PERCUTANEOUS CLOSURE OF THE SMALL PATENT DUCTUS-ARTERIOSUS USING OCCLUDING SPRING COILS

Objectives. This report summarizes our experience with the use of occl uding spring coils to close the small patent ductus arteriosus. Backgr ound. Several patent ductus arteriosus occluders (most notably the Ras hkind device) have been developed and studied. Occluding spring coils have been used to close abnormal vessels and. vascular connections. We previously reported the use of occluding spring coils to close the sm all patent ductus arteriosus in a small group of patients. This report describes our series of patients having patent ductus arteriosus clos ure with occluding spring coils. Methods. Between June 1990 and June 1 993, 30 patients underwent cardiac catheterization to have patent duct us arteriosus closure by occluding spring coils. Selection criteria we re age >6 months and narrowest patent ductus arteriosus internal dimen sion less than or equal to 3.0 mm by color how imaging. Definitive sel ection war; based on review of aortograms performed at catheterization . A 5.2F coronary catheter was used to deliver one or two standard occ luding spring coils. A loop was delivered in the main pulmonary artery , and the remainder of the coil was delivered across the patent ductus arteriosus and into the aortic diverticulum. Patent ductus arteriosus closure was confirmed by aortography or color how imaging, or both. F ollow up after coil placement occurred at 6 weeks and 6 months and inc luded two-view chest radiography, echocardiography and color flow imag ing. Results. Of the 30 patients, 29 had successful implantation by on e (27 patients) or two (2 patients) occluding spring coils. Of these 2 9 patients, 19 had a clinically apparent and 10 had a silent patent du ctus arteriosus. Average ductus minimal internal dimension was 1.7 mm (range 1.0 to 3.0). Complete closure of the ductus was confirmed in 27 patients by aortography or color flow imaging or both (in 24 within 4 h, in 2 after 6 weeks and in 1 after 6 months). Six weeks after impla ntation, two patients had a tiny residual patent ductus arteriosus not ed on color flow imaging. One patient did not have successful implanta tion. This patient had a 3.2-mm ductus, and two coils migrated to the distal left pulmonary artery and could not be retrieved. There were no deaths or any significant complications noted during early or late fo llow-up in these patients. Conclusions. Occluding spring coils may hav e additional application in closing the small patent ductus arteriosus .