Coil occlusion of patent ductus arteriosus.

BACKGROUND: Coils are the only devices available for transcatheter occlusion of patent ductus arteriosus (PDA) in Japan. Since April 1999, we have introduced a 0.052-inch Gianturco coil (0.052-inch coil) to close PDA >or=2.5 mm. METHODS AND RESULTS: A retrospective survey of the outcome of coil occlusions for PDA >or=2.5 mm before and after the 0.052-inch coil became available found that (1) the frequency of PDA >or=2.5 mm among all candidates for coil occlusion significantly increased after the availability of a 0.052-inch coil (p<0.01); (2) deployment complicated by migration (p<0.01), and prolonged procedure time (p<0.05) were significantly decreased after the introduction of the 0.052-inch coil. In a multivariate logistic regression model for uneventful deployment adjusted for age, pulmonary to systemic flow ratio, and use of a 0.052-inch coil, use of the 0.052-inch coil significantly decreased eventful deployment (p<0.05); and (3) successful deployment of a coil for PDA >or=4 mm significantly increased with the 0.052-inch coil (p<0.01). Complete occlusion was achieved once deployment was successful. CONCLUSION: Introduction of the 0.052-inch coil decreased complicated coil occlusion deployment for PDA >or=2.5 mm, and contributed to a better likelihood of coil occlusion for PDA >or=4 mm.     

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.     

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.     

The snare-assisted technique for transcatheter coil occlusion of moderate to large patent ductus arteriosus: immediate and intermediate results.

OBJECTIVES: The purpose of this study was to evaluate the feasibility, safety and efficacy of using a snare-assisted technique to coil occlude the moderate to large size patent ductus arteriosus (PDA). BACKGROUND: Transcatheter occlusion of small PDAs using Gianturco coils is safe and effective. However, in larger size PDAs and/or those with short PDA length, the procedure still carries risks of coil embolization, incomplete occlusion and failure to implant the coil. METHODS: From January 1994 to June 1997, the records of 104 consecutive snare-assisted coil occlusions of moderate to large PDAs (minimum diameter >2.0 mm) were reviewed. Immediate and intermediate outcomes including complete and partial occlusion, failure to implant and complications were analyzed with respect to ductal type and size. RESULTS: Patient age ranged from 0.1 to 70.1 years (median 3.3 years). Minimum PDA diameter ranged from 2.1 to 6.8 mm (mean 3.0 +/- 0.9 mm). Angiographic types were A-62, B-13, C-6, D-14 and E-9. Using the snare-assisted technique, coil placement was successful in 104/104 patients (100%), irrespective of size or angiographic type. Immediate complete closure was observed in 73/104 (70.2%) and was related to smaller PDA size, but not to angiographic type. Complete closure was documented in 102/104 (98.1%) at 2- to 16-month follow-up. Successful closure was unrelated to PDA size or type. Coil embolization to the pulmonary artery occurred in 3/104 (2.9%) patients and was not related to PDA size or type. The need for multiple coils was found in 28/104 patients (26.9%), and was related to larger PDA size, but not to angiographic type. CONCLUSIONS: The snare-assisted delivery technique allows successful occlusion of moderate to large PDAs up to 6.8 mm, irrespective of angiographic type. This technique permits improved control and accuracy of coil placement, and facilitates delivery of multiple coils.     

Safety and efficacy of using 0.052-inch Gianturco coil for closure of large ( > or = 4mm) patent ductus arteriosus

Transcatheter closure of patent ductus arteriosus (PDA) is now a well-established treatment alternative to surgery in many cardiology centers. Of all the methods used, transcatheter coil occlusion is the preferred therapy. For small PDA, the method using 0.038" Gianturco coils has proven safe and effective. However, this therapeutic strategy has encountered some difficulties with large PDA. This study provides an alternative strategy, using 0.052" Gianturco coil and complete closure of residual shunt with multiple coils to close large PDA. Fifteen patients underwent transcatheter coil occlusion of large ( > or = 4mm) patent ductus arteriosus. The intermediate success rate was 86.7%. There were four complications and only two patients had to be referred for surgery.     

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 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.     

Transcatheter closure of patent ductus arteriosus with Nit-Occlud coils.

The detachable coils have been successfully used for transcatheter occlusion of small- to moderate-sized patent ductus arteriosus (PDA). We report our experience regarding the use of the Nit-Occlud coils (NOCs) for transcatheter PDA and major aortopulmonary collateral (MAPCA) occlusion. Single NOCs were used to close PDA in 26 patients, and one small and two large MAPCAs in two patients. Mean age and weight of the patients were 7.7 +/- 5.4 years and 20.6 +/- 11.6 kg. Mean minimum duct diameter was 2.8 +/- 0.8 mm; ampulla, 8.7 +/- 2.4 mm; and PDA length, 9.3 +/- 4.4 mm. Mean pulmonary artery pressure ranged from 9 to 51 mm Hg and pulmonary/systemic flow ratio from 1.1 to 5.8. Ductal shape was conical in 24 patients. Route of approach was venous in 23 and arterial in 3. Successful coil implantation was achieved in 24/26 (92.3%). Mean procedure and fluoroscopy time were 67.2 +/- 22.1 and 14.9 +/- 6.5 min. The three MAPCAs were also successfully occluded using NOC Medium and Flex. Postimplantation angiograms revealed no leak in 3, a trace or small leak in 17, and a medium leak in 4 patients. Mean follow-up was 7 +/- 5 months. Complete occlusion was achieved in 17/24 (71%) at 24 hr, 19/24 (79%) by 1 month, 13/15 (87%) by 3 months, 14/15 (93%) by 6 months, and 10/11 (90%) by 12 months postprocedure. Hemolysis, late embolization, duct recanalization, and flow disturbances were not observed. Transcatheter occlusion of moderate-sized PDAs and MAPCAs using NOCs seems to offer a safe, simple, and controlled method in pediatric patients.     

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.     

Endothelialization of the coils used to occlude a persistent ductus arteriosus: an angiographic study

To assess the endothelialization of the coils used to close a persistent ductus arteriosus (PDA), the present study comprised a review of the follow-up aortograms and pulmonary angiograms in 25 patients who underwent coil occlusion. The minimal diameter and the length of the PDA were measured prior to the procedure, and the shortest distance between the aortic end of the deployed coil and the aortic end of the PDA was measured after coil deployment. Evidence of endothelial coverage of the coil was sought on follow-up angiograms performed 6-24 (15+/-5) months later and the factors that determined the thickness of the endothelial coverage on the aortic end were investigated. Separation of the coil and the contrast column were detected at the aortic end in all cases and at the pulmonary end in 18 of 25 cases. The thickness of the separation ranged from 0.4 to 1.3 (0.7+/-0.2) mm at the aortic end and 0.3 to 0.8 (0.6+/-0.2) mm at the pulmonary end. The length of the ductus and of the ampulla had a significant positive correlation with the thickness of the aortic end separation. Apparent endothelial coverage of the coil was completed by 6 months after coil occlusion. Infective endocarditis or thromboembolism is an unlikely complication once endothelium covers the implanted coil.     

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.     

Transcatheter closure of persistent arterial ducts with different types of coils

BACKGROUND: Different types of coils have been designed for transcatheter closure of persistent arterial ducts. We compared the efficacy and safety of three types of coils: Gianturco coils (Cook), Cook detachable coils (Cook), and Duct Occlud devices (pfm). METHODS: Sixty-three patients underwent coil occlusion of arterial ducts between April 1995 and July 2000. The mean age and weight were 4.8+/-3.4 years and 16.5+/-7.6 kg, respectively. The results and complications of ductal occlusion among the three types of coils were compared. Kaplan-Meier analysis was used to assess reduction in the prevalence of residual shunt with time, and multiple regression analysis was performed to identify predictors of complete occlusion. RESULTS: Coil occlusion of persistent arterial ducts that measured 2. 2 +/- 0.8 mm was feasible in 90% (57/63) of patients. Gianturco coils were used in 29, Duct Occlud devices in 16, and Cook detachable coils in 12 patients. The prevalence of residual shunt at 24 hours, 6 months, 12 months, and 24 months was 42%, 20%, 18%, and 14%, respectively. The reduction in prevalence of residual shunt with time tended to be greater when Gianturco coils were used (P =. 067). Logistic regression identified the use of Gianturco coils to be a significant predictor of complete ductal occlusion on follow-up (P =.04). Pull-through of coils occurred in 4.8% (3/63) and coil embolization in 6.3% (4/63). There was no association between the type of coil and the risk of embolization (P = 1.00). CONCLUSIONS: Transcatheter occlusion of small persistent arterial ducts with coils is safe and effective. There is no advantage of detachable coils (Cook detachable coils and Duct Occlud devices) over nondetachable Gianturco coils in reducing the risk of embolization. Our findings are in favor of the inexpensive, but more effective, Gianturco coils for occluding small arterial ducts of 3 mm or less.     

Comparison of two transcatheter device strategies for occlusion of the patent ductus arteriosus

Objectives: The present study evaluates two transcatheter closure strategies utilized at a single center and makes recommendations for device selection when occluding the patent ductus arteriosus. Background: A variety of devices are available for transcatheter closure of the patent ductus arteriosus (PDA) but no guidelines exist to guide operator device choice. Methods: A total of 132 patients underwent attempted transcatheter PDA closure utilizing one of two consecutive closure strategies between January 2000 and June 2005. Strategy A (n = 64; January 2000–May 2003) utilized Gianturco coils only. Strategy B (n = 68; June 2003–June 2005) utilized a single Gianturco coil for the PDA with a minimal diameter ≤1 mm (n = 28) or an Amplatzer Duct Occluder (ADO) if the PDA diameter exceeded 1 mm (n = 40). Success was defined as complete occlusion on a follow up echocardiogram. Results: 58 of 64 (90.6%) patients treated utilizing strategy A had successful coil implantation. 68 of 68 (100%) patients treated utilizing strategy B had successful coil/device implantation. At follow up echocardiography, 32 of 44 (72.7%) strategy A patients had complete ductal closure, as compared with 57 of 58 (98.3%) strategy B patients (P < 0.0001). Stepwise logistic regression analysis identified closure strategy as the most powerful predictor of procedural success (OR = 85.9; CI 5.6–9.99). Conclusions: A transcatheter PDA closure strategy consisting of a single Gianturco coil for PDA ≤ 1 mm or an ADO for larger sized PDA (strategy B) achieves superior outcomes compared to the use of coils alone. © 2008 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.     

Transcatheter coil embolization of a high-flow coronary artery fistula using 0.052-inch gianturco coils: a case report.

A giant, high-flow coronary fistula is usually difficult to treat by transcatheter coil embolization, but the 0.052-inch Gianturco coil, which is larger and has a stronger shape memory than conventional coils, is now available. Using this device and additional conventional coils, a high-flow coronary artery fistula in a healthy 31-year-old man was successfully embolized. The new Gianturco coil widens the indication for the transcatheter embolization of coronary artery fistulas.     

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.     

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.     

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.     

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.     

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.