Percutaneous coil occlusion of ductus arteriosus in absent pulmonary valve and intact ventricular septum.

Abstract

We recently described a patient with an absent pulmonary valve, intact ventricular septum, and patent ductus arteriosus, who showed serious cardiorespiratory failure immediately after birth [1]. The patient responded to conservative therapy to alleviate pulmonary vascular resistance, followed by plication and suspension of the pulmonary artery, which was performed, in part, because the ductus was small. There have been reports of newborns with the same heart defects and the same large ductus arteriosus, which provoked fatal heart failure [3, 4]. In such conditions, ligation of the ductus is indispensable for successful management [2]. The ductus in our patient could not be easily ligated at the palliative operation because it was hidden behind the huge pulmonary trunk, and because the patient was critically ill. More recently we conducted transcatheter closure of the ductus using Cook detachable spring coils, because the left-toright shunt flow through the ductus produced volume overload in the right ventricle, and because the ductus remained a potential focus for infective endocarditis. On admission, the patient was 7 years old, and he showed prominent stridor when he caught a cold. He sometimes complained of mild frontal chest pain on twisting or exercise. Tachydyspnea, edema, and hepatosplenomegaly were not noted during treatment with digitalis and diuretics. A chest x-ray showed cardiomegaly and slightly increased pulmonary vasculature (Fig. 1A). Cardiac catheterization revealed that the pulmonary/ systemic flow ratio was 130% without pulmonary or right ventricular hypertension. The right ventricular enddiastolic volume (RVEDV) was 290% of normal on angiogram. Aortography showed that the minimal diameter of the ductus was 3.5 mm, so we delivered two Cook detachable spring coils retrograde arterially according to the technique described in a previous report [5]. We used an 8-mm diameter helical coil and added a 5-mm coil. Although a small residual left-to-right shunt was ob