.4±9.2 | 18.3±3.9 | 14.6±3.4 | <0.01 | <0.05 | <0.01 | | Ductal Size (mm) | 3.7±0.8 | 3.5±0.9 | 4.2±1.6 | NS | <0.05 | <0.05 | | Size of Sheath (mm) | 5.3±0.6 | 2.9±0.4 | 2.4±0.3 | <0.01 | <0.05 | <0.01 | | Time for Procedure (mm) | 11.0±20.0 | 58.0±14.0 | 82.0±23.0 | <0.01 | <0.05 | <0.01 | | Screening Time (mm) | 54.0±13.0 | 12.0±6.0 | 20.0±8.0 | <0.01 | <0.01 | <0.01 | | Successful Implantation | 92% (23/25) | 100% (48/48) | 100% (9/9) | <0.01 | NS | <0.01 | | Residual Shunt at 3 months of follow up | None | 10.4% (5/48) | 22.2% (2/9) | <0.01 | NS | <0.01 | | Major Complications | | | | | | | | | Local | 24% (6/26) | None | None | <0.01 | NS | <0.01 | | | Systemic | 8% (2/25) | 2.0% (1/48) | None | <0.01 | NS | <0.01 | | Abbreviations: | P1=Porstmann vs Rashkind
P2=Rashkind vs Sideris
P3=Porstmann vs Sideris | Conclusion The Porstmann's method was technically demanding requiring long procedural and screening time, a larger size sheath to work on older children of higher body weight and with a relative higher failure and complication rate. However, there was no residual shunt on follow-up. On the other hand, both Rashkind and Sideris methods could be performed in smaller children with shorter procedural and screening time, a 100% success rate and minimal complications. Residual shunt, however, occurred as frequent as 10-22%.
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