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.