Improved Closure Rates Research Articles

Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins.

Great saphenous vein diameter (GSV) of >8mm was predictor of recanalization following Venaseal cyanoacrylate treatment. The aim of this study was to report our modified protocol with a single extra-drop for treatment for GSV>8mm, and comparative duplex results in closure rates. Patients in our single-centre registry treated with Venaseal were followed up by serial duplex examinations at week 1 and month(s)- 1, 6, 12, 18, 24, and then annually. The primary endpoint was successful obliteration of the GSV, secondary endpoints were closure distance from Saphenofemoral junction (SFJ), presence of endovenous glue-induced thrombosis (EGIT) or deep vein thrombosis. A total of 243 legs in 123 consecutive patients with duplex-proven SFJ/GSV incompetence were included in this study between September 2014 and October 2020. The median duplex follow-up period of this cohort of patients was 24 (range 0.2-58) months. Comparing closure rates in GSV diameter ≥8mm treated with normal protocol, the 'extra-drop protocol' significantly improved closure rates (p = .034). However, the closure rates of ≥8mm GSV treated with 'extra-drop protocol' was still not as good as GSV <8mm (p < .001). There were no statistically significant differences in the stump distance between the three groups and no difference in the occurrence of EGIT. There were no deep vein thrombosis. Our experience showed that VenaSeal cyanoacrylate worked best in GSV<8mm diameter. Even in GSV diameter of ≥8mm which has a higher recanalization rate on follow-up duplex, our modified extra-drop protocol significantly improved the closure rates, and did not predispose to development of EGIT.

Combining 3D heads-up display viewing system and intraoperative optical coherence tomography-assisted vitrectomy for myopic foveoschisis

Objective To observe the clinical efficacy of digital 3D heads-up display viewing system(3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF). Methods A retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery. Results The fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P<0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system. Conclusions 3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA. Key words: Vitreoretinal surgery/instrumentation; Tomography, optical coherence; Retinoschisis/surgery; Myopiadegenerative/complications; 3D heads-up display viewing system

Characterization of Epiretinal Proliferation in Full-Thickness Macular Holes and Effects on Surgical Outcomes

Epiretinal proliferation is a distinct clinical entity from epiretinal membrane that classically is associated with lamellar macular holes, but its prevalence and association with full-thickness macular holes (FTMH) have not been well described. We characterized macular hole-associated epiretinal proliferation (MHEP) and its effects on long-term surgical outcomes. Multicenter, interventional, retrospective case-control study. Consecutive eyes that underwent surgery for FTMH with a minimum of 12 months follow-up. All eyes underwent pars plana vitrectomy, removal of any epiretinal membranes, and gas tamponade, with or without internal limiting membrane (ILM) peeling. Spectral-domain OCT imaging was obtained before and after surgery. Improvement in visual acuity and single-surgery hole closure rates in eyes with, versus without, MHEP at 12 months. Seven hundred twenty-five charts were analyzed, and 113 patients met inclusion criteria. Of 113 eyes with FTMH, 30 (26.5%) showed MHEP. Patients with FTMH and MHEP were older (P < 0.002) and more often men (P= 0.001), and showed more advanced macular hole stages than those without MHEP (P= 0.010). A full posterior vitreous detachment was more common in eyes with MHEP (P < 0.004). Twelve months after surgery, FTMH with MHEP patients showed significantly less improvement in visual acuity (P= 0.019) with higher rates of ellipsoid and external limiting membrane defects (P < 0.05) and with a higher rate of failure to close with 1 surgery compared to FTMH without MHEP (26.7% vs. 4.8%; P= 0.002]). Peeling the ILM was associated with improved rates of hole closure in FTMH with MHEP (P < 0.001). Multivariate testing confirmed that the presence of MHEP was an independent risk factor for less visual improvement (P= 0.031) and for single-surgery nonclosure (P= 0.009) and that ILM peeling improved single-surgery closure rates (P= 0.026). We found that FTMH with MHEP showed poorer anatomic and visual outcomes after vitrectomy compared with FTMH without MHEP. Internal limiting membrane peeling was associated with improved closure rates and should be considered when MHEP is detected before surgery.

Effects of Vitamin B Complex and Vitamin C on Human Skin Cells: Is the Perceived Effect Measurable?

Vitamins are essential for human health. In terms of local application for wound healing, vitamins' positive effect remains unclear. However, because of the regular appearance of nutritional deficiency in chronic wound patients, a favorable impact of locally applied vitamins can be hypothesized. Vitamins B3, B5, B6, B7, B9, B10, B12, and C individually as well as different combinations of B vitamins were investigated regarding their ability to promote proliferation and migration of human skin fibroblasts and keratinocytes. Proliferation assays with and without bacterial challenge, immunocytochemical staining, and scratch assay were used to determine the most effective combination(s). Some vitamin combinations showed a positive impact on proliferation, especially for keratinocytes after 72 hours. In terms of wound closure, the combinations B9 and B12; B3, B5, B6, and B10; and B3, B5, and B7 improved closure rates by 25% to 30%. The improved closure rates are also reflected by immunocytochemically detected upregulation of the migration marker CXCR4 for several combinations. Certain combinations of B vitamins demonstrate a positive influence on human keratinocytes and fibroblasts. Vitamins especially promoted fibroblast migration, and a statistically significant induction of keratinocyte proliferation was observed. Therefore, local vitamin application could benefit the physiologic wound healing process.

INTERNAL LIMITING MEMBRANE PEELING IN MACULAR HOLE SURGERY; WHY, WHEN, AND HOW?

To review the current rationale for internal limiting membrane (ILM) peeling in macular hole (MH) surgery and to discuss the evidence base behind why, when, and how surgeons peel the ILM. Review of the current literature. Pars plana vitrectomy is an effective treatment for idiopathic MH, and peeling of the ILM has been shown to improve closure rates and to prevent postoperative reopening. However, some authors argue against ILM peeling because it results in a number of changes in retinal structure and function and may not be necessary in all cases. Furthermore, the extent of ILM peeling optimally performed and the most favorable techniques to remove the ILM are uncertain. Several technique variations including ILM flaps, ILM scraping, and foveal sparing ILM peeling have been described as alternatives to conventional peeling in specific clinical scenarios. Internal limiting membrane peeling improves MH closure rates but can have several consequences on retinal structure and function. Adjuvants to aid peeling, instrumentation, technique, and experience may all alter the outcome. Hole size and other variables are important in assessing the requirement for peeling and potentially its extent. A variety of evolving alternatives to conventional peeling may improve outcomes and need further study.

Collagen Type 1 Accelerates Healing of Ruptured Fetal Membranes

Preterm premature rupture of membranes (pPROM) is a major cause of preterm birth. Recently, extracellular matrix-directed treatment is applied for wound healing. Here, we used a pregnant mouse model to test the efficacy of collagen type 1 gel for healing of the prematurely ruptured fetal membranes. Although injection of PBS into the ruptured fetal membranes resulted in 40% closure, injection of collagen type 1 improved closure rates to 90% within 72 h. Macrophages of the M2 wound healing phenotype were entrapped in the collagen layer. In primary human amnion mesenchymal cells, collagen type 1 gels activated collagen receptor discoidin domain receptor 2 (DDR2) to induce myosin light chain phosphorylation and migration of injured amnion mesenchymal cells. These findings define the mechanisms for matrix-directed therapeutics for pPROM.

INTERNAL ASPIRATION UNDER PERFLUOROCARBON LIQUID FOR THE MANAGEMENT OF LARGE MACULAR HOLES.

To report the outcomes of pars plana vitrectomy with internal aspiration under perfluorocarbon liquid for large macular holes (MH). Retrospective consecutive case series of patients with large (>400 µm) MH. All treated were with pars plana vitrectomy, internal limiting membrane peeling, internal fluid aspiration under perfluorocarbon liquid, and gas/oil tamponade. Outcomes included closure rate and visual acuity at 6 months. Twenty eyes of 20 patients were included. Mean age of patients was 67.6 ± 7.3 years. Mean MH size was 609.4 ± 154.7 μm. Mean symptoms duration was 9.05 ± 7.3 months. Unfavorable prognostic factors included chronic MHs (≥4 months) in 15 eyes (75%), refractory MH in 6 eyes (30%), and poor initial visual acuity (≤20/200 logarithm of minimal angle of resolution) in 18 eyes (90%). Gas tamponade was used in 18 eyes (90%). Nineteen MHs (95%) had closed after a single operation. Two (10.5%) had Type-II closure. Mean visual acuity improved significantly from 20/330 to 20/140 Snellen acuity (1.22 ± 0.31-0.85 ± 0.35 logarithm of minimal angle of resolution; P < 0.001). Fifteen eyes (75%) had visual acuity improvement of more than 0.2 logarithm of minimal angle of resolution. Thirteen eyes (65%) achieved visual acuity better than 20/200. Pars plana vitrectomy combined with internal fluid aspiration under perfluorocarbon liquid is an effective and safe surgical technique for the management of large MH. This innovative technique offers improved closure rates and visual acuity results.

Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis.

To determine which independent variables influence the efficacy of type I tympanoplasty in adult and pediatric populations. A search of the PubMed database and Cochrane Database of Systematic Reviews using the key words "tympanoplasty OR myringoplasty" from January 1966 to July 2014 was performed. Studies reporting outcomes of myringoplasty or Type I tympanoplasty in primary non-cholesteatomatous chronic tympanic membrane (TM) perforation were included. Of 4,698 abstracts reviewed, 214 studies involving 26,097 patients met our inclusion criteria and contributed to meta-analysis. The primary outcome of success was defined as closure rate at 12 months. The independent variables analyzed were age, follow-up period, approach, graft material, perforation cause, size, location, ear dryness, and surgical technique. Only those studies providing data on a given parameter of interest could be included when comparing each variable. The weighted average success rate of tympanic closure was 86.6%. Based on this meta-analysis, pediatric surgery has a 5.8% higher failure rate than adults and there is no correlation between follow-up period and success. Other variables associated with improved closure rates include perforation with a size less than 50% of total area (improved by 6.1%) and the use of cartilage as a graft (improved by 2.8% compared with fascia), while ears that were operated on while still discharging, those in different locations of the pars tensa, or using different surgical approaches or techniques did not have significantly different outcomes.

Direct application of bFGF without edge trimming on human subacute tympanic membrane perforation

ObjectiveTo investigate the feasibility of direct application of basic fibroblast growth factor (bFGF) without edge trimming on human subacute traumatic tympanic membrane perforation (TMP). MethodsA total of 29 patients with traumatic TMPs beyond 1month after trauma were enrolled. Patients were placed into two groups: an observation group (n=17) and a bFGF-treated group (n=12). The bFGF-treated group was treated by direct application of bFGF, in which the margin of the perforation was not trimmed. All patients were followed at least once per week until the perforation was completely closed or for up to 6months. The closure rate and closure time were estimated. ResultsAt 6months, 11/12 (91.7%) perforations achieved complete closure after bFGF treatment. The mean closure time was 18.1±11.4days (range=3–65days). Purulent otorrhea was found after treatment in five patients, but resolved after oral amoxicillin and ofloxacin ear drops. Of these five patients, four achieved complete closure. However, only 9/17 (52.9%) perforations achieved complete spontaneous closure in the observation group. FGF-treated groups had significantly improved closure rates compared to the observation group (91.7% vs. 52.9%, respectively, P=0.03). ConclusionsAlthough the margin of the perforation was not trimmed, direct application of bFGF on human subacute TMP was feasible, and it could significantly improve the closure rate of the subacute TMPs. The technique was simple and convenient. Thus, direct application of bFGF should be recommended pre-myringoplasty.

Suture choice matters in rabbit model of laparoscopic, preperitoneal, inguinal hernia repair.

We evaluated the effect of different suture materials in a laparoscopic preperitoneal ligation of the patent processus vaginalis in a rabbit survival model. New Zealand White rabbits underwent laparoscopic assisted preperitoneal ligation of the patent processus vaginalis. The processus vaginalis was closed with silk (n=10), polyglactin 910 (Vicryl(®); Ethicon, a Johnson & Johnson Company, Somerville, NJ) (n=10), or polypropylene (Prolene(®); Ethicon) (n=10). At necropsy, the suture was removed, and repair integrity was evaluated. All rabbits survived to necropsy without complications. No suture material was identified during necropsy of the Vicryl group. Eight (80%) of the Vicryl closures failed, with six (60%) failing at initial inspection. Following removal of suture material, nine (90%) of the Prolene closures failed, and only one (10%) of the silk closures failed (P=.009). The silk suture resulted in an improved closure rate. Ligation with silk suture probably incited an increased inflammatory response that likely created a scar while persisting long enough for the scar to become established. In contrast, the Vicryl sutures probably failed because the sutures dissolved before a scar was able to fully develop. Finally, the Prolene closures were suture dependent as evidenced by failure when the suture was removed. Nonabsorbable braided suture may improve closure of pediatric indirect inguinal hernias during laparoscopic-assisted preperitoneal ligation.

Planned re-laparotomy and the need for optimization of physiology and immunology.

Planned re-laparotomy or damage control laparotomy (DCL), first described by Dr. Harlan Stone in 1983, has become a widely utilized technique in a broad range of patients and operative situations. Studies have validated the use of DCL by demonstrating decreased mortality and morbidity in trauma, general surgery and abdominal vascular catastrophes. Indications for planned re-laparotomy include severe physiologic derangements, coagulopathy, concern for bowel ischemia, and abdominal compartment syndrome. The immunology of DCL patients is not well described in humans, but promising animal studies suggest a benefit from the open abdomen (OA) and several human trials on this subject are currently underway. Optimal critical care of patients with OA's, including sedation, paralysis, nutrition, antimicrobial and fluid management strategies have been associated with improved closure rates and recovery.

Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper

Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure.

Closure of post-laryngectomy pharyngocutaneous fistulae

BackgroundClosure of salvage laryngectomy defects with vascularized tissue remains controversial.MethodsWe evaluate outcomes in patients who required repair of a fistula after attempted primary closure of salvage laryngectomy defect and assess risk factors for persistent fistula. Between 2001 and 2010, 20 patients were treated for pharyngocutaneous fistulae after primary closure of a salvage laryngectomy. All patients required free flap repair for definitive fistula management.ResultsPatients presented with fistulae from one to 18 months in duration; median time to closure was seven days. Radial forearm free flap was used in 86% of patients. With free flap alone 50% of patients achieved fistula closure. Additional procedures improved closure rate to 85%. Recipient vessels were used in the neck in 54.5%, compared to internal mammary vessels in 45.5%. Hypothyroidism was identified as a risk factor for persistent fistula (p = 0.01). Chronic steroid use (p = 0.08) did not reach significance as a risk factor for fistula closure. Gastroesophageal reflux disease was newly diagnosed or noted as a comorbidity in 14 patients (70%) in this study. It did not reach statistical significance as a risk factor in refistulization (p = 0.12). Complications included leak, carotid blowout, infection, free flap loss, and late refistulization. Overall flap failure in this study was 4.5%.ConclusionsDelayed secondary repair of pharygocutaneous fistulas after salvage laryngectomy is associated with a higher complication rate and poor success rates compared to use of vascularized tissue at the time of salvage laryngectomy. Prolonged wound healing in these patients is associated with hypothyroidism.

Escalating dose indomethacin for prophylactic closure of patent ductus arteriosus does not improve closure rates and is associated with increased complications

Escalating dose indomethacin for prophylactic closure of patent ductus arteriosus does not improve closure rates and is associated with increased complications

Device Closure Rates of Simple Atrial Septal Defects Optimized by the STARFlex Device

This study sought to review the outcomes of 3 generations of closure devices for secundum atrial septal defects (ASDs) at a single institution. Transcatheter closure of ASDs is now increasingly performed with devices that have been modified over time to improve performance. A review of prospective clinical trials of Clamshell (C.R. Bard Inc., Murray Hill, New Jersey), CardioSEAL (NMT Medical Inc., Boston, Massachusetts), and STARFlex (NMT Medical Inc.) closure devices for simple ASDs was performed. The entry criteria for these trials were age > or =2 years, isolated secundum ASD, evidence of right ventricular volume overload, and maximum stretched diameter varying from 20 to 25 mm. Successful outcomes were defined as no more than small residual leak (< or =2 mm) with absence of a severe complication or the need for an additional device or surgery. A total of 72 Clamshell, 30 CardioSEAL, and 42 STARFlex devices were placed in uncomplicated ASDs. Each device modification resulted in improved closure rates, with the STARFlex device achieving a 93% complete closure rate with a device/stretched diameter ratio significantly smaller than with the other devices (p = 0.001). Severe complications occurred in 5 Clamshell, 1 CardioSEAL, and 0 STARFlex cases. Successful outcomes increased for each generation of device (79%, 93%, and 98% respectively, p = 0.009). There have been no long-term complications for either the CardioSEAL or the STARFlex devices. Modifications in 3 generations of devices have resulted in improved results for percutaneous ASD closure.

Low Fistula Rate in Palatal Clefts Closed with the Furlow Technique Using Decellularized Dermis

Despite the advances in cleft palate closure over the past 20 years, postoperative fistulas are still a significant problem. Fistula rates average 10 to 23 percent, and it has been suggested that wide clefts have a higher rate of fistula formation. In an attempt to improve closure rates, the authors placed decellularized dermal graft within the closure of 31 consecutive palatal cleft closures using the Furlow technique, with one attending surgeon. A retrospective review of this series of patients was analyzed for cleft width, Veau type, and rate of healing. Average cleft width was 12.2 mm (range, 8 to 15 mm). There were one Veau type I, five Veau type II, 20 Veau type III, and six Veau type IV patients. The average age at time of palate repair was 11.75 months (range, 8 to 28 months). One patient (Veau type IV, 15-mm width) developed fistula (3.2 percent fistula rate overall). There was no evidence of rejection, scarring, or impaired palatal motion by examination. A low fistula rate was obtained in Furlow technique palatal cleft repairs using decellularized dermis when compared with historical controls. Decellularized dermis may provide an additional barrier to wound breakdown in the postoperative period and may improve fistula rate.

Surgical repair of full-thickness idiopathic macular holes associated with significant macular drusen

Objective To evaluate the visual and anatomic results of surgically repaired macular holes in eyes with intermediate or large-sized macular drusen. Design Retrospective noncomparative case series. Participants Thirty-four eyes of 32 patients undergoing macular hole surgery with preoperative intermediate or large-sized macular drusen as defined by the Age-Related Eye Disease Study (AREDS). Intervention Pars plana vitrectomy for standard macular hole repair performed by multiple surgeons. Main outcome measures Visual acuity, anatomic hole closure. Results Initial hole closure failed in 8 eyes (24%) overall, 5 of 28 eyes (18%) with AREDS category 2 drusen and 3 of 6 eyes (50%) with category 3 drusen ( P = 0.1263). Final macular hole closure was seen in 93% of category 2 and 67% of category 3 eyes ( P = 0.1347). Mean final visual acuity was 20/60 overall, 20/60 for category 2, and 20/50 for category 3 eyes. Conclusions A trend of reduced initial macular hole closure was seen in eyes with significant macular drusen. Reoperation improved closure rates. If closure was accomplished, visual outcomes were excellent.

Short versus prolonged indomethacin therapy for patent ductus arteriosus in preterm infants

Objective: To evaluate whether a prolonged low-dose course of indomethacin would produce an improved closure rate and have fewer side effects compared with a short standard dosage schedule in the management of patent ductus arteriosus (PDA) in preterm infants. Study design: Sixty-one infants of gestational ages 24 to 32 weeks with a PDA confirmed with echocardiography were randomized to receive 0.2 to 0.1 to 0.1 mg/kg indomethacin in 24 hours (short course, n = 31) or 0.1 mg/kg every 24 hours 7 times (long course, n = 30). Echocardiography was done 3, 9, and 14 days after the treatment was started, and side effects were monitored. Results: Primary PDA closure occurred more often in the short course group (94% vs 67%, P = .011), but the sustained closure rates were not different (74% vs 60%). Surgical PDA ligations were less frequent in the short course group than in the long course group. The short course group had a shorter duration of oxygen supplementation, less frequent symptoms of necrotizing enterocolitis, and a lower rate of urea retention. Mortality and other neonatal morbidity rates were similar. Conclusion: A prolonged low-dosage indomethacin regimen offers no advantage compared with a standard-dosage short course in the management of a hemodynamically significant PDA in preterm infants. (J Pediatr 1999;134:552-7)

Evaluation of Gianturco Coils for Closure of Large (≥3.5 mm) Patent Ductus Arteriosus

Objectives. This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (≥3.5 mm) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils.Background. Coil closure of PDAs has become increasingly popular. However, the technique has significant limitations when used to close large PDAs. This report evaluates patient characteristics, PDA anatomy, hemodynamic variables, delivery technique and coil geometry to determine predictors of success.Methods. Between January 1995 and January 1997, 16 of 118 patients undergoing catheterization for PDA closure were found to have large PDAs. Their median age and weight were 14 months (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respectively. The mean PDA diameter was 4.3 mm (range 3.5 to 5.9). Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096-cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynamic and technical variables between successes and failures were compared.Results. Eleven (69%) of 16 patients had successful closure of their PDA. Failures occurred only in patients <8 months of age with an indexed PDA diameter >7 mm/m and a pulmonary/systemic flow ratio ≥2.8:1. Use of 0.052-in. coils tended to reduce the incidence of embolization and the number of coils needed for closure.Conclusions. Patients >8 months of age can have successful closure of large PDAs with currently available Gianturco coils. The 0.052-in. Gianturco coils can be used safely to close large PDAs in infants as small as 6 kg. Increased experience and improved coil design may improve closure rates of large PDAs in infants.