Transarterial occlusion of patent ductus arteriosus with Gianturco coils in pediatric patients: a preliminary result in central Taiwan.

OBJECTIVE: We wish to present the preliminary result of transarterial occlusion of patent ductus arteriosus (PDA) with Gianturco coils in pediatric patients in central Taiwan. MATERIALS AND METHODS: We attempted occlusion of PDA with Gianturco coils in a total of 26 consecutive patients, 13 infants and 13 children, 23 female and three male, between July 1 1997 to September 30 1998. Median patient age was 2.57 years (from 0.25 to 14.02 years old). Median patient weight was 10.8 kg (4.0 to 36.0 kg). Premature babies with PDA, full-term babies who were less than three months old and patients who had other congenital heart disease were not included in this study. All PDAs were approached transarterially from the femoral artery. Coils were selected to provide a helical diameter that was twice or more the minimum ductus diameter and a length approximating five loops. In five patients who had a PDA diameter > or =3.5 mm, we used a snare technique to assist coil delivery beforehand, and to test coil stability, or to retrieve coil that had migrated to the pulmonary artery afterwards. Physical auscultation, chest radiographs and echocardiography with color Doppler were done in all patients within 24 h, and one, two, three, six and 12 months after coil occlusion. RESULTS: The median ductus minimum diameter was 2.3 mm (range, 1.0 to 4.7 mm). Fifteen patients had the megaphone type (type A), four had the window type (type B), five had the tubular type (type C), one had the aneurysmal type (type D) and one had the elongated conical type (type E). Twenty-one patients underwent single coil occlusion and five had multiple coils occlusion. Twenty-one patients had immediate angiographic closure of the ductus and disappearance of heart murmur at 15 min after the procedure. Dark-brown urine (hemoglobinuria) was found in one patient, 10 h after the first procedure, due to a mild residual ductal shunt. Two more coils were implanted in a second procedure that was performed within 24 h, and the ductus was completely occluded. The dark-brown urine regressed. At one month follow-up, four patients had mild residual ductal shunts, which were completely occluded by one more coil in three patients and by two more coils in the other patient. Malpositioned coils were deployed in five patients immediately after the procedure. In total, the closure rate at 15 min, within 24 h, and at one, two, three, six and 12 months were 81, 85, 85, 100, 100, 100 and 100%, respectively. In one year of follow-up, there was no instance of coil migration, ductus reopening or stenosis of the left pulmonary artery. CONCLUSIONS: Transarterial occlusion of PDA, with a Gianturco coil having approximately five loops, can be effectively achieved in patients with a minimum ductus diameter up to 4.7 mm. In patients with a ductus of more than 3.5 mm, the snare-assisted technique was employed advantageously to control coil delivery with accuracy and stability. Coil malposition or migration can be easily retrieved using a 10-mm Nitnol snare catheter. Hemoglobinuria, due to intravascular hemolysis, may regress within 24 h after the second attempt at coil implantation.     

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.     

New technique using temporary balloon occlusion for transcatheter closure of patent ductus arteriosus with Gianturco coils

We describe our early experience with a new technique involving temporary balloon occlusion for transcathether closure of patent ductus arteriosus (PDA) using single or multiple Gianturco coils. Coil occlusion was attempted in 21 patients of median age 3 (range 1–11) years, and angiographic PDA diameter 3.0 mm ± 0.87 mm. The inflated balloon of a pulmonary wedge pressure catheter over a transductal wire was used to mechanically hold the first extruded loop of the coil at the pulmonary end of the duct. If a residual shunt persisted after the delivery of the first coil, additional coils were delivered with or without the balloon support. One to nine coils (median 2) of different sizes varying between 3–12 mm diameter and 4–15 cm length were used. Immediate angiographic occlusion rate was 47.6%. However, color Doppler (CD) at 24 hours and at 6 weeks revealed complete closure in 66.6% and 80.9%, respectively. Blood transfusion was required in 2 (9.5%) patients. Three out of 56 coils (5.4%) embolized during deployment. The use of balloon occlusion is effective and safe in the treatment of ducti up to 4.7 mm. Residual shunts tend to occlude with time. Cathet. Cardiovasc. Diagn. 41:62–70, 1997. © 1997 Wiley-Liss, Inc.     

Evaluation of Gianturco Coils for Closure of Large (≥3.5 mm) Patent Ductus Arteriosus

Objectives. This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (≥3.5 mm) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils.

Background. Coil closure of PDAs has become increasingly popular. However, the technique has significant limitations when used to close large PDAs. This report evaluates patient characteristics, PDA anatomy, hemodynamic variables, delivery technique and coil geometry to determine predictors of success.

Methods. Between January 1995 and January 1997, 16 of 118 patients undergoing catheterization for PDA closure were found to have large PDAs. Their median age and weight were 14 months (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respectively. The mean PDA diameter was 4.3 mm (range 3.5 to 5.9). Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096-cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynamic and technical variables between successes and failures were compared.

Results. Eleven (69%) of 16 patients had successful closure of their PDA. Failures occurred only in patients <8 months of age with an indexed PDA diameter >7 mm/m and a pulmonary/systemic flow ratio ≥2.8:1. Use of 0.052-in. coils tended to reduce the incidence of embolization and the number of coils needed for closure.

Conclusions. Patients >8 months of age can have successful closure of large PDAs with currently available Gianturco coils. The 0.052-in. Gianturco coils can be used safely to close large PDAs in infants as small as 6 kg. Increased experience and improved coil design may improve closure rates of large PDAs in infants.     

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.     

Advantages and disadvantages of coils for transcatheter closure of patent ductus arteriosus

Different coils have been used to close the patient ductus arteriosus (PDA). In small- and moderate-sized PDA, coils are an adequate alternative to surgery and/or to other devices. The aim of the study is to review and discuss the advantages and disadvantages of using coils (excluding PFM coils PFM Medical, Germany) to close PDA. Cambier was the first to successfully close a PDA using a Gianturco coil. To date, thousands of patients worldwide have undergone transcatheter closure of PDA using this or other types of coils. The use of coils is analyzed with regard to costs in comparison with other therapeutic modalities; techniques--anterograde, retrograde approach, selection of coil size--in relation to the size of the PDA and the available sizes of coils; efficacy of the rate of complete occlusion and the need for reocclusion; and safety in relation to embolization rate, other complications including hemolysis, left pulmonary artery LPA stenosis and coarctation. It is concluded that coils are a cheap alternative for the occlusion of PDA in the small-to-moderate PDA. The technique can be learned quite quickly, it has a high rate of complete occlusion, and has an acceptable rate of safety. The disadvantages include a moderate rate of coil embolization and of hemolysis in patients with residual shunt after coil occlusion in large PDAs. When more than one coil is used, the potential for developing LPA stenosis is high.     

Transcatheter occlusion of the patent ductus arteriosus with a single device technique: comparison between the Cook detachable coil and the Rashkind umbrella device

Transcatheter coil occlusion of the patent ductus arteriosus (PDA) has become the interventional treatment option of choice. Immediate occlusion of any residual shunting results in excellent closure rates, but frequently requires multiple coil deployment. Aims: To assess the efficacy and limitations of single Cook detachable coil PDA closure compared to a preceding series of Rashkind umbrella procedures. Methods and results: Between 1990 and 1999, transcatheter occlusion of a small (<2 mm; n=45) or moderate-sized (2-4 mm; n=47) PDA was successfully attempted in 90/92 consecutive patients (mean age 6+/-4.8 years) with a coil (39/41) or Rashkind device (51/51). Immediate angiographic closure rates for both devices were low, although better for small (54-68%) than moderate ducts (7-22%, P<0.01). A 2-year echocardiographic closure rate of small ducts increased to 92% for the coil group versus 95% for the Rashkind group. By that time, moderate-sized ducts were only occluded in 64% with the coil and 54% with the Rashkind device. A visible residual shunt at post-implant angiography in moderate ducts was associated with a high incidence (59%) of long-term echocardiographic shunt patency and a need for repeat interventions for audible residual shunts (32%). Conclusions: Single coil transcatheter occlusion is the treatment of choice for the small duct as most residual shunts will resolve spontaneously. However, long-term shunt persistence after single coil deployment in moderate sized ducts is as frequent as with the Rashkind device. A primary multiple coil approach is advocated if the postcoil aortogram shows residual ductal shunting and if there is persistence of a ductal murmur on auscultation.     

Trans‐catheter closure of patent ductus arteriosus—What is the best device?

Background : Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA) has evolved to be the procedure of choice. Gianturco and Flipper coils are the most commonly used coils in the United States for closure of small and moderate size PDAs. For larger PDAs, interventionalists in the United States commonly use the Amplatzer Duct Occluder (ADO) and those in Europe use the ADO or the Nit‐Occlud Coils (NOC). A comparison between Gianturco coils, Flipper coils, ADO, and NOC has never been made. Objective : To compare the success and complication rate associated with the four different devices used for transcatheter closure of PDA. Success was defined as complete closure of PDA with absence of a residual shunt (R.S.) at six months follow‐up. Methods : Two institutions collaborated in combining their data to evaluate the results of transcatheter closure of PDA. Results : Totally, 546 patients underwent successful PDA occlusion at both institutions. Gianturco and Flipper coils were used in 120 (22%) and 119 (22%) patients respectively. A total of 152 (28%) patients received ADO and 155 (28%) patients received NOC. Immediate R.S. were noted in 226 (41.4%) patients in the entire study group with the NOC group having the highest percentage of R.S. (80/155, 51.6%, P = 0.004). Of the 484 patients with follow‐up echocardiograms at 6 months, 35 (7.2%) patients had persistent R.S. The NOC (3/143, 2.1%) and ADO (5/150, 3.3%) groups had the least R.S. at six months follow‐up. Conclusion : Per our definition of success, the Nit‐Occlud coils and the Amplatzer duct‐occluder devices had significantly higher success rate for PDA occlusion versus the coils. © 2010 Wiley‐Liss, Inc.     

The duct-occlud device: design,clinical results,and future directions

The successful employment of embolization coils for transcatheter occlusion of the patent ductus arteriosus (PDA) has resulted in acceptance of transcatheter occlusion as the treatment of choice for small to medium-sized PDAs. The Duct-Occlud device was developed to further improve the technique by utilizing a controlled release mechanism and coil shape specifically designed for the geometry of the ductus arteriosus. Clinical studies have demonstrated excellent efficacy with low embolization rates and low incidences of complications. Newer modifications have been designed for occlusion of larger PDAs and subaortic ventricular septal defects, and preliminary clinical results have been promising.     

Retrograde transcatheter occlusion of patent ductus arteriosus: preliminary experience in Gianturco coil technique without heparinization

BACKGROUND: The aim of this study was to report the initial experience of using the Gianturco coil (Cook Cardiology, Bloomington, Indiana) without heparinization to close patent ductus arteriosus (PDA). PATIENTS AND METHODS: Forty consecutive patients (30 females, 10 males) underwent transcatheter closure of a PDA via the right femoral artery approach without heparinization. Patients ages ranged from 7 months to 55 years (median, 6.8 years); weights ranged from 7.8 65 kg (median, 18.3 kg). Twenty-one patients had cardiomegaly (n = 21), congestive heart failure (n = 10), or both (n = 10). The PDAs measured 0.8 4.5 mm (median, 2.6 mm) at the narrowest diameter; the mean Qp/Qs ranged from 1.0 2.6 (1.4 +/- 0.4). The helical diameter of the coil that we chose was 1.7 times the narrowest PDA diameter. The length of the coil was sufficient to produce 4 or 5 loops. RESULTS: Successful coil placement was accomplished in all 40 patients. Thirty-five patients (87.5%) underwent single coil implantation, 2 patients (5%) had 2 coils, and 3 patients (7.5%) had 3 coils. Complete ductus occlusion was achieved in 80% of cases at the end of the procedure, while 8 patients had minimal shunt detected by aortography or echocardiography. The occlusion rate increased to 87.5% by the next day, 90% by 1 month, 92.5% by 3 months, 95% by 6 months, and 97.5% by 9 and 12 months. Only one asymptomatic patient had minimal residual shunt detected by color Doppler at 12 months follow-up. At a median follow-up of 17 months (range, 5 25 months), no patient had thromboembolism, endocarditis, coil migration, diminished femoral pulse or hemolysis. CONCLUSION: Our preliminary results suggest that retrograde transcatheter closure of PDA with the Gianturco coil without heparinization is feasible, safe and efficacious. A single coil allowed complete occlusion of PDA 3 mm in diameter.     

Patent ductus arteriosus closure using the new Amplatzer Duct Occluder. Preliminary results and review of the literature.

BACKGROUND: Patent ductus arteriosus (PDA) is the second most common congenital heart disease. A large number of surgical and transcatheter techniques for the interruption or closure of PDA has been reported. The aim of this study was to assess the immediate and short-term results of transcatheter closure of PDA using the new, self-expandable, self-centering, and repositionable Amplatzer Duct Occluder device. METHODS: We attempted occlusion of PDA with the Amplatzer Duct Occluder in seven consecutive patients, one child and six adults, four females and three males, between September 1999 and January 30th 2000. All PDAs but one were approached from the femoral venous site; the Amplatzer Duct Occluder size was selected in order to be 2 mm larger than the duct's diameter at its narrowest site and the mean PDA diameter was 5.4+/-2.5 mm (range 3-9). All patients underwent physical examination, chest X-ray and echocardiography within 48 hours and on first and third month after PDA occlusion. RESULTS: Four patients had a megaphone type (type A), and three had an elongated, conical type (type E) PDA. Four patients had immediate, complete angiographic closure of the ductus 10 minutes after the procedure, one had a trace shunt and two had small shunts which all disappeared within 48 hours. The average fluoroscopy time and procedural time were 34.4+/-10.6 min (range 21-50) and 105+/-38.9 min (range 75-190) respectively. There were no complications at follow-up. CONCLUSIONS: Transcatheter closure of PDA using the new Amplatzer Duct Occluder is an easy and effective technique. Moreover it is safe even in the presence of wide PDAs.     

Comparison between the safety profile and clinical results of the Cook detachable and Gianturco coils for transcatheter closure of patent ductus arteriosus in 272 patients

OBJECTIVES: We evaluated the occlusion rate and safety of Cook detachable coils versus Gianturco coils in transcatheter closure of patent ductus arteriosus (PDA). BACKGROUND: The Cook detachable coil recently was introduced in an attempt to improve the safety of transcatheter closure of PDA. METHODS: Between January 1994 and September 1998, 272 patients underwent transcatheter PDA closure. Cook detachable coils were used in 137 patients, with a mean age of 43.9 months and weight of 13.8 kg. In 135 patients, Gianturco coils were used, with a mean age of 56.8 months and weight of 17.8 kg. The mean narrowest diameter of the PDA in the Cook detachable coil group was 2.85 mm versus 2.32 mm for the Gianturco coil group. RESULTS: The Cook detachable coil group was younger and weighed less than the Gianturco group (P < 0.05 and 0.02, respectively). Their narrowest PDA diameter was larger (P < 0.01). Embolization rate was significantly lower in the Cook coil group (9[6.5%] of 137 vs 22 (16.3%) of 135; P = < 0.013). The mean follow-up for the Cook coil group was significantly shorter (0.55 years) than for the Gianturco coil group (1.18 years; P < 0.001). On an intention-to-treat basis, complete occlusion by echocardiography was achieved in 99 (72.3%) of 137 patients in the Cook detachable coil group, which was significantly less than the Gianturco coil group (114 [84.4%] of 135; P = 0.008). CONCLUSION: Cook detachable coils for transcatheter closures of the PDA are safer than Gianturco coils. Hence, children with large ductal can be treated earlier in life. Short-term complete occlusion rate was lower in the Cook detachable coil group. This rate can be explained by a shorter follow-up time, larger ductal diameter, and the different materials used for the detachable coils.     

Transcatheter closure of large patent ductus arteriosus (> or = 4 mm) with multiple Gianturco coils: immediate and mid-term results.

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.     

Transcatheter coil embolization of large-size patent ductus arteriosus in adult patients: usefulness and problems

Transcatheter coil embolization of the patent ductus arteriosus (PDA) has been frequently used in children, especially for small lesions. It was attempted in 3 adults using Cook detachable coils. For 2 of the patients, relatively old age and heart failure were the reasons for choosing coil embolization of the PDA. In the remaining patient, who had Wolff-Parkinson-White syndrome, coil embolization was performed after radiofrequency catheter ablation of Kent's bundle. Their respective minimal PDA diameters were 5.0 mm, 4.5 mm and 4.0 mm measured by transesophageal echocardiography. Two coils were placed in 2 patients and 1 coil in the remaining patient. After the procedures, the size of the left ventricle decreased and heart failure was improved in 2 patients, although all 3 patients had a residual shunt, which caused hemolytic anemia in 2 patients. Repeat coil-embolization procedures resulted in complete occlusion and the hemolysis disappeared in these patients. In adult patients who have heart failure due to large PDA, coil embolization with detachable coils, even if residual shunt persists, is useful for improvement of the heart failure. In cases of hemolysis related to residual shunt, a second coil-embolization procedure can improve it completely.     

Percutaneous closure of patent ductus arteriosus: A multiinstitutional registry comparing multiple devices

Background: There are no guidelines and multiple devices available now for closure of PDA. Objective: We sought to determine which devices are used and their outcomes. Methods: Prospectively collected data on closure of PDA at 12 US catheterization labs was entered into the MAGIC data registry between November 2005 and September 2008. Results: PDA closure was accomplished in 357 of 359 attempted closures during the study period. Mean age, weight, and minimum ductal diameter were 4.3 ± 6.8 years, 18.7 ± 18.4 kg, and 2.1 ± 1.4 mm, respectively. Devices used were Gianturco coils (161/359), Amplatzer Duct Occluder (ADO, 174/359), Flipper coils (18/359), and other devices (6/359). Gianturco coils had the least fluoroscopy and contrast exposure (8.7 ± 7.5 min, P = 0.00001, 2.6 ± 1.4 cm³ kg^?1, P = 0.00001). Immediate angiographic success rates were 96.9% (156/161) for Gianturco coils, 89.7% (156/174) for the ADO, 100% (18/18) for Flipper coils, and 66.7% (4/6) for other devices. Major complication rates were 0.6% for Gianturco coils (1/161), 1.7% for ADO (3/174), and 83.3% for other devices (4/6). Minor complication rates by device were 1.9% for Gianturco coils (3/161), 2.3% for ADO (4/174), and 16.7% (1/6) for other devices. Conclusions: Gianturco coils, the ADO and Flipper coils were immediately successful with low complication profiles. The ADO and Gianturco coils were the predominate devices. The ADO was the device of choice for PDA > 3 mm with good success. In PDA < 3 mm, the Gianturco coil is as effective and safe as the ADO with less cost, less radiation, and less contrast exposure. © 2010 Wiley‐Liss, Inc.     

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.     

Long-term outcome comparison between rashkind umbrella and gianturco coils occlusion in native patent ductus arteriosus

Background: The Rashkind Umbrella device has proven effective in closing small to moderate size patent ductus arteriosus. A comparable early occlusion rate was also seen in PDA occlusion using Gianturco coils. This study addresses the long-term outcome of both techniques in a single centre. Methods: Review was undertaken of 522 patients with PDA who underwent transcatheter occlusion before January 1997; 244 patients (mean: age 8.0±6.7 years, weight 21.8±12.9 kg, PDA size 3.2±1.0 mm) were intended to receive the Rashkind Umbrella device and the remaining 278 patients (mean: age 6.4±5.6 years, weight 18.6±11.2 kg, PDA size 2.5±1.0 mm) would receive Gianturco coils. Deployment failure occurred in 8 patients (3%) and 6 (2%) during the initial learning curve of the Rashkind Umbrella and Gianturco coil, respectively. In the Rashkind Umbrella group, haemolysis occurred in 6, device embolisation in 3, and 1 patient died from anaesthetic sequelae. Peripheral pulmonary embolisation of coils occurred in 7 patients and all were successfully retrieved. Results: Results were analysed from 228 and 258 patients who had successful Rashkind Umbrella device and Gianturco coil deployment respectively. All had completed at least 1 year follow-up. They were evaluated clinically for residual ductal murmur and echocardiographically for a residual ductal shunt and presence of pulmonary artery or aortic obstruction. The Rashkind Umbrella group had significantly higher residual shunt compared to the Gianturco coil group at various stages of follow-up (p<0.05), 40% v 22% at 24 hours, 29% v 7% at 3 months, 25% v 4% at 6 months and 22% v 3% at 1 year. In 57 patients, a reocclusion procedure during the study period was undertaken to effect immediate complete occlusion. Mild left pulmonary artery stenosis (velocity<2 m/s) was noted in 6 patients who had multiple coils and one who had a 17 mm Rashkind Umbrella device. Conclusions: Transcatheter occlusion of PDA using the Gianturco coil is safer and more effective than the Rashkind Umbrella device. It has become the first choice for treating small to moderate size native PDA at our institution.     

Reopening After Successful Coil Occlusion for Patent Ductus Arteriosus

Objectives. This study was performed to determine the frequency of patent ductus arteriosus (PDA) reopening and the factors that may predict reopening after successful coil occlusion.Background. Transcatheter coil occlusion is a widely used and accepted method to close a PDA. After documented successful coil occlusion, we found PDAs that reopened. We hypothesized that specific factors are involved in those that reopened.Methods. All patients who underwent percutaneous transarterial PDA coil occlusion were studied. Successful coil occlusion was documented. PDA reopening was determined when Doppler-echocardiography (DE) performed after the procedure was negative for PDA flow but at follow-up demonstrated PDA shunting. Patients with a reopened PDA were compared with all other patients in evaluating independent variables.Results. Coil occlusion for PDA was attempted in 22 patients. Clinical success was achieved in 20 patients (91%), and DE was negative for PDA shunting in 19 patients (90%). At follow-up, five patients demonstrated reopening. The PDA minimal diameter was 1.4 ± 0.5 mm (mean ± SD) for the reopened group and 1.2 ± 0.7 mm for the other patients. The PDA length was 2.9 ± 1.9 mm for the reopened group and 7.1 ± 3.2 mm for all other patients. All those with type B PDA were in the reopened group. When independent variables were compared between groups, only PDA length and type B PDA predicted reopening (p < 0.05).Conclusions. PDA reopening may occur after successful coil occlusion. Short PDA length and type B PDA are associated with reopening. The data suggest that in such anatomy, alternative strategies to the current coil occlusion technique should be considered.     

Transcatheter closure of patent ductus arteriosus and aorto‐pulmonary vessels using non‐ferromagnetic Inconel MReye embolization coils

Objectives . We report the use of non‐ferromagnetic embolization coils for transcatheter PDA closure. Background . Transcatheter patent ductus arteriosus (PDA) closure has been performed for 40 years. A number of devices have been used with varying degrees of success. Gianturco embolization coils have been used frequently since 1992 with excellent results. These coils are a stainless steel alloy, and create an artifact when subsequent MRI imaging is performed. Methods . Eight patients underwent right and left heart catheterization and transcatheter PDA closure. Angiography displayed a PDA with left to right shunting. The minimum PDA diameter was measured. An Inconel MReye coil was implanted using standard retrograde technique. A postimplant angiogram was performed. Evaluations were performed the following morning and after 2 months. Results . The median age was 5.5 years, median weight was 24 kg. The PDA minimum diameter was 1.7 mm (range 1.4–2.4 mm), with a median Qp:Qs=1.33:1. In all patients, the PDA was completely immediately closed using one Inconel coil. Two patients also had a small aorto‐pulmonary collateral vessel that was occluded using a separate Inconel coil. All patients had follow‐up evaluation the following day; the PDA remained completely occluded and there was no obstruction of the pulmonary artery branches or descending aorta. Seven patients had subsequent follow‐up and echocardiograms; the PDA remained completely occluded. There were no complications. Conclusion . The Inconel MReye coil is safe and effective for coil occlusion of small PDA and aorto‐pulmonary vessels. Additional studies are needed to define the maximum vessel diameter for Inconel coil occlusion. © 2008 Wiley‐Liss, Inc.