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.     

Changes in coil morphology following transcatheter coil occlusion of the patent ductus arteriosus using a modified snare technique.

We observed a decrease in length of the Gianturco coils following transcatheter occlusion of the patent ductus arteriosus (PDA). Coil length was measured on chest radiograph within 24 hr of coil placement and compared to the length at the time of follow-up. Echocardiograms were also reviewed for evidence of duct recanalization. Twenty-seven patients met inclusion criteria. The median time to follow-up was 5 months (1--12 months). Twenty-four out of 27 (89%) patients had a decrease in coil length by 1.9 +/- 1.1 mm (P < 0.01). This was an average decrease of 16%. One patient had an increase in length and two patients had no change in coil length. Nineteen out of 27 patients had echocardiograms. Despite the change in coil length, there was no evidence of flow acceleration in the pulmonary artery or descending aorta. No patients had evidence of duct recanalization.     

Severe hemolysis following partial coil-occlusion of patent ductus arteriosus

Severe hemolysis occurred in a one-year-old boy following partial coil occlusion of a patent ductus arteriosus with a small but high-velocity residual shunt. Hemolysis abated rapidly and completely after placement of a second coil fully occluded the ductus. © 1996 Wiley-Liss, Inc.     

Radiation exposure to children during coil occlusion of the patent ductus arteriosus

The risks of excessive exposure to ionizing radiation are well described and measures are routinely taken to limit such exposure to both patient and personnel in the catheterization laboratory. Coil occlusion of the patent ductus arteriosus (PDA) as well as other more complex pediatric interventions has raised concern regarding radiation exposure, particularly as minimally invasive surgical techniques are being developed which lack such exposure risk. In eight consecutive patients, aged 0.7–7 years (median, 2.3 years), coil occlusion of a PDA was performed and surface entrance radiation dose determined by thermoluminescent dosimetry (TD). Total cumulative doses (PA + lateral dose) were also calculated for each patient. Entrance and cumulative dose was likewise measured in 12 patients undergoing standard diagnostic catheterization (DC) and in 5 consecutive patients undergoing pulmonary balloon valvuloplasty (PBV). The groups were comparable in age, weight, and body surface area (BSA). Total cumulative dose in the PDA patients was 97 ± 25 mGy (mean ± SE). There was no significant difference between the three groups in entrance dose absorbed at each location or in total cumulative dose. The mean total fluoroscopy time in the PDA occlusion group was significantly less than that of the PBV group (10.1 ± 1.81 min vs. 19.3 ± 2.29 min, P < 0.05) but was comparable to the DC group (13.2 ± 1.5 min, P = NS). When the subjects were analyzed collectively, no correlation between fluoroscopy time and measured entrance dose was observed. The strongest correlates of total cumulative dose were patient weight (r = 0.67, P < 0.001) and BSA (r = 0.62, P = 0.001). Patients undergoing coil occlusion of a PDA are not exposed to increased radiation entrance dose compared to those undergoing standard DC and PBV. Furthermore, surface entrance radiation dose as determined by TD varies according to patient size for a given fluoroscopy time. Cathet. Cardiovasc. Intervent. 47:449–454, 1999. © 1999 Wiley-Liss, Inc.     

Severe intravascular hemolysis after transcatheter closure of a large patent ductus arteriosus using the Amplatzer duct occluder: successful resolution by intradevice coil deployment.

A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a large patent ductus arteriosus using an Amplatzer duct occluder. Percutaneous deployment of fibered platinum coils within the nitinol wire cage of the Amplatzer duct occluder abolished the residual shunt through the device and resulted in cessation of intravascular hemolysis and reversal of its adverse sequelae.     

Transcatheter occlusion of the patent ductus arteriosus: Use of the retrievable coil device

The Cook Retrievable Embolization Coil has been designed to improve delivery and positioning during coil embolization of the patent ductus arteriosus (PDA). We report our experience with the use of this new technique. Twenty-eight patients underwent coil embolization of a PDA using the retrievable system. The median patient age was 4.5 years (range, 2 months to 33 years), median weight 17.2 kg (range, 3.1–100 kg). The mean minimum diameter was 1.1 mm (range, 0.3–3.8 mm). One or two Cook Retrievable Embolization Coils were implanted in each PDA. Successful delivery was achieved in 27 cases. There was no shunt by angiography in 19 of the patients (70%). Color echocardiography documented no shunt in 13 of 17 patients (77%). The retrievable coil system represents a successful method of PDA occlusion with good control of coil positioning and delivery. Cathet. Cardiovasc. Intervent. 46:434–437, 1999. © 1999 Wiley-Liss, Inc.     

Follow-up of coil occlusion of patent ductus arteriosus

Objective. We sought to determine the prevalence and fate of residual ductal shunting following coil occlusion of patent ductus arteriosus.Background. Although transcatheter coil occlusion of patent ductus arteriosus has gained popularity, few follow-up data have been reported.Methods. A review of 75 patients who underwent coil occlusion was performed. Residual shunting was investigated by Doppler echocardiography in follow-up. Angiograms were reviewed to obtain minimal ductal diameter and ductal angiographic type.Results. Residual shunts were found in 31 patients (41%) on the day of the procedure, and of these, spontaneous closure was noted in 17 (55%) at 2 weeks to 20 months of follow-up. Of the 75 patients studied, 5 (7%) required a second coil procedure, and 10 (13%) remained with persistent residual shunts at most recent follow-up. Actuarial analysis estimated a 6 ± 5% prevalence of residual shunts 20 months after a single coil procedure and 3 ± 3% after all coil procedures. Minimal ductal diameter was associated with immediate complete ductal occlusion by a single coil. These patients had significantly smaller (p = 0.003) minimal ductal diameters (1.2 ± 0.7 mm) than those who required two coils during their initial procedure to achieve immediate occlusion (1.9 ± 0.7 mm), those who required a second coil procedure (2.0 ± 0.9 mm), those who had spontaneous closure of residual shunts (1.9 ± 0.7 mm) and those with persistent residual shunts (2.0 ± 0.9 mm). No association was identified between ductal angiographic type and outcome of coil occlusion. No late adverse clinical events of coil occlusion or evidence of recanalization was found.Conclusions. Small residual shunts are common after coil embolization of patent ductus arteriosus, but most close spontaneously. Actuarial analysis estimates complete closure in 94% at 20 months, and reintervention was required in only 7% of patients.     

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.     

Snare-assisted transcatheter coil occlusion of patent ductus arteriosus

Transcatheter occlusion of a small or moderate patent ductus arteriosus (PDA) using Gianturco coils is safe and effective. Several investigators have reported using different techniques with variable results. To eliminate the serious potential complications of inadvertent coil embolization to undesirable sites and to improve control of the coil throughout the procedure, a modified snare-assisted method with approach from the main pulmonary artery was developed. However, articles discussing this technique are still limited. Herein, we report our successful experience of the snare-assisted technique to occlude small or moderate PDAs in three children aged from 1 to 8 years old. We achieved immediate total occlusion in all three cases with no complications. All three patients were discharged the next day and there was no coil dislodgement, left pulmonary stenosis, or residual shunting during the follow-up period of up to 3 years. This technique had the advantages of safety, optimal positioning, and improved stability of coil implantation.     

Balloon dilatation of the very small patent ductus arteriosus in preparation for transcatheter occlusion

Balloon dilatation of the very small ductus arteriosus is described, and its application in five patients undergoing catheter occlusion is presented and discussed.     

Transcatheter coil embolization for patent ductus arteriosus in the elderly: Report of a case and review of the published work

Patent ductus arteriosus is the third most common congenital cardiovascular anomaly, however, it is rarely found in the elderly. We describe a case of patent ductus arteriosus in a 72-year-old woman in whom patent ductus arteriosus was successfully managed by transcatheter coil embolization. The patient had been diagnosed with a heart murmur for the first time 1 year earlier at the age of 71. She was asymptomatic but a continuous murmur was heard. Cardiac catheterization revealed migration of a catheter from the main pulmonary artery into the descending aorta through a patent ductus arteriosus and a significant step-up of oxygen saturation in the main pulmonary artery with a pulmonary-to-systemic flow ratio of 1.68. Aortograms demonstrated a communication between the aorta and the pulmonary artery through a patent ductus arteriosus with a minimal diameter of 3.7 mm. Transcatheter coil embolization of the patent ductus arteriosus was successfully carried out with two 0.052-inch-diameter Gianturco coils. Doppler echocardiographic study confirmed no residual shunt in the main pulmonary artery after the procedure. Non-surgical transcatheter occlusion using coil embolization appears to be an effective and minimally invasive technique for treatment of patent ductus arteriosus in the elderly.     

国产蘑菇伞型封堵器封堵巨大动脉导管未闭的可行性研究

目的探讨采用国产蘑菇伞型封堵器经导管封堵巨大动脉导管未闭(PDA)的可行性。方法全组15例,其中男3例,女12例,年龄21±8(16～46)岁。PDA最窄处直径为16±3mm(13～22mm),均采用国产蘑菇伞型封堵器经股静脉途径对PDA进行封堵。封堵前后行主动脉弓降部造影并测定肺动脉压力。封堵成功者分别于术后1周、1个月和6个月复查超声心动图。结果15例巨大PDA选用的封堵器直径为23±4mm(18～32mm),封堵后30min主动脉弓降部造影均显示主-肺动脉水平仅有经封堵器孔眼的微量到少量残余分流。封堵后13例患者肺动脉收缩压峰值较封堵前有不同程度下降(70±29mmHgvs113±21mmHg,P<0.05,1mmHg=0.133kPa),2例因试封堵后肺动脉压力升高而放弃封堵。无一例发生严重并发症。封堵成功者术后复查超声心动图,其中11例于术后1周、1例于术后1个月残余分流消失,另1例于术后6个月时残存少量分流。结论采用国产蘑菇伞型封堵器经导管封堵巨大PDA是一种安全有效的介入治疗方法。     

Giant aneurysm following coil occlusion of patent ductus arteriosus.

A case is described in which a giant aneurysm developed following successful PDA coil occlusion in an infant with Marfan syndrome. This rare and severe complication brings into question the need for careful evaluation of these children before and after transcatheter occlusion.     

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.     

Bioptome-assisted coil occlusion of moderate-large patent ductus arteriosus in infants and small children.

Coil occlusion of patent ductus arteriosus (PDA), although inexpensive, is technically challenging for the moderate-large ducts in small children. Bioptome assistance allows better control and precision. We describe case selection strategies, technique, immediate and short-term results of bioptome-assisted closure of moderate-large (>/= 3 mm) PDA in 86 infants and children 6 mm (> 4 mm for children under 5 kg) and/or shallow ampullae (by echocardiography) underwent operation (n = 41). Specific technical modifications included use of long sheaths (5.5-8 Fr) for duct delineation and coil delivery, cutting of coils turns (51 patients) to accommodate the coils in the ampulla, and simultaneous delivery of multiple coils (n = 43). As far as possible, coils were deployed entirely in the ampulla. Median fluoroscopy time was 7.3 min (1.2-42 min). Successful deployment was feasible in all (final pulmonary artery mean pressures, 20 +/- 4.6 mm Hg). Coils embolized in 14 (16%) patients (all retrieved). Complete occlusion occurred immediately in 63 patients (73%) and in 77 patients (89%) at 24 hr. Three patients had new gradients in the left pulmonary artery. Follow-up (62 patients; median duration, 13 months) revealed small residual Doppler flows in 11 patients (18%) at the most recent visit. Bioptome-assisted coil occlusion of moderate-large PDA in selected infants and small children is feasible with encouraging results.     

Aortic valve regurgitation following percutaneous closure of patent ductus arteriosus

Objectives : To determine the incidence and outcome of aortic valve regurgitation (AR) following the percutaneous closure of patent ductus arteriosus (PDA). Background : Aortic valve regurgitation is an overlooked consequence of percutaneous PDA closure. Methods : Between December 2000 and May 2009, 51 children underwent percutaneous closure of PDA using Amplatzer Duct Occluders. Their median age at the time of the procedure was 2.6 years (range: 0.6–18.0 years), and median weight was 14.0 kg (range: 7.6–75.0 kg). Follow‐up echocardiograms were performed a day after the procedure and at 1, 3, 12 months, and yearly thereafter. Results : A day after the procedure, AR was detected for the first time in 13 of 48 patients (27.0%). A group of patients with newly developed AR was significantly different from a group of patients with competent aortic valves with respect to their age, weight, and minimal PDA diameter indexed to the body weight. The follow‐up period ranged from 0.2 to 8.5 years (median 3.3 years) and at the latest follow‐up evaluation, AR persisted in a single patient (2.0%) 6 years after the procedure. Conclusions : The aortic valve regurgitation following percutaneous PDA closure is trivial to mild and transient. It develops in approximately a quarter of children after percutaneous closure of PDA with a minimal diameter ≥1.5 mm and is more likely to develop in infants and small children having significant left‐to‐right shunts. © 2010 Wiley‐Liss, Inc.     

Transcatheter embolization coil closure of patent ductus arteriosus -modified delivery for enhanced control during coil positioning

The use of Gianturco coils (Cook, Inc., Bloomington, IN) has been recently described as a method of occluding restrictive patent ductus arteriosus (PDA). Precise control of the coil during positioning or withdrawal is difficult. We designed an inexpensive and readily available system to control the coil during delivery and repositioning. A 5 French Mallincrodt vertebral catheter was heat tapered to allow slight, but definite resistance of a 0.035″ guide wire when it was passed through the catheter. The delivery system has been used to successfully coil occlude restrictive PDAs in seven patients. The system has added no additional costs to the procedure and has provided improved control of the coil position prior to release of the coil. © 1995 Wiley-Liss, Inc.     

The intermittent ductus revisited: Echocardiographic evidence and successful coil occlusion: A case report and review of literature

Intermittent occurrence of a large ductal shunt by physical examination and Doppler echocardiography is reported. Cineangiography confirmed a tubular ductus arteriosus with an angulated, narrow, pulmonary end. Presumably this angulation intermittently caused functional closure of the ductus. Trans-arterial delivery of coils resulted in complete occlusion. Cathet. Cardiovasc. Diagn. 45:260–263, 1998. © 1998 Wiley-Liss, Inc.     

New approach to the diagnosis of patent ductus arteriosus during catheterization

The diagnosis of patent ductus arteriosus (PDA) usually requires catheterization, as does percutaneous treatment of the disorder. To obtain pressure gradients, a catheter can be passed in either direction through the PDA, from the pulmonary artery to the aorta or via the more common route of aorta to pulmonary artery. Several types of catheters have been used, but to date there have been no reports showing the use of a left internal mammary artery (LIMA) angiographic catheter for this purpose. We report successful passage of this catheter from the aorta across a PDA to the pulmonary artery in 15 adult patients who were observed to have no complications. Cathet. Cardiovasc. Intervent. 46:350–351, 1999. © 1999 Wiley-Liss, Inc.