Transcatheter Coil Closure Research Articles

Pulmonary Arteriovenous Malformations in a 18-months-old Child: A Case Report

Pulmonary Arteriovenous Malformation (PAVM) is a cardiovascular anomaly in which an anatomic communication between the pulmonary artery and pulmonary vein is formed, resulting in an additional cardiac shunt from the right to left side. PAVM is a rare disease, reported more in females, but in newborns comparatively higher in males. Cases can vary from asymptomatic to symptomatic such as having dyspnoea, hypoxia, cyanosis, neurological symptoms. They are mostly congenital having association with Hereditary Haemorrhagic Telangiectasia (HHT). Herby, author present a case of 18-months-old female was admitted with peripheral cyanosis in the Paediatric Department. Her saturation was 76%, after admission she received three doses of salbutamol nebulisation and was kept on 3 litre oxygen until her saturation increased to around 90%. On auscultation, a murmur of grade 2/6 heard in the left axilla with clear lung fields. Chest X-ray detected a prominent lobulated opacity in the left sided lung adjacent to the heart border. An echocardiogram was done which turned out normal. Thoracic Computed Tomography (CT) scan with contrast showed a vascular malformation in the apical region of the left lower lobe. Pulmonary angiography showed multiple vascular lesions in the peripheries which was consistent with arteriovenous malformation. The child was diagnosed with PAVM. A transcatheter embolisation and coil closure of AVM was performed and postprocedure the child was stable.

Expectant management of prolonged hemolysis following complete transcatheter coil closure of a patent ductus arteriosus after previous pulmonary artery banding: a case report

BackgroundTranscatheter coil occlusion has been the treatment of choice for closure of small patent ductus arteriosus (PDA). In spite of its safety, complications such as hemolysis still occasionally occur. And the hemolysis almost always occurs following partial transcatheter closure of PDA; hence, it occurs extremely rarely following complete transcatheter closure of PDA without residual ductal flow.Case presentationHere, we describe a male newborn who developed prolonged hemolysis following complete transcatheter coil closure of his PDA after previous palliative pulmonary artery banding. Over the following days, we corrected his refractory anemia by repeated blood transfusion with packed red blood cells and frequently monitored his hemoglobin, serum total bilirubin, and serum lactate dehydrogenase. We speculated that the high-velocity pulmonary blood flow jet coming into contact with the extruded part of the coil led to red blood cell mechanical injury, thereby resulting in the hemolysis. We adopted expectant management in expectation of the endothelialization of the coil with a resultant reduction in the hemolysis. The hemolysis, as expected, was reduced gradually until it spontaneously resolved 81 days after coil implantation.ConclusionsThis case reminds us that hemolysis can still potentially occur following complete transcatheter coil closure of PDA. It also highlights the importance of preventing coils from extruding into the pulmonary artery in patients after previous pulmonary artery banding.

Transcatheter Occlusion of Patent Ductus Arteriosus in Pre-Term Infants

The aim of this study was to describe our institutional experience with transcatheter coil occlusion of patent ductus arteriosus (PDA) in symptomatic low birth weight pre-term infants. Transcatheter treatment of PDA in very small infants (<2 kg) is technically challenging and therefore often not considered as an alternative to traditionally accepted modalities (surgical or medical treatment). Coil occlusion was offered as an option to selected infants with symptomatic PDA. Case selection for the transcatheter procedure was determined by the patient's weight, PDA size, size of ampulla, and the anticipated coil mass required for complete closure (determined through echocardiography). The PDA occlusion was achieved with coils delivered with assistance of a 3-F bioptome. Arterial access and catheter manipulation within the cardiac chambers were avoided whenever feasible. Eight pre-term infants underwent coil occlusion. Gestational age ranged from 27 to 32 weeks (28.7 +/- 1.9 weeks). The median birth weight was 1,040 g (range 700 to 1,700 g), and the median weight at the time of procedure was 1,100 g (range 930 to 1,800 g). Three patients were receiving mechanical ventilation before intervention. Duct sizes ranged between 2 and 3.5 mm. Complete occlusion of the duct was instantly achieved in 7 patients, and 1 patient had a small residual flow for 24 h. There were no major procedure or access-related complications; 4 patients were discharged within 72 h; 1 patient was discharged on Day 10. Three patients required prolonged ventilation (34 and 150 days) due to pulmonary pathology. It is technically feasible to undertake transcatheter coil closure of PDA in carefully selected symptomatic pre-term infants, and it is a safe alternative to surgical ligation.

Guidewire and catheter manipulation without coil placement to close minimal patent ductus arteriosus

Background Transcatheter coil closure (TCC) is safe and effective for most patients with PDA, but coil associated complications may occasionally be encountered. For occlusion of minimal PDA (< 1 mm), we employed a closure protocol with guidewire and catheter manipulation. Methods Between April 2000 and September 2004, 38 patients with a minimal PDA were classified into two groups according to the occlusion method at our institution. Group A consisted of 11 patients (age range 0.7 to 3.5 years; mean age 1.6 years) who underwent guidewire and catheter manipulation. Group B consisted of 27 patients (age range 0.5 to 2.7 years; mean age 1.3 years) who underwent TCC of PDA. Results In group A (a PDA 0.4–0.9 mm), 9 (82%) patients had successful closure, and two (18%) patients failed the manipulation. No patient had complications during the procedure or follow-up. In group B (a PDA 0.5–0.9 mm), 26 (96%) patients had successful closure and 1 (4%) patient failed the attempt at TCC. No adverse events of coil closure was found during follow-up. Compared to the patients in group B, those in group A differed significantly in terms of procedure time. There were no significant differences in age, sex, body weight, PDA size, fluoroscopy time, success rate, and complication rate. Conclusions Our results indicate that the manipulation is safe and effective for patients with minimal PDA. The manipulation technique can be tried before TCC in patients with minimal PDA.

Iatrogenic cardiovocal syndrome caused by transcatheter coil closure of patent ductus arteriosus

Two infants developed hoarseness unexpectedly the day after transcatheter coil closure of a slender patent ductus arteriosus (PDA). The pathogenesis of this complication appears to be similar to that of the classic cardiovocal syndrome. During the intervention, the inappropriately implanted coil might have distorted the slender PDA, thereby causing angulation of the pliable PDA itself and precipitating impingement on the left recurrent laryngeal nerve. Fortunately, both infants recovered spontaneously from the hoarseness within several weeks. At present, the definite underlying neuropathology of this complication is unknown as we have not yet confirmed recovery of the left vocal cord movement by follow-up fibreoptic bronchoscopy. Iatrogenic cardiovocal syndrome could occur in infants after transcatheter coil closure of a slender PDA, using the currently popular 0.038-inch coil. A coil with a smaller diameter might prevent the occurrence of this syndrome.

Iatrogenic cardiovocal syndrome caused by transcatheter coil closure of patent ductus arteriosus

Abstract Two infants developed hoarseness unexpectedly the day after transcatheter coil closure of a slender patent ductus arteriosus (PDA). The pathogenesis of this complication appears to be similar to that of the classic cardiovocal syndrome. During the intervention, the inappropriately implanted coil might have distorted the slender PDA, thereby causing angulation of the pliable PDA itself and precipitating impingement on the left recurrent laryngeal nerve. Fortunately, both infants recovered spontaneously from the hoarseness within several weeks. At present, the definite underlying neuropathology of this complication is unknown as we have not yet confirmed recovery of the left vocal cord movement by follow-up fibreoptic bronchoscopy. Conclusion : Iatrogenic cardiovocal syndrome could occur in infants after transcatheter coil closure of a slender PDA, using the currently popular 0.038-inch coil. A coil with a smaller diameter might prevent the occurrence of this syndrome.

Transcatheter Coil Closure of Pulmonary Arteriovenous Malformations in Children

Pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation of the lung that may lead to cyanosis, epistaxis, hemoptysis, and neurological deficits or cerebral abscess. The purpose of this study is to assess the effectiveness of percutaneous transcatheter embolization of PAVF in pediatric patients. Transcatheter embolization of PAVF using spring coils was performed in three patients (two males and one female) who presented between 1989 and 1999. The age at presentation ranged from 8 months to 3 years (mean 19.6 months). All patients had cyanosis and clubbing. Neurological, dermatological, or other cardiac manifestations were absent. The arterial oxygen saturations at presentation ranged from 60 to 72% (mean 64%). During eight procedures, multiple coils (total of 41 coils, average 14 coils per patient) were delivered to occlude the fistulas successfully. There was complete occlusion of the fistulas in all patients after the multiple interventions. The aortic saturations increased from a mean of 66% to a mean of 95%. Chest radiographs demonstrated dramatic regression of the pulmonary shadows in all three patients. There were no complications encountered during the procedures or during follow-up. Transcatheter coil embolization of PAVF is a safe and effective method of treatment in the pediatric age group. Patients may require multiple procedures to completely occlude the fistulas. Long-term follow-up is essential to ensure absence of recurrence due to recanalization.

A case of patent ductus arteriosus, detected at the mitral valve surgery and underwent transcatheter coil closure

A case of patent ductus arteriosus, detected at the mitral valve surgery and underwent transcatheter coil closure

Index of suspicion.

Index of suspicion.

Transcatheter coil closure of a right pulmonary artery to left atrial fistula in an ill neonate

Transcatheter coil closure of a right pulmonary artery to left atrial fistula in an ill neonate

Long‐term outcome of transcatheter coil closure of small to large patent ductus arteriosus

Coil closure of patent ductus arteriosus (PDA) has become an accepted alternative to surgical closure in most pediatric cardiac centers. However, little is known about the mid- to long-term outcome of this procedure. Therefore, we evaluated the immediate, short-, and long-term outcome of transcatheter coil closure (TCC) of PDA using single or multiple Gianturco coils or the Gianturco-Grifka Vascular Occlusive Device (GGVOD). One hundred forty-nine patients underwent an attempt at TCC of their PDAs at a median age of 2.4 years (2 weeks to 55 years) and median weight of 13.5 kg (2.3–87 kg). There were 33 patients < 1 year of age. The median PDA minimal diameter was 2 mm (0.4–7 mm) with 26 patients whose PDA minimal diameter was > 4 mm. A 4 Fr catheter was used for coil deployment in 136 patients, a 3 Fr in 4, and an 8 Fr in 4 patients who received the GGVOD. A single coil was used in 77 patients and multiple coils (2–6) were used in 66 patients. One hundred forty-six patients had successful closure (142 had immediate complete closure and 4 had residual shunt), 3 patients failed the initial attempt (2 underwent surgical ligation and 1 had a successful second attempt a year later). Of the four patients with residual shunt, three underwent a second procedure with implantation of 1–3 coils resulting in complete closure in all and one patient had spontaneous resolution of the residual shunt. Complications were encountered in nine patients: six had coil migration with successful retrieval in four; two had left pulmonary artery stenosis (2.4 kg and 6.3 kg infants), and one patient had loss of femoral arterial pulse. The median fluoroscopy time was 16 min (2–152 min). One hundred forty-two patients had the procedure as an outpatient, five patients stayed greater than 24 hr, and two of these patients were in hospital for 1 month for noncardiac reasons. At a median follow-up interval of 3.0 years (1 month to 5.1 years), there were no episodes of delayed coil migration, delayed recanalization, thromboembolic episodes, or bacterial endocarditis. Lung perfusion scans performed at a median follow-up interval of 1.6 years in 31 patients who received multiple coils revealed 45% ± 5% blood flow to the left lung. Long-term follow-up of coil closure of PDA indicates that the technique is safe and effective for most pa-tients with PDA up to a diameter of 7 mm. Cathet. Cardiovasc. Intervent. 47:457–461, 1999. © 1999 Wiley-Liss, Inc.

Long-term outcome of transcatheter coil closure of small to large patent ductus arteriosus.

Coil closure of patent ductus arteriosus (PDA) has become an accepted alternative to surgical closure in most pediatric cardiac centers. However, little is known about the mid-to long-term outcome of this procedure. Therefore, we evaluated the immediate, short-, and long-term outcome of transcatheter coil closure (TCC) of PDA using single or multiple Gianturco coils or the Gianturco-Grifka Vascular Occlusive Device (GGVOD). One hundred forty-nine patients underwent an attempt at TCC of their PDAs at a median age of 2.4 years (2 weeks to 55 years) and median weight of 13.5 kg (2.3-87 kg). There were 33 patients < 1 year of age. The median PDA minimal diameter was 2 mm (0.4-7 mm) with 26 patients whose PDA minimal diameter was > 4 mm. A 4 Fr catheter was used for coil deployment in 136 patients, a 3 Fr in 4, and an 8 Fr in 4 patients who received the GGVOD. A single coil was used in 77 patients and multiple coils (2-6) were used in 66 patients. One hundred forty-six patients had successful closure (142 had immediate complete closure and 4 had residual shunt), 3 patients failed the initial attempt (2 underwent surgical ligation and 1 had a successful second attempt a year later). Of the four patients with residual shunt, three underwent a second procedure with implantation of 1-3 coils resulting in complete closure in all and one patient had spontaneous resolution of the residual shunt. Complications were encountered in nine patients: six had coil migration with successful retrieval in four; two had left pulmonary artery stenosis (2.4 kg and 6.3 kg infants), and one patient had loss of femoral arterial pulse. The median fluoroscopy time was 16 min (2-152 min). One hundred forty-two patients had the procedure as an outpatient, five patients stayed greater than 24 hr, and two of these patients were in hospital for 1 month for noncardiac reasons. At a median follow-up interval of 3.0 years (1 month to 5.1 years), there were no episodes of delayed coil migration, delayed recanalization, thromboembolic episodes, or bacterial endocarditis. Lung perfusion scans performed at a median follow-up interval of 1.6 years in 31 patients who received multiple coils revealed 45% +/- 5% blood flow to the left lung. Long-term follow-up of coil closure of PDA indicates that the technique is safe and effective for most patients with PDA up to a diameter of 7 mm.

921-69 Transcatheter Closure of the Persistently Patent Ductus Arteriosus Using Occluding Coils

Transcatheter coil closure (TCC) of the Patent Ductus Arteriosus (PDA) was attempted in 29 patients (pts) with a median age of 3.2 years (6 months-55 yearsl and a median weight of 14.0 kg (4.3-Bl kg). Previously, 114 pts with PDA underwent closure with the Rashkind umbrella device in our institution but this device is no longer available. Ducti measured 0.5–5.0 mm (mean = 1.B mm) at the narrowest point. A single coil was implanted in 12 pts, two in 15 and three in 2. The first coil implanted had a diameter twice the minimal internal diameter of the PDA and a length sufficient for at least 4 loops. One to 1.5 loops were delivered in the main pulmonary artery. and the remaining loops were released in the aortic ductal diverticulum. Coil embolization occurred in 3 pts: all coils were successfully retrieved. In another patient 3 coils were removed from the PDA. after proper placement. because of left pulmonary artery obstruction. Coil re-implantation was successful in all of these patients. Aortography, performed 10 minutes after coil implantation, showed complete closure in 25/29 pts (86%). Four hours after the procedure, 27/29 pts (93%1 had no evidence of PDA by color flow Doppler. Thirteen pts were done as outpatients, 13 were discharged in 24 hr, and 3 had prolonged hospitalization for other medical problems. Follow-up ranged from 1 month to 4 years in 27/29 pts. None had detectable murmurs. Small residual PDA shunt by color flow Doppler persisted in 2 pts. No aortic obstruction, pulmonary artery stenosis. hemolysis, or late coil migration has been observed. These results compare favourably with our Rashkind device occlusion results where the closure rate was 52% by angiography (p &lt; 0.01) and 71% by color flow Doppler (p = 002) at discharge. Furthermore, the cost of TCC was 25% less than the Rashkind device occlusion, and 40% less than surgical closure. TCC of small to moderate PDA is an effective technique without significant morbidity. It appears significantly more effective and costefficient than the Rashkind device occlusion, and it can be done safely as an outpatient procedure.

Transcatheter coil closure of a congenital coronary arterial fistula

Congenital coronary arterial fistulas to atria1 or ventricular chambers are an uncommon form of heart disease that requires surgical closure in chi1dhood.l Conventional management includes a thoracotomy with either epicardial closure of the fistula, or with cardiopulmonary bypass and cardiotomy to close the site of drainage.2 Transcatheter coil embolization, utilized for the closure of “unwanted” vascular communications such as bronchial collaterals, arteriovenous malformations, or Blalock-Taussig shunts,3T 4has not been used as treatment for congenital coronary arterial fistulas. This report describes the use of Gianturco spring coil embolization in a 13-month-old child with a large right coronary arterial-to-right atrial fistula. Complete closure was accomplished in the cardiac catheterization laboratory, obviating the need for surgical correction. This is the first report and description of the technique for this alternative form of therapy. A 13-month-old girl was referred for evaluation of a continuous murmur and slow weight gain. Her weight was 7.7 kg (less than the fifth percentile) with a body length of 76 cm (fiftieth percentile). On physical examination she was a small infant without evidence of respiratory distress. The cardiac impulse was mildly hyperdynamic. Si was normal and Ss was split with a normal pulmonic component. There was no Ss, S4, or ejection click. There was a grade II to III/ VI continuous machinery murmur heard at the left midsternal border with a grade II/VI mid-diastolic rumble at the apex. The liver was palpable 3 cm below the right costal margin. The femoral pulses were bounding. Electrocardiogram revealed a normal sinus rhythm with right ventricular conduction delay and left ventricular hypertrophy. The chest x-ray film showed mild cardiac enlargement with increased pulmonary blood flow and a prominent right atria1 shadow. A two-dimensional echocardiogram with color-flow Doppler demonstrated a large coronary arterial fistula that arose near the ostia of the right main coronary artery. This fistula was tortuous and coursed to the right atrial-superior vena caval junction near the interatrial groove, and drained through multiple small fenestrations into the right atrium. The right ventricle was dilated, consistent with a volume overload, and there was no evidence of a patent ductus arteriosus. At cardiac catheterization there was a moderate left-to-right shunt with a Qp/Qs