REOPENING AFTER SUCCESSFUL COIL OCCLUSION FOR PATENT DUCTUS-ARTERIOSUS

Objectives. This study was performed to determine the frequency of pat ent ductus arteriosus (PDA) reopening and the factors that may predict reopening after successful coil occlusion. Background. Transcatheter coil occlusion is a widely used and accepted method to close a PDA. Af ter documented successful coil occlusion, we found PDAs that reopened. We hypothesized that specific factors are involved in those that reop ened. Methods. All patients who underwent percutaneous transarterial P DA coil occlusion were studied. Successful coil occlusion was document ed. PDA reopening was determined when Doppler-echocardiography (DE) pe rformed after the procedure was negative for PDA dow but at follow-up demonstrated PDA shunting, Patients with a reopened PDA were compared with all other patients in evaluating independent variables. Results. Coil occlusion for PDA was attempted in 22 patients. Clinical success was achieved in 20 patients (91%), and DE was negative for PDA shuntin g in 19 patients (90%). At follow-up, five patients demonstrated reope ning. The PDA minimal diameter was 1.4 +/- 0.5 mm (mean +/- SD) for th e reopened group and 1.2 +/- 0.7 mm for the other patients. The PDA le ngth was 2.9 +/- 1.9 mm for the reopened group and 7.1 +/- 3.2 mm for all other patients. All those with type B PDA were in the reopened gro up. When independent variables were compared between groups, only PDA length and type B PDA predicted reopening (p < 0.05). Conclusions. PDA reopening may occur after successful coil occlusion. Short PDA length and type B PDA are associated with reopening. The data suggest that i n such anatomy, alternative strategies to the current coil occlusion t echnique should be considered. (C) 1998 by the American College of Car diology.