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Alternative uses of the Rashkind umbrella device in congenital and post-surgical cardiovascular lesions—early results and impact on clinical course

Published online by Cambridge University Press:  19 August 2008

Hussein Tabatabaei ,
David G. Nykanen ,
William G. Williams ,
Robert M. Freedom  and
Lee N. Benson
Hussein Tabatabaei
Affiliation:
From the Departments of Pediatrics and Surgery, Divisions of Cardiology and Cardiovascular Surgery, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, University of Toronto, School of Medicine, Toronto
David G. Nykanen
Affiliation:
From the Departments of Pediatrics and Surgery, Divisions of Cardiology and Cardiovascular Surgery, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, University of Toronto, School of Medicine, Toronto
William G. Williams
Affiliation:
From the Departments of Pediatrics and Surgery, Divisions of Cardiology and Cardiovascular Surgery, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, University of Toronto, School of Medicine, Toronto
Robert M. Freedom
Affiliation:
From the Departments of Pediatrics and Surgery, Divisions of Cardiology and Cardiovascular Surgery, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, University of Toronto, School of Medicine, Toronto
Lee N. Benson*
Affiliation:
From the Departments of Pediatrics and Surgery, Divisions of Cardiology and Cardiovascular Surgery, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, University of Toronto, School of Medicine, Toronto
*
Dr. Lee N. Benson, The Hospital For Sick Children, 555 University Avenue, Toronto Ontario, Canada, M5G 1X8. Tel. 416 8136141; Fax. 4168137547.
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Summary

Implantation of the Rashkind double umbrella device for closure of the persistently patent arterial duct is now routine in many units. The use of this device in non-ductal positions, however, has been reported in only a limited number of patients, and its impact on the subsequent clinical course has not been established. A retrospective review of all such occlusions, therefore, was undertaken to address the early results and impact on clinical management. From 9/1988 through 2/1994, implantation of a double umbrella device was attempted in 21 patients (eight female, 13 male) with cardiovascular communications other than a persistent arterial duct excluding the intentional fenestrations made in the modified Fontan procedure. Median age at implantation was 2.6 years (three months-12.4 years) and weight was 11.6 kg (4.1–45) kg. Lesions included four ventricular septal defects, an aortopulmonary window, an aortopulmonary collateral artery, an atrial septal defect, four Gore-tex® shunts, and a residual persistent communication between the superior caval vein and the right atrium following either a bidirectional cavopulmonary anastomosis, or a classical Glenn operation. Eight patients underwent occlusion of unintentional residual right-to-left (six) or left-to-right (two) communications following the Fontan procedure. Implantation was accomplished in all without mortality, utilizing either 12 mm (13) or 17 mm (eight) devices. Surgical removal of the device was required in one patient four weeks subsequent to implantation. At latest follow-up (1–66 months, median four months), color-flow Doppler studies revealed complete occlusion in 17 (77%) patients. Implantation of the double umbrella in sites other than the duct is, therefore, feasible and simplified technically with a modification of the delivery system. Such novel applications of transcatheter intervention using double umbrella devices may avoid or complement subsequent surgery.

Keywords

Pediatric cardiac Catheterizationinterventional Catheterizationvascular communications
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 4 , October 1996 , pp. 320 - 326
Copyright
Copyright © Cambridge University Press 1996

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