TRANSCATHETER OCCLUSION OF PATENT DUCTUS-ARTERIOSUS WITH GIANTURCO COILS

Background. Transcatheter occlusion with Gianturco coils has been atte mpted in a small number of patients with tiny (less-than-or-equal-to 1 .5-mm diameter) patent ductus arteriosus, and preliminary results have been encouraging. The present study extends this method to larger duc tus sizes and makes recommendations for proper coil size selection. Me thods and Results. Coil occlusion was attempted in 24 consecutive pati ents with patent ductus arteriosus who did not require other cardiac s urgery. Median patient age was 4.2 years (8 months to 30 years), and m ean ductus diameter was 1.7+/-0.8 mm. Two instances of coil embolizati on occurred in the first 4 patients, with successful coil retrieval. B ased on this experience, we proposed that the coil helical diameter sh ould be twice or more the minimum ductus diameter, with coil length su fficient for three or more loops. With these recommendations, coils we re successfully implanted in the subsequent 20 consecutive patients. O f the 22 patients with successful coil implantation, 15 (68%) had no r esidual shunting, and 7 had trace residual shunting by angiography. Th e continuous murmur was abolished in all 22 patients. No significant c omplications occurred, and all patients were discharged within 24 hour s of successful coil implantation. No change in the systolic pressure gradient between main and left pulmonary artery or ascending and desce nding aorta was observed. Conclusions. Transcatheter occlusion of pate nt ductus arteriosus can be safely and effectively achieved in patient s with ductus diameters up to 3.3 mm. Coil occlusion does not cause ob struction to flow in the left pulmonary artery or descending aorta. Co ils should be selected to provide a helical diameter twice or more the minimum ductus diameter and a length sufficient for three or more loo ps.