The effectiveness and safety of a protocol for transcatheter patent ductus
arteriosus (PDA) closure was assessed. Our goal is complete mechanical occl
usion of the PDA in the catheterization laboratory by adding coils until it
is no longer possible to cross the PDA with a guidewire. Detachable coil c
losure of a PDA with a narrowest diameter of 2.4 +/- 0.1 mm was attempted i
n 83 patients with a median age of 2.8 years (0.7 to 27.8 years) and whose
median weight was 14.5 kg (6 to 61.6 kg). Coils were successfully implanted
in 82 of 83 patients, and in 1 patient a large Rashkind double umbrella wa
s used instead. Complete closure was obtained in 80 (97.6%) patients, 48 of
those (59%) received more than one coil. Reintervention for residual shunt
ing was required in only 1 patient and another patient has a trivial residu
al shunt. Device embolization occurred in three cases. Despite the use of m
ultiple coils there was no evidence of significant left pulmonary artery st
enosis. The fluoroscopy time increased from 14.0 +/- 2.0 minutes for a sing
le coil to 25.3 +/- 2.9 minutes for multiple coils (p < 0.01). Attempting t
o obtain complete mechanical occlusion of the PDA during the implant proced
ure by adding extra coils reduces the need for reintervention for residual
or recurrent shunting.