Objectives-To describe the incidence and management of haemolysis after tra
nscatheter coil occlusion of the arterial duct.
Design-Prospective clinical and echocardiographic follow up of patients who
have undergone implantation of the Cook detachable duct occlusion coil. Se
tting-Tertiary paediatric cardiac centre.
Patients-Five cases of haemolysis (two girls aged 6 and 11 months; three bo
ys aged 6, 17, and 14 months) from a series of 137 duct coil implantations.
Main outcome measures-The occurrence of clinically significant haemolysis a
fter implantation of duct occlusion coils and resolution of haematuria afte
r completion of duct occlusion.
Results-Haemolysis was detected in five of 137 procedures following implant
ation of Cook detachable duct coils. Four patients became symptomatic 12 ho
urs after the procedure but in one haemolysis was detected three months lat
er. Resolution of ongoing haemolysis was achieved within 48 hours of detect
ion with further coil implantations, but haematuria persisted for up to 10
days. In one patient the extensive destruction of erythrocytes resulted in
acute renal failure requiring peritoneal dialysis.
Conclusions-Haemolysis is an important complication after duct coil implant
ation. It occurred in 3.6% of 137 procedures in this series and is most Lik
ely to occur in young patients with relatively large ducts. Further coil im
plantation to occlude the duct completely is not only successful but techni
cally relatively straightforward and should be undertaken early if major co
mplications such as severe anaemia and renal failure are to be avoided.