Transcatheter management of residual shunts after initial transcatheter closure of a patent XXXX .

@entity1 @entity4991 @entity432 @entity850 @entity2142
OBJECTIVES: To assess the efficacy and safety of transcatheter reocclusion of persistent leaks following previously attempted transcatheter occlusion of persistent @entity432 . DESIGN: Retrospective study. SETTING: Tertiary pediatric cardiology centre. @entity1 : From February 1987 through October 1996, trans-catheter occlusion of a residual ductal shunt was attempted in 42 consecutive @entity1 at a median age of 5.0 years (range 1.6 years to 16.2 years). INTERVENTIONS: Fourty @entity1 had successful placement of a double umbrella occluder (n=27) or coils (n=13) across residual shunts. Complications included device embolization in two @entity1 and @entity2142 in one @entity1 . OUTCOME MEASURES AND RESULTS: Mean z-score for left ventricular end-diastolic dimension (LVEDD) at initial echocardiography was +2.55 +/- 1.89 (P<0.0001 versus normal); z-score for left pulmonary artery ( @entity4991 ) diameter was +2.00 +/- 1.52 (P<0.0001). Mean @entity4991 to right pulmonary artery (RPA) diameter ratio was 1.05 +/- 0.18. At follow-up echocardiogram, a median of two years (range six months to 7.7 years) after the second procedure, a shunt was persistent in 3% of the @entity1 . Mean LVEDD and @entity4991 diameter z-value, and mean @entity4991 to RPA diameter had dropped significantly to +0.42 +/- 1.31, +0.07 +/- 1.15 and 0.86 +/- 0.14 (P<0.001), respectively. @entity4991 flow acceleration was present in 25% of @entity1 . Three of nine @entity1 , in whom lung perfusion scan was performed, had left lung perfusion below 40%. Small weight and age at catheterization were significant risk factors for @entity4991 flow disturbance. CONCLUSIONS: Repeat transcatheter occlusion is safe and successful in eliminating residual shunt across the @entity432 . Attention should, however, be addressed to the potential for @entity4991 @entity850 and growth, and flow should be regularly assessed.
