Long-term outcome of transcatheter coil closure of small to large patent ductus arteriosus

Coil closure of patent ductus arteriosus (PDA) has become an accepted alter native to surgical closure in most pediatric cardiac centers, However, litt le is known about the mid- to long-term outcome of this procedure, Therefor e, we evaluated the immediate, short-, and long-term outcome of transcathet er coil closure (TCC) of PDA using single or multiple Gianturco coils or th e Gianturco-Grifka Vascular Occlusive Device (GGVOD). One hundred forty-nin e patients underwent an attempt at TCC of their PDAs at a median age of 2.4 years (2 weeks to 55 years) and median weight of 13.5 kg (2.3-87 kg). Ther e were 33 patients < 1 year of age. The median PDA minimal diameter was 2 m m (0.4-7 mm) with 26 patients whose PDA minimal diameter was > 4 mm. A 4 Fr catheter was used for coil deployment in 136 patients, a 3 Fr in 4, and an 8 Fr in 4 patients who received the GGVOD, A single coil was used in 77 pa tients and multiple coils (2-6) were used in 66 patients, One hundred forty -six patients had successful closure (142 had immediate complete closure an d 4 had residual shunt), 3 patients failed the initial attempt (2 underwent surgical ligation and 1 had a successful second attempt a year later), Of the four patients with residual shunt, three underwent a second procedure w ith implantation of 1-3 coils resulting in complete closure in all and one patient had spontaneous resolution of the residual shunt. Complications wer e encountered in nine patients: six had coil migration with successful retr ieval in four; two had left pulmonary artery stenosis (2.4 kg and 6.3 kg in fants), and one patient had loss of femoral arterial pulse. The median fluo roscopy time was 16 min (2-152 min). One hundred forty-two patients had the procedure as an outpatient, five patients stayed greater than 24 hr, and t wo of these patients were in hospital for 1 month for noncardiac reasons, A t a median follow-up interval of 3.0 years (1 month to 5.1 years), there we re no episodes of delayed coil migration, delayed recanalization, thromboem bolic episodes, or bacterial endocarditis. Lung perfusion scans performed a t a median follow-up interval of 1.6 years in 31 patients who received mult iple coils revealed 45% +/- 5% blood flow to the left lung. Long-term follo w-up of coil closure of PDA indicates that the technique is safe and effect ive for most patients with PDA up to a diameter of 7 mm, Cathet. Cardiovasc . Intervent. 47:457-461, 1999. (C) 1999 Wiley-Liss, Inc.