Transcatheter coil embolization of large-size patent ductus arteriosus in adult patients - Usefulness and problems

Transcatheter coil embolization of the patent ductus arteriosus (PDA) has b een frequently used in children, especially for small lesions. It was attem pted in 3 adults using Cook detachable coils. For 2 of the patients, relati vely old age and heart failure were the reasons for choosing coil embolizat ion of the PDA. In the remaining patient, who had Wolff-Parkinson-White syn drome, coil embolization was performed after radiofrequency catheter ablati on of Kent's bundle. Their respective minimal PDA diameters were 5.0 mm, 4. 5 mm and 4.0 mm measured by transesophageal echocardiography. Two coils wer e placed in 2 patients and 1 coil in the remaining patient. After the proce dures, the size of the left ventricle decreased and heart failure was impro ved in 2 patients, although all 3 patients had a residual shunt, which caus ed hemolytic anemia in 2 patients. Repeat coil-embolization procedures resu lted in complete occlusion and the hemolysis disappeared in these patients. In adult patients who have heart failure due to large PDA, coil embolizati on with detachable coils, even if residual shunt persists, is useful for im provement of the heart failure. In cases of hemolysis related to residual s hunt, a second coil-embolization procedure can improve it completely.