Outcome of Percutaneous Transarterial Coil Occlusion in Patients with Isolated Patent Ductus Arteriosus Using an Upstream-and-Push Maneuver

Abstract

There are limited data on the outcome of percutaneous transarterial coil occlusion for isolated patent ductus arteriosus (PDA) in Taiwan. This study evaluated the 2-year outcome of 52 patients with isolated PDA who received percutaneous transarterial coil occlusion by an upstream-and-push maneuver. From July 1997 to June 2002, a total of 52 patients (25 infants, 27 children) underwent occlusion of PDA with standard Gianturco coils. There were 39 females and 13 males. Patient age ranged between 7 days and 14 years, and weight was between 3 and 45 kg. Percutaneous transarterial coil occlusion was performed by an upstream-and-push maneuver. Chest auscultations, chest radiographs, and Doppler echocardiography were performed in all patients within 24 hours, and 1, 3, 6, 12 and 24 months after coil occlusion. Mean PDA diameter at the pulmonary end was 2.34 +/- 1.00 mm (range, 1.00-4.80 mm). Angiographic classification was megaphone type in 32 patients, window type in seven, tubular type in six, aneurysmal type in three, and elongated conical type in four. Complete PDA occlusion was performed with a single coil in 41 (79%) patients and with multiple coils in 11 (21%). The mean ratio of pulmonary to systemic blood flow was 1.95 +/- 0.95 (range, 1.10-5.80) before the procedure, and 1.02 +/- 0.04 (range, 1.00-1.20) after the procedure (p < 0.001). Immediate occlusion of the ductus was achieved 15 minutes after the procedure in 44 (85%) patients. Occlusion was achieved in 92% of patients within 24 hours and in 100% of patients by the 1-month follow-up. Follow-up at 24 months after the procedure revealed no complications. Percutaneous transarterial coil occlusion with 5-loop Gianturco coils can be effectively and safely achieved in patients with a PDA minimum diameter < 5 mm.