TRANSCATHETER CLOSURE OF PATENT DUCTUS-ARTERIOSUS USING CONTROLLED-RELEASE COILS

Controlled-release coils have become available recently for the closur e of patent ductus arteriosus (PDA). Transcatheter closure of patent a rterial ducts was attempted in 13 patients, ranging in age from 5 mont hs to 15 years, mean 4.1 years. Implantation of controlled-release PDA coils was attempted via the femoral artery through 5 Fr catheters in all cases except one, in whom both the femoral arterial and venous rou tes were used. The procedure was successful in 10 of the 13 patients. In these, the pulmonary artery systolic pressure ranged between 25 and 42 mmHg and the duct diameter varied from 1.5 to 6 mm at its narrowes t point. Six of the patients received a single coil. Two coils were in serted in three patients and three coils in one patient, In three pati ents the ducts were too large for safe release of the coils, despite a ttempted implantation of up to three coils simultaneously. These coils were easily withdrawn into the catheter. Immediately at the end of th e procedure, the duct was completely occluded in nine of the 10 patien ts, and in one patient there was a small residual flow. The procedure time varied between 35 min and 2.5 h, mean 81 min and the fluoroscopy time varied from 5 to 78 min, mean 25 min. None of the patients experi enced hemorrhage, diminished lower extremity pulse, hemolysis or infec tion. In one patient, a 5 mm coil embolized into the right pulmonary a rtery soon after release. It was retrieved with a snare, then 8 mm and a 5 mm coil were implanted satisfactorily in the arteriaI duct. At fo llow-up by color Doppler echocardiography, the duct was completely occ luded in all patients. Transcatheter closure of patent arterial ducts by controlled-release PDA coils Ts effective and safe. Even when more than one coil is inserted, it is still cheaper than transcatheter umbr ella closure, This method is therefore of great value, particularly in less affluent countries.