Abstract
OBJECTIVE: To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus (PDA) > or = 4 mm with multiple Gianturco coils. (Transcatheter closure of large PDAs using the Rashkind occluder or the buttoned device is associated with a 7-38% incidence of residual shunt.) METHODS: 19 patients (7 male, 12 female) underwent an attempt at anterograde transcatheter closure with multiple Gianturco coils of a large PDA at a median age of 3.8 yr (range 2 weeks-34 yr) and median weight of 14 kg (range 2.3-80 kg). RESULTS: The median PDA diameter at the narrowest segment was 4.3 mm (range 4-7 mm) and the mean (SD) Qp/Qs was 1.9 (0.8). Each patient had left atrial and left ventricular volume overload. A 4F catheter was used to deliver the coils in all patients. There was immediate and complete closure in 16/18; one patient had residual shunt that was closed at a second procedure and the other had spontaneous disappearance of the residual shunt at the six week visit. A short ductus (angiographic type B) in one patient could not be closed. The median number of coils placed at the first attempt to close the ductus was 4 (range 2-6 coils) and the median fluoroscopy time was 40 minutes (range 13-152 minutes). Mild left pulmonary artery stenosis occurred in the two smallest patients. Coil migration to the lung occurred in 3 patients with retrieval of coils in two patients. All procedures but one were done on an outpatient basis. At a median follow up of 1.6 yr (range 2 weeks-2.2 yr) all patients had complete closure with no new complications. CONCLUSIONS: Anterograde transcatheter closure with multiple Gianturco coils is an effective treatment for most patients with large PDA of diameters up to 7 mm. This technique can be performed in small infants on an outpatient basis without the need for general endotracheal anaesthesia.
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- Bridges N. D., Perry S. B., Parness I., Keane J. F., Lock J. E. Transcatheter closure of a large patent ductus arteriosus with the clamshell septal umbrella. J Am Coll Cardiol. 1991 Nov 1;18(5):1297–1302. doi: 10.1016/0735-1097(91)90551-j. [DOI] [PubMed] [Google Scholar]
- Hijazi Z. M., Geggel R. L. Results of anterograde transcatheter closure of patent ductus arteriosus using single or multiple Gianturco coils. Am J Cardiol. 1994 Nov 1;74(9):925–929. doi: 10.1016/0002-9149(94)90588-6. [DOI] [PubMed] [Google Scholar]
- Hijazi Z. M., Lloyd T. R., Beekman R. H., 3rd, Geggel R. L. Transcatheter closure with single or multiple Gianturco coils of patent ductus arteriosus in infants weighing < or = 8 kg: retrograde versus antegrade approach. Am Heart J. 1996 Oct;132(4):827–835. doi: 10.1016/s0002-8703(96)90318-x. [DOI] [PubMed] [Google Scholar]
- Hosking M. C., Benson L. N., Musewe N., Dyck J. D., Freedom R. M. Transcatheter occlusion of the persistently patent ductus arteriosus. Forty-month follow-up and prevalence of residual shunting. Circulation. 1991 Dec;84(6):2313–2317. doi: 10.1161/01.cir.84.6.2313. [DOI] [PubMed] [Google Scholar]
- Ino T., Nishimoto K., Akimoto K., Ohkubo M., Yabuta K. Is transcatheter closure of patent ductus arteriosus using multiple coils feasible? Am J Cardiol. 1995 Sep 15;76(8):637–637. doi: 10.1016/s0002-9149(99)80176-3. [DOI] [PubMed] [Google Scholar]
- Krichenko A., Benson L. N., Burrows P., Möes C. A., McLaughlin P., Freedom R. M. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol. 1989 Apr 1;63(12):877–880. doi: 10.1016/0002-9149(89)90064-7. [DOI] [PubMed] [Google Scholar]
- Rao P. S., Sideris E. B., Haddad J., Rey C., Hausdorf G., Wilson A. D., Smith P. A., Chopra P. S. Transcatheter occlusion of patent ductus arteriosus with adjustable buttoned device. Initial clinical experience. Circulation. 1993 Sep;88(3):1119–1126. doi: 10.1161/01.cir.88.3.1119. [DOI] [PubMed] [Google Scholar]
- Rashkind W. J., Mullins C. E., Hellenbrand W. E., Tait M. A. Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System. Circulation. 1987 Mar;75(3):583–592. doi: 10.1161/01.cir.75.3.583. [DOI] [PubMed] [Google Scholar]
- Verin V. E., Saveliev S. V., Kolody S. M., Prokubovski V. I. Results of transcatheter closure of the patent ductus arteriosus with the Botallooccluder. J Am Coll Cardiol. 1993 Nov 1;22(5):1509–1514. doi: 10.1016/0735-1097(93)90564-h. [DOI] [PubMed] [Google Scholar]