921-70 Right and Left Pulmonary Artery Size and Flow Disturbances After Patent Ductus Arteriosus Coil Occlusion: A Serial Echocardiographic Study

Abstract

Transcatheter closure of patent ductus arteriosus (PDA) with Gianturco coils may potentially impinge on adjacent vascular structures. The purpose of this study was to assess flow disturbances and size of the left pulmonary artery (LPA). right pulmonary artery (RPA), and descending aorta (DAo) following PDA coil occlusion. Serial echocardiographic follow-up was available in 25 children (age range 0.4–13 years, mean-4.4 years: weight range 3.437 kg. mean-16.5 kg). who underwent successful coil implantation. Complete two dimensional and Doppler echocardiography (EC) examination was performed before, immediately after (19/25). and at > 6 months (range 8–21 months) in 12/25. The main pulmonary artery (MPA), LPA and RPA diameters were measured by electronic calipers and indexed to patient weight. LPA index is defined as LPA diameter (cm) divided by weight (kg) and RPA index is calculated by the same method. LPA index was then compared to RPA index for each follow-up EC examination. Doppler interrogation was performed across MPA. LPA, RPA and DAo during each study. The coil could be visualized near the origin of the LPA in 9/12 (75%) and in the DAo in 5/12 (42%). A significant increase in LPA flow velocity was noted in 4/12 (33%). pre coil velocity 0.9–1.1 m/sec, and post coil velocity 1.5–2.1 m/sec. p < 0.05. The velocity increase persisted in 3/4 patients and resolved in 1/4 at 12 months follow-up. There was a significant velocity increase in the DAo in 1/12 (8%), (2.2 m/sec), that resolved at 14 months follow-up. There was no significant increase in flow velocity in the RPA or MPA. Four of 12 patients (33%) had decreased relative size of the LPA (mean LPA index pre 0.073 and post 0.056) compared to the RPA size (RPA index mean pre 0.076 and post 0.070) at follow-up (12–15 months). One patient had mild coil related stenosis of the origin of the LPA (increase in velocity 0.9 m/sec pre to 2.1 m/sec post coil): this was persistent at 12 month follow-up. 1. LPA relative size may decrease following PDA coil occlusion, hence serial follow-up echocardiography is recommended to assess long term LPA growth. 2. Minor flow disturbances may be seen in the LPA and DAo post PDA coil occlusion.