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 art eriosus has gained popularity, few follow-up data have been reported. Methods. A review of 75 patients who underwent coil occlusion was perf ormed. Residual shunting was investigated by Doppler echocardiography in follow-up. Angiograms were reviewed to obtain minimal ductal diamet er and ductal angiographic type. Results. Residual shunts were found i n 31 patients (41%) on the day of the procedure, and of these, spontan eous closure was noted in 17 (55%) at 2 weeks to 20 months of follow-u p; 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 resi dual shunts 20 months after a single coil procedure and 3 +/- 3% after all coil procedures. Minimal ductal diameter was associated with imme diate complete ductal occlusion by a single coil. These patients had s ignificantly 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 clos ure of residual shunts (1.9 +/- 0.7 mm) and those with persistent resi dual shunts (2.0 +/- 0.9 mm). No association was identified between du ctal angiographic type and outcome of coil occlusion. No late adverse clinical events of coil occlusion or evidence of recanalization was fo und. Conclusions. Small residual shunts are common after coil emboliza tion of patent ductus arteriosus, but most close spontaneously. Actuar ial analysis estimates complete closure in 94% at 20 months, and reint ervention was required in only 7% of patients.