Transcatheter coil embolization of large-size patent ductus arteriosus in adult patients: usefulness and problems
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Published on: November 4, 2021
1Department of Cardiology, Hiroshima Prefectural Hiroshima Hospital, Japan.
Insights
Transcatheter coil embolization effectively treats adult patent ductus arteriosus (PDA), improving heart failure symptoms. Repeat procedures can resolve residual shunts and associated hemolytic anemia.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Transcatheter coil embolization is a common treatment for pediatric patent ductus arteriosus (PDA).
- Its application in adult PDA, particularly with heart failure or complex arrhythmias, is less established.
Observation:
- Three adult patients with PDA underwent transcatheter coil embolization using Cook detachable coils.
- Indications included heart failure in two patients and Wolff-Parkinson-White syndrome in one, following ablation.
Findings:
- Coil embolization led to left ventricular size reduction and improved heart failure in two patients.
- All patients had residual shunts post-procedure, causing hemolytic anemia in two.
- Repeat embolization achieved complete occlusion and resolved hemolysis in affected patients.
Implications:
- Transcatheter coil embolization is a viable option for improving heart failure in adult PDA patients, even with residual shunts.
- Secondary coil embolization is effective in managing residual shunt-related hemolytic anemia.
Abstract:
Transcatheter coil embolization of the patent ductus arteriosus (PDA) has been frequently used in children, especially for small lesions. It was attempted in 3 adults using Cook detachable coils. For 2 of the patients, relatively old age and heart failure were the reasons for choosing coil embolization of the PDA. In the remaining patient, who had Wolff-Parkinson-White syndrome, coil embolization was performed after radiofrequency catheter ablation of Kent's bundle. Their respective minimal PDA diameters were 5.0 mm, 4.5 mm and 4.0 mm measured by transesophageal echocardiography. Two coils were placed in 2 patients and 1 coil in the remaining patient. After the procedures, the size of the left ventricle decreased and heart failure was improved in 2 patients, although all 3 patients had a residual shunt, which caused hemolytic anemia in 2 patients. Repeat coil-embolization procedures resulted in complete occlusion and the hemolysis disappeared in these patients. In adult patients who have heart failure due to large PDA, coil embolization with detachable coils, even if residual shunt persists, is useful for improvement of the heart failure. In cases of hemolysis related to residual shunt, a second coil-embolization procedure can improve it completely.
