921-69 Transcatheter Closure of the Persistently Patent Ductus Arteriosus Using Occluding Coils

Abstract

Transcatheter coil closure (TCC) of the Patent Ductus Arteriosus (PDA) was attempted in 29 patients (pts) with a median age of 3.2 years (6 months-55 yearsl and a median weight of 14.0 kg (4.3-Bl kg). Previously, 114 pts with PDA underwent closure with the Rashkind umbrella device in our institution but this device is no longer available. Ducti measured 0.5–5.0 mm (mean = 1.B mm) at the narrowest point. A single coil was implanted in 12 pts, two in 15 and three in 2. The first coil implanted had a diameter twice the minimal internal diameter of the PDA and a length sufficient for at least 4 loops. One to 1.5 loops were delivered in the main pulmonary artery. and the remaining loops were released in the aortic ductal diverticulum. Coil embolization occurred in 3 pts: all coils were successfully retrieved. In another patient 3 coils were removed from the PDA. after proper placement. because of left pulmonary artery obstruction. Coil re-implantation was successful in all of these patients. Aortography, performed 10 minutes after coil implantation, showed complete closure in 25/29 pts (86%). Four hours after the procedure, 27/29 pts (93%1 had no evidence of PDA by color flow Doppler. Thirteen pts were done as outpatients, 13 were discharged in 24 hr, and 3 had prolonged hospitalization for other medical problems. Follow-up ranged from 1 month to 4 years in 27/29 pts. None had detectable murmurs. Small residual PDA shunt by color flow Doppler persisted in 2 pts. No aortic obstruction, pulmonary artery stenosis. hemolysis, or late coil migration has been observed. These results compare favourably with our Rashkind device occlusion results where the closure rate was 52% by angiography (p < 0.01) and 71% by color flow Doppler (p = 002) at discharge. Furthermore, the cost of TCC was 25% less than the Rashkind device occlusion, and 40% less than surgical closure. TCC of small to moderate PDA is an effective technique without significant morbidity. It appears significantly more effective and costefficient than the Rashkind device occlusion, and it can be done safely as an outpatient procedure.