INTRAVASCULAR ULTRASOUND DURING TRANSCATHETER COIL CLOSURE OF PATENT DUCTUS-ARTERIOSUS - COMPARISON WITH ANGIOGRAPHY

Precise delineation of the size and shape of the ductus arteriosus may help in catheter closure. The use of Intravascular Ultra Sound (IVUS) to study the diameter of patent ductus arteriosus (PDA) has not been reported. We prospectively evaluated the use of IVUS and compared it t o angiography in determining the size and shape of PDA and to assess t he degree of coil protrusion into the descending aorta and the clinica l relevance after coil closure. Twenty-six patients (17 female, 9 male ) underwent transcatheter closure of PDA using single or multiple Gian turco coils. The median age of the patients was 1.7 yr (range, 2 month s-34 yr) and the median weight was 10.9 kg (range 4.2-80 kg). A good q uality IVUS image was obtained in all patients using 3.8 Fr, 30 MHz ca theters. The median PDA diameter measured by angiography was 2.8 mm (r ange 1.6-5.7 mm) and by IVUS was 3.2 mm (range 1.7-5.7). There was exc ellent agreement between IVUS and angiography (D IVUS = 0.25+0.97D an gio, r = 0.90, (D: diameter in mm). After closure, coils could be seen protruding into the aorta,with a median percent coil protrusion of 17 .3% (range 0.0-47%). Only one patient had the coil protruding into mor e than 1/2 the aorta. This coil was retrieved and another coil was pla ced successfully. On follow-up at a median interval of 2.4 yr. (range 1.1-3.2 yr), there has been no clinical evidence for thromboembolic ev ents. We conclude that IVUS use to assess the size of PDA is accurate. On mid-term follow-up, coil protrusion into the aorta seems to be ben ign. Further follow-up is needed.