EVALUATION OF GIANTURCO COILS FOR CLOSURE OF LARGE (GREATER-THAN-OR-EQUAL-TO-3.5 MM) PATENT DUCTUS-ARTERIOSUS

Objectives. This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (greater than or equal to 3.5 mm ) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils. Background. Coil closure of PDAs has become increasingly popul ar, However, the technique has significant limitations when used to cl ose large PDAs. This report evaluates patient characteristics, PDA ana tomy, hemodynamic variables, delivery technique and coil geometry to d etermine predictors of success. Methods. Between January 1995 and Janu ary 1997, 16 of 118 patients undergoing catheterization for PDA closur e were found to have large PDAs. Their median age and weight were 14 m onths (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respe ctively, The mean PDA diameter was 4.3 mm (range 3.5 to 5.9), Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096 -cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynam ic and technical variables between successes and failures were compare d. Results. Eleven (69%) of 16 patients had successful closure of thei r PDA, Failures occurred only in patients <8 months of age with an ind exed PDA diameter >7 mm/m and a pulmonary/systemic how ratio greater t han or equal to 2.8:1. Use of 0.052-in. coils tended to reduce the inc idence of embolization and the number of coils needed for closure, Con clusions. Patients >8 months of age can have successful closure of lar ge PDAs with currently available Gianturco coils, The 0.052-in. Giantu rco coils can be used safely to close large PDAs in infants as small a s 6 kg. Increased experience and improved coil design may improve clos ure rates of large PDAs in infants. (C) 1997 by the American College o f Cardiology.