Coil occlusion of the patent ductus arteriosus: Lessons learned

Purpose: To review the clinical outcomes of catheter-directed coil occlusio n (coil occlusion) of persistently patent ductus arteriosus (PDA) at a pedi atric tertiary care hospital. Methods: A retrospective review of all patients referred to the Cardiac Cat heterization Laboratory for coil occlusion at our institution was performed . Twenty-one consecutive patients (12 female) underwent coil occlusion and follow-up between May 1995 and December 1997. We undertook PDA occlusion if : (a) the PDA narrowed to less than 4 mm on echocardiogram and (b) the mini mum body weight was approximately 10 kg. Standard right and retrograde left heart catheterization was performed, followed by coil occlusion. Color-flo w mapping (CFM) was used intra-procedurally to confirm occlusion of the PDA with a follow-up study several weeks later. Results: The median age and weight of the patients were 33 months and 13.2 kg, respectively. Fourteen patients received one coil, with six requiring a second coil and one requiring multiple coils. Initial follow-up was at a m edian of 2.4 months. At latest follow-up, 2 patients still have persistent flow at the ductal level. The coils were deployed without complication or e mbolization. Conclusions: A review of our first 21 cases demonstrated three important le ssons: (1) the maximum diameter of the PDA suitable for coil occlusion is a pproximately 3 mm; (2) CFM must show complete obliteration of flow in the c atheterization lab in order to ensure occlusion of the PDA at follow-up; an d (3) the Jackson detachable system allows for precise placement of the coi l, often within another coil.