Transarterial occlusion of patent ductus arteriosus with Gianturco coils in pediatric patients: a preliminary result in central Taiwan

Objective: We wish to present the preliminary result of transarterial occlu sion of patent ductus arteriosus (PDA) with Gianturco coils in pediatric pa tients in central Taiwan. Materials and Methods: We attempted occlusion of PDA with Gianturco coils in a total of 26 consecutive patients, 13 infants and 13 children, 23 female and three male, between July 1 1997 to September 30 1998. Median patient age was 2.57 years (from 0.25 to 14.02 years old). Median patient weight was 10.8 kg (4.0 to 36.0 kg). Premature babies with PDA, full-term babies who were less than three months old and patients who had other congenital heart disease were not included in this study. All PDA s were approached transarterially from the femoral artery. Coils were selec ted to provide a helical diameter that was twice or more the minimum ductus diameter and a length approximating five loops. In five patients who had a PDA diameter greater than or equal to 3.5 mm, we used a snare technique to assist coil delivery beforehand, and to test coil stability, or to retriev e coil that had migrated to the pulmonary artery afterwards. Physical auscu ltation, chest radiographs and echocardiography with color Doppler were don e in all patients within 24 h, and one, two, three, six and 12 months after coil occlusion. Results. The median ductus minimum diameter was 2.3 mm (ra nge, 1.0 to 4.7 mm). Fifteen patients had the megaphone type (type A), four had the window type (type B), five had the tubular type (type C), one had the aneurysmal type (type D) and one had the elongated conical type (type E ). Twenty-one patients underwent single coil occlusion and five had multipl e coils occlusion. Twenty-one patients had immediate angiographic closure o f the ductus and disappearance of heart murmur at 15 min after the procedur e. Dark-brown urine (hemoglobinuria) was found in one patient, 10 h after t he first procedure, due to a mild residual ductal shunt. Two more coils wer e implanted in a second procedure that was performed within 24 h, and the d uctus was completely occluded, The dark-brown urine regressed. At one month follow-up, four patients had mild residual ductal. shunts, which were comp letely occluded by one more coil in three patients and by two more coils in the other patient. Malpositioned coils were deployed in five patients imme diately after the procedure. In total, the closure rate at 15 min, within 2 4 h, and at one, two, three, six and 12 months were 81, 85, 85, 100, 100, 1 00 and 100%, respectively. In one year of follow-up, there was no instance of coil migration, ductus reopening or stenosis of the left pulmonary arter y. Conclusions. Transarterial occlusion of PDA, with a Gianturco coil havin g approximately five loops, can be effectively achieved in patients with a minimum ductus diameter up to 4.7 Mn. In patients with a ductus of more tha n 3.5 mm, the snare-assisted technique was employed advantageously to contr ol coil delivery with accuracy and stability. Coil malposition or migration can be easily retrieved using a 10-mm Nitnol snare catheter. Hemoglobinuri a, due to intravascular hemolysis, may regress within 24 h after the second attempt at coil implantation. (C) 1999 Elsevier Science Ireland Ltd. All r ights reserved.