Results of anterograde transcatheter closure of patent ductus arteriosus using single or multiple gianturco coils

Abstract

Retrograde coil embolization of the patent ductus arteriosus (PDA) has been reported for ducts <3.3 mm in diameter using 5 to 5.5Fr catheters. Our objective was to assess the immediate and short-term results of anterograde transcatheter closure of the PDA using single or multiple Gianturco coils. Thirty-three patients (11 males and 22 females) underwent an attempt at transcatheter closure of the PDA anterogradely at a median age of 2.8 years (range 0.1 to 19) and median weight of 14 kg (range 2.3 to 64). The median PDA diameter at its narrowest segment was 2.8 mm (range 0.5 to 5.3). A 4Fr catheter was used for delivery of the coils in 30 patients and a 3Fr catheter was used in 3 patients. Eighteen patients underwent multiple coil closure for a PDA diameter of ≥2.5 mm (using 2 coils in 9, 3 coils in 6, 4 coils in 1, and 5 coils in 2 patients). Follow-up evaluation was performed with color flow mapping of the main pulmonary artery. Thirty-one of the 33 patients had complete closure by the coil technique. The 2 unsuccessful attempts were in 2 patients with a large ductus measuring ≥4.3 mm and of angiographic type B. For all 13 patients in whom a single coil and in 17 patients in whom multiple coils were placed, there was immediate complete closure that persisted at a median follow-up period of 3.8 months. The median fluoroscopy time was 24 minutes. All patients (except for 1 inpatient) were discharged home on the same day. The 2 patients who received 5 coils each had mild left pulmonary artery obstruction. Anterograde transcatheter closure is an effective therapy for patients with PDA diameters up to 5.2 mm using the single or multiple coil technique. This technique can be performed in small infants on an outpatient basis without the need for general endotracheal anesthesia.