Journal of Invasive Cardiology

Transcatheter closure of a small patent ductus arteriosus (PDA) is now an established treatment in many pediatric cardiology centers. As for occlusion of large PDA, interventional cardiologists are still looking for a simple, but safe and effective procedure. There are several reports using various devices and novel techniques for occlusion of large PDA.1–5 Although the procedures are effective approaches, some use expensive devices and some require exquisitely complex techniques. The increased costs and technical difficulty prevent their widespread use by interventional cardiologists.

Transcatheter coil occlusion of PDA, which was developed by Dr. Cambier and colleagues in 1992,6 is a relatively safe, effective and low-cost procedure. However, this technique has significant limitations when used to close large PDA. In our hospital, transcatheter coil occlusion of PDA has become a preferred therapeutic choice. For large PDA, we consider the sturdier 0.052´´ coil to be a useful device for closure of large defects. The 0.052´´ Gianturco coils (Cook Cardiology, Inc., Bloomington, Indiana) are constructed from heavier gauge wire than the 0.038´´ Gianturco coils. During deployment, the 0.052´´ coil also winds more tightly and maintains its loop configuration more efficiently than the commonly used 0.038´´ coil. Therefore, the implanted 0.052´´ coil will be seated in the ductal ampulla more efficiently than the 0.038´´ coil. We performed several cases of transcatheter closure of large PDA using the 0.052´´ Gianturco coils, with a success rate of 86.7%. We believe the use of 0.052´´ coil provides an effective and easy way to close large PDA. This study reports our experience and evaluates the safety and efficacy of using 0.052´´ coil with the multiple-coil strategy for the closure of large PDA.

Methods

From August 1997 to March 2001, a total of 208 patients underwent transcatheter coil occlusion of PDA in our hospital. Of these, fifteen patients had PDA >= 4 mm in minimal diameter and received at least one 0.052´´ coil implantation for PDA. These 15 patients constituted our study group. Patient age at the time of PDA closure, minimal diameter of the ductus, diameter of the ampulla, Qp/Qs, and incidence of complications were analyzed. Patient ages ranged from 10 months to 44 years (mean, 11.2 years). Weights ranged between 8.8–54 kg (mean, 29.2 kg). All 15 patients had undergone at least one 0.052´´ coil implantation attempt for PDA. The characteristic findings of these 15 patients were clinical and echocardiographic features of large PDA, asymptomatic adolescent or adult with PDA measuring >= 4 mm on color flow echocardiography. PDAs were typed according to the classification described by Krischenko et al.7 Anesthesia was achieved with a combination of intravenously administered ketamine and midazolam. All patients received 50 units/kg intravenous heparin after insertion of a femoral arterial sheath to avoid the risk of femoral arterial thrombosis. All patients underwent color Doppler echocardiography before leaving the catheterization laboratory, and at one day and three months post-procedure.