Bioptome-assisted simultaneous delivery of multiple coils for occlusion of the large patent ductus arteriosus.

We describe a novel method that allows bioptome-assisted delivery of multiple Gianturco coils simultaneously for occlusion of the large patent ductus arteriosus (PDA). Two or more coils were intertwined at one end and held by a bioptome (5.2 Fr) and pulled into a short introducer. The coils were then deployed in the PDA via a long sheath (7-11 Fr) previously placed across the duct via the femoral vein. Twelve patients (6 months to 64 years; median, 10.5 years) with large PDAs (4.7 +/- 1.3 mm; range, 3.1-8.4 mm; PA mean pressure, 40 +/- 17 mm Hg; pulse pressure 63 +/- 18 mm Hg) underwent bioptome-assisted occlusion with multiple coils at our institutions. The procedure was uneventful in nine patients (fluoroscopy time, 6-23 min) and prolonged in three patients (fluoroscopy time, 26, 72, and 120 min) because of dislodgment of the coil mass and embolization of an additional coil. Successful coil deployment was feasible in all patients. Three patients required repeat coil deployment for flow elimination (hemolysis occurred in two). Flow elimination was demonstrated on the last follow-up evaluation in all except two patients. One infant has developed significant left pulmonary artery stenosis. Bioptome-assisted PDA occlusion using multiple coils delivered simultaneously may be a promising alternative to devices for transcatheter closure of large PDAs. Cathet Cardiovasc Intervent 2001;54:95-100.     

Additional aortopulmonary collaterals in patients referred for coil occlusion of a patent ductus arteriosus

Coexisting aortopulmonary collaterals in patients diagnosed with a patent ductus arteriosus (PDA) are rare findings. Percutaneous transcatheter closure of PDA and requisite aortography offer an unique opportunity to identify and treat these systemic arterial anomalies, which would be missed by echocardiographic evaluation alone. The significance of these collaterals is unclear, but it may contribute to left heart dilation from additional left to right shunting in patients with an otherwise isolated small PDA. Of 18 patients undergoing transcatheter occlusion of a PDA with Gianturco coils, 2 were found to an additional significant aortopulmonary collaterals, which were also occluded. © 1996 Wiley-Liss, Inc.     

Hemolysis complicating coil occlusion of patent ductus arteriosus

We report on 5 patients who developed hemolysis (the Hemolysis group) following coil occlusion for PDA, and compare their data to 66 cases which were not complicated by hemolysis despite residual leak (the No Hemolysis group). A significant leak with a heart murmur was more frequent in the Hemolysis group than in the No Hemolysis group. The ratio of the sum of the loop diameter of coils to the minimal diameter of the ductus (C/D) in those who developed persistent hemolysis that needed a second intervention (2.2 ± 0.4) was significantly smaller than in the No Hemolysis group (3.1 ± 1.1). Persistent hemolysis can occur if a significant residual shunt remains after implantation of coils with small C/D. As this complication may be avoided by complete closure or, if not complete, a minimal leak, we should be careful to make residual leaks as small as possible by the use of multiple coils. Cathet. Cardiovasc. Diagn. 43:50–53, 1998. © 1998 Wiley-Liss, Inc.     

Transcatheter closure of patent ductus arteriosus using Gianturco coils in adolescents and adults.

We present the short- and intermediate-term results of transcatheter closure of patent ductus arteriosus with Gianturco coils in adolescents and adults. During a 5-year period, 55 patients (44 females, 11 males) with ages ranging from 14 to 72 years (median, 23) underwent attempted transcatheter closure of patent ductus with the Gianturco coils. The diameter of the narrowest segment of the ductus ranged from 0.8 to 7.6 mm (3.9 +/- 1.3 mm). The 55 patients were divided into three groups. Group I consisted of nine patients with a ductal diameter < or = 3 mm, group II consisted of 27 patients with a ductal diameter > 3 mm but < or = 4 mm, and group III consisted of 19 patients with a ductal diameter > 4 mm. Four- to five-loop Gianturco coils were used, which were deployed via retrograde aortic route. Multiple-coil technique was generally applied in group II patients. Balloon occlusion technique in combination with multiple-coil technique was generally used in group III patients. Deployment of coil was successful in 51 patients (93%) but failed in 4. The success rate of coil deployment in group I, II, and III were 100% (9/9), 96% (26/27), and 84% (16/19), respectively. A mean of 1.9 +/- 0.7 coils was deployed per patient. Of the four patients with unsuccessful coil deployment, three underwent surgery and one received implantation with Amplatzer duct occluder. Distal embolization of 21 coils occurred in 10 patients (3 in group II and 7 in group III), from whom 20 coils were retrieved with a gooseneck snare and 1 coil was removed during surgery. The mean diameter of ductus in the 10 patients with distal embolization was significantly larger than that in those without (5.2 +/- 1.4 vs. 3.7 +/- 1.1 mm; P < 0.01). Among the 51 patients with successful coil deployment, immediate complete closure was achieved in 20 (39%), while trivial to mild leak was present in 31 (61%). No significant complications were encountered. After a follow-up period ranging from 5 to 42 months, four patients had a small residual shunt and three underwent a second intervention with complete occlusion. None had left pulmonary artery stenosis documented with Doppler echocardiography. Transcatheter closure of ductus with the Gianturco coils is safe and feasible in the majority of adolescents and adults. Taking high embolization rate in patients with a ductus diameter > 4 mm into consideration, controlled-release coils, Buttoned device, or Amplatzer duct occluder can be a better choice.     

Coarctation of the aorta following coil occlusion of a patent ductus arteriosus

A case is described in which coarctation of the aorta develops following coil occlusion of a patent ductus arteriosus with a single Gianturco coil. This finding has yet to be reported in children undergoing this procedure and demonstrates the possibility of its occurrence and brings into question the need for and the duration of antibiotic prophylaxis following coil deployment. Cathet. Cardiovasc. Diagn. 43:60–62, 1998. © 1998 Wiley-Liss, Inc.     

成人复杂动脉导管未闭介入治疗的有效性和安全性

目的:评价经导管介入治疗对成人复杂动脉导管未闭(PDA)患者的有效性与安全性。方法:回顾2004-04-2008-04期间在北京安贞医院接受经导管介入治疗的成人复杂PDA患者112例,最小直径<3.0mm者选用弹簧栓子,最小直径≥3.0mm者选用Amplatzer或国产蘑菇伞形动脉导管封堵器;不能常规建立输送轨道的患者采用逆行建轨方法,在常规操作的基础上,复杂PDA介入治疗遵循各自的特殊性;介入治疗成功的患者分别于术后第1周及第1、3、6和12个月行彩色多普勒超声心动图检查随访。结果:总体成功率达93.8%,术后1年残余分流的发生率为1.8%,均为少量分流,无需特殊处理,肺动脉收缩压介入治疗后[(58±20)mmHg,1mmHg=0.133kPa]较介入治疗前[(94±21)mmHg]显著下降约35mmHg(P<0.001);无一例发生死亡、再通、封堵器脱位及介入相关的肺动脉或主动脉狭窄等严重并发症,发生溶血及穿刺部位血管并发症的患者经保守治疗后均康复出院。结论:对于并发有解剖学或血流动力学异常的成人复杂PDA患者,经导管介入治疗是一种安全、有效的治疗手段。     

Transcatheter closure of the patent ductus arteriosus in adults using the gianturco coil

Background and hypothesis: Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risks. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. Methods: Six adults with mean age of 39.1 years (range 23.1–62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0–5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occulsion of the PDA using Gianturco coils. Results: Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. Conclusion: Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.     

经导管封堵治疗动脉导管未闭伴重度肺动脉高压

目的评价经导管封堵术治疗动脉导管未闭伴重度肺动脉高压病人的临床疗效与安全性。方法选择在我院接受经导管封堵术治疗且肺动脉收缩压在80mmHg或以上,肺动脉平均压在60mmHg或以上的动脉导管未闭病人31例,回顾性分析病人术中及术后随访资料。结果31例病人术前肺动脉收缩压80～183（112±28）mmHg,肺动脉平均压63～130（82±22）mmHg。其中30例经导管封堵成功（成功率97％）,1例巨大型动脉导管未闭因无合适封堵器而行手术治疗。封堵后10min,26例肺动脉收缩压下降30mmHg以上,2例肺动脉收缩压下降20％以上,另2例肺动脉收缩压无明显改变。1例用房间隔缺损封堵器封堵巨大型动脉导管未闭,在术后3d复查心脏超声时发现封堵器脱人肺动脉而转入外科手术治疗;在5例双向分流者中,1例于术后2个月因重度肺部感染死亡,1例于封堵后血氧饱和度明显增加,但肺动脉压无明显下降,术后2年出现右心功能不全表现。结论动脉导管未闭伴重度肺动脉高压病人,若心脏超声检查示左向右分流,可用经导管封堵术进行根治;但若为双向分流时,经导管封堵治疗应慎重。     

Angiographic and hemodynamic predictors for successful outcome of transcatheter occlusion of patent ductus arteriosus in infants less than 8 kilograms.

Transcatheter occlusion of patent ductus arteriosus (PDA) using Gianturco coils (GCs) has been performed for the past decade. However, little has been written regarding anatomical and hemodynamic predictors for successful occlusion of the PDA in infants. This report is to evaluate the outcome of transcatheter occlusion of PDA in symptomatic infants less than 8 kg and to assess predictors of successful occlusion. Retrospective review of catheterization charts and cineangiograms of 42 symptomatic infants who underwent cardiac catheterization for attempted transcatheter occlusion of their PDA was conducted. The hemodynamic and angiographic data evaluated included the length/diameter (L/D) ratio, defined as the length divided by the narrowest diameter of the ductus arteriosus, and preocclusion pulmonary artery pressures. Thirty-one out of 42 patients (74%) had successful occlusion. Twenty-nine out of 42 infants had an L/D ratio > 3. Of these, 26 (90%) had successful occlusion of their PDA. Thirteen out of 42 patients had an L/D ratio < or = 3. Of these, 8 (62%) had unsuccessful occlusion. Complications encountered were transient loss of femoral arterial pulse (n = 6), coil embolization (n = 5), hemolysis (n = 2), and mild left pulmonary artery obstruction (n = 2). No permanent loss of femoral arterial pulse was noted. These complications resulted in no mortality and minimal morbidity. The L/D ratio was the strongest predictor of successful outcome, with an L/D ratio greater than 3.0 being more amenable to transcatheter occlusion (odds ratio of 4.6). Other predictors for success included lower preocclusion systolic, diastolic, and mean pulmonary artery pressure and smaller ductal diameter. Our conclusion was that infants less than 8 kg with an L/D ratio > 3.0 can safely and successfully undergo transcatheter occlusion of their PDA using transcatheter coils.     

Virtual endoscopy using multidetector-row CT for coil occlusion of patent ductus arteriosus.

The objective of this study was to report the clinical value of virtual endoscopy using multidetector-row CT (MDCT) for coil occlusion of patent ductus arteriosus (PDA). We studied 10 consecutive patients with PDA undergoing cardiac catheterization and coil occlusion. All patients had previously undergone MDCT, and subsequently underwent transcatheter closure of ductus. MDCT evaluations were performed again in 1-3 months after occlusion. Virtual endoscopy showed the anatomy of the orifice of the ductus and spatial relations of adjacent structures from both the aortic and pulmonary sides in all patients. We were able to observe the inner space, and fly through the PDA. This approach is the virtual view of the catheter advancing during coil occlusion. Following occlusion, visualization of the coil can also be established by viewing from inside. Coil protrusion into the aortic and pulmonary sides was clearly observed. Virtual endoscopy provides unique information regarding the ductal lumen that is of use for the coil occlusion of PDA.     

Transcatheter closure of a patent ductus arteriosus in an elderly patient with the Gianturco-Grifka vascular occlusion device

This paper reports the unusual case of a 76-year-old woman who was discovered to have a hemodynamically significant patent ductus arteriosus following uneventful mitral valve replacement, utilizing cardiopulmonary bypass. The shunt was successfully eliminated using a new transcatheter device, thereby obviating the need for further surgery. The patient did not have calcification within the ductus, making diagnosis prior to surgery more difficult.     

Hemolysis following coil embolization of a patent ductus arteriosus

We describe the development of hemolysis from moderate residual shunting across a patent ductus arteriosus following coil embolization. The fall in hemoglobin levels from 11.6 to 6.0 gm/dl necessitated a second coil procedure which resulted in complete closure of the residual shunting and resolution of hemolysis. Therefore, appearance of anemia following coil embolization of patent ductus arteriosus should be monitored closely; however, repeat coil embolization with elimination of residual shunt will lead to prompt recovery of normal hemoglobin levels. © 1996 Wiley-Liss, Inc.     

Transcatheter occlusion of patent ductus arteriosus using a new angled Amplatzer duct occluder: initial clinical experience.

In the present study, we report the initial clinical experience with the new angled Amplatzer duct occluder (ADO) for the percutaneous closure of patent ductus arteriosus (PDA). Percutaneous closure of PDA using standard ADO in infants and in patients with small PDA ampulla is difficult, or even impossible, due to protrusion of the aortic disk into the descending thoracic aorta. The aortic disk of an angled ADO is angled at 32 degrees to the body of the device and concave toward the aorta to prevent protrusion of the disk into the aorta. Percutaneous closure of PDA was attempted in nine patients with a median age of 5.2 years (range, 0.5-12.7) and median weight of 20 kg (range, 4.9-55). Selection of the occluder and the implantation technique were similar to the standard ADO. The minimal PDA diameter ranged from 2.1 to 3.7 mm (median, 2.5 mm). Occluders were successfully implanted in all patients. Immediate complete PDA closure was achieved in all patients. There were no complications. The new angled ADO is a safe and effective device for PDA closure, particularly suitable for infants and patients with small PDA ampulla. Further studies and long-term follow-up are necessary to confirm our initial experience.     

Percutaneous closure of patent ductus arteriosus using special screwing detachable coils

Jackson screwing detachable coils, developed for arterial and venous embolization, have been successfully employed recently for the percutaneous occlusion of patent ductus arteriosus (PDA). Special screwing detachable coils were designed for closure of the PDA, and the experience gained by their use is described in this report. Occlusion was attempted in 29 patients with a minimal ductal diameter of 0.9–4.2 mm. Coils were successfully placed in all 29 patients. One coil, which embolized 10 min after detachment, was retrieved. In 26 patients (89%), complete closure was achieved. Only 35 coils were placed in 29 patients. Residual shunts in three patients are minimal, detectable only on color-flow mapping. Screwing detachable coils for closure of PDA are safe and effective for occlusion of PDA with a minimal diameter <4.2 mm. Embolization of the coil is very rare. A high closure rate is achieved with a low number of placed coils. Cathet. Cardiovasc. Diagn. 41:386–391, 1997. © 1997 Wiley-Liss, Inc.     

Unraveling of a Gianturco coil during reocclusion of a patent ductus arteriosus

The Gianturco spring coil has been employed in the setting of the small arterial duct and for reocclusion of residual shunts; the ability to manipulate the coil is advantageous for optimal results. This case study reports an associated complication of unraveling of the coil. Careful attention to coil appearance during manipulation and the use of 0.038-inch coils may reduce this risk. © 1996 Wiley-Liss, Inc.     

极低体重早产儿动脉导管未闭的治疗

目的:探讨极低体重早产儿动脉导管未闭(PDA)的治疗方法。方法:本研究回顾性分析6例经外科手术治疗的PDA的极低体重早产儿的临床特点。结果:4例患者布洛芬治疗失败、2例患者因药物禁忌行动脉导管结扎术,术后由对呼吸机依赖转为3～4d过渡脱机,胃肠内喂养耐受性及体重增加显著改善[(45±41)∶(258±77)g/周,P<0.001],5例存活患者均无手术并发症,1例患者死于早产儿并发症。结论:对于有手术指征的PDA的极低体重早产儿,外科手术结扎是安全而有效的方法。     

Transcatheter occlusion of the patent ductus arteriosus in infants: Experimental testing of a new Amplatzer device

Objectives: This study assessed the feasibility and efficacy of implanting a new miniaturized nitinol device to occlude the patent ductus arteriosus (PDA) in a newborn porcine model. Background: Transcatheter device closure is the standard of care for PDA in older children and adults. Currently available technology is not designed for the newborn infant. Methods: The Amplatzer Duct Occluder II 0.5 is a new transcatheter Nitinol device without fabric designed to close the PDA with small aortic and pulmonary artery structures. The device was implanted in 8 infant pigs (average weight 2,400 g) after balloon dilation of PDA (average diameter 2.7 mm, average length 5.8 mm) with immediate, ～ 7, ～ 30, and ～ 90 day follow‐up by echocardiography, angiography, and final pathological examination. Half were implanted arterial, and half venous. Results: The device was successfully implanted in all animals. There was complete occlusion of the PDA in all cases without obstruction of the pulmonary arteries or aorta. There was complete late endothelialization without thrombus. The only complication was transection of a femoral artery accessed by cutdown. Conclusions: The success of this animal study confirms safety and feasibility of the Amplatzer Duct Occluder II 0.5 (now known as the ADO II AS) for use when the aorta and pulmonary arteries are small. Consideration can be given to transcatheter closure of the PDA in preterm and other small infants with this device. © 2011 Wiley Periodicals, Inc.