Circulation, Vol 88, 1412-1420, Copyright © 1993 by American Heart Association
TR Lloyd, R Fedderly, AM Mendelsohn, SK Sandhu and RH Beekman 3d
BACKGROUND. Transcatheter occlusion with Gianturco coils has been attempted
in a small number of patients with tiny (< or = 1.5-mm diameter) patent
ductus arteriosus, and preliminary results have been encouraging. The
present study extends this method to larger ductus sizes and makes
recommendations for proper coil size selection. METHODS AND RESULTS. Coil
occlusion was attempted in 24 consecutive patients with patent ductus
arteriosus who did not require other cardiac surgery. Median patient age
was 4.2 years (8 months to 30 years), and mean ductus diameter was 1.7 +/-
0.8 mm. Two instances of coil embolization occurred in the first 4
patients, with successful coil retrieval. Based on this experience, we
proposed that the coil helical diameter should be twice or more the minimum
ductus diameter, with coil length sufficient for three or more loops. With
these recommendations, coils were successfully implanted in the subsequent
20 consecutive patients. Of the 22 patients with successful coil
implantation, 15 (68%) had no residual shunting, and 7 had trace residual
shunting by angiography. The continuous murmur was abolished in all 22
patients. No significant complications occurred, and all patients were
discharged within 24 hours of successful coil implantation. No change in
the systolic pressure gradient between main and left pulmonary artery or
ascending and descending aorta was observed. CONCLUSIONS. Transcatheter
occlusion of patent ductus arteriosus can be safely and effectively
achieved in patients with ductus diameters up to 3.3 mm. Coil occlusion
does not cause obstruction to flow in the left pulmonary artery or
descending aorta. Coils should be selected to provide a helical diameter
twice or more the minimum ductus diameter and a length sufficient for three
or more loops.
ARTICLES
Transcatheter occlusion of patent ductus arteriosus with Gianturco coils
Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, Mich.
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