TRANSCATHETER EMBOLIZATION OF ABNORMAL INTRATHORACIC VESSELS USING COILS IN THE SETTING OF CHILDREN WITH CONGENITAL HEART-DISEASE

Objective: it was the purpose of this retrospective study to assess th e efficacy and the rate of complications of transcatheter embolization of abnormal intrathoracic vessels using coils in children with comple x congenital heart disease. Patients and methods: in 17 children (mean age 9.2+/-5.9 years) with complex congenital heart disease, occlusion by catheter intervention was attempted in 29 abnormal intrathoracic v essels: 13 aorto-pulmonary collaterals, 12 arterio-pulmonary collatera ls, 2 systemic arteries supplying pulmonary sequestrations, one centra l venous connection and a Blalock-Taussig shunt. The mean diameter of the vessels was 4.7+/-1.6 mm (range 2-8 mm). Steel coils with a helica l diameter of three, five or eight mm were used. After selective cathe terization of the vessel, they were delivered through a 5 F endhole ca theter. The helical diameter of the coils was chosen in order to excee d the inner diameter of the vessel by 10-30%. Results: as assessed by selective angiography performed 10 minutes or more after release of th e coil, 27 of the 29 vessels (93%) were successfully occluded. A mean of 2.6 coils (range 1-11) were necessary for successful occlusion. Com plications were encountered during 4 attempts of occlusion (14%). Of a total of 76 coils delivered, 4 coils (5%) secondarily migrated after release from the catheter, mostly to branches of the pulmonary arterie s. This complication was seen predominantly in those vessels with the largest diameters. Three of the dislocated coils were left in place as they did not significantly obstruct flow of blood. One coil was retri eved by a basket catheter. Conclusion: transcatheter embolization of a bnormal intrathoracic vessels using coils in children with congenital heart disease is an effective therapy. Potential complications warrant careful evaluation of the indications for these procedures.