Intravascular Ultrasound During Transcatheter Coil Closure of Patent Ductus Arteriosus: Comparison with Angiography

Precise delineation of the size and shape of the ductus arteriosus may help in catheter closure. The use of Intravascular Ultra Sound (IVUS) to study the diameter of patent ductus arteriosus (PDA) has not been reported. We prospectively evaluated the use of IVUS and compared it to angiography in determining the size and shape of PDA and to assess the degree of coil protrusion into the descending aorta and the clinical relevance after coil closure. Twenty-six patients (17 female, 9 male) underwent transcatheter closure of PDA using single or multiple Gianturco coils. The median age of the patients was 1.7 yr (range, 2 monthsÐ34 yr) and the median weight was 10.9 kg (range 4.2Ð80 kg). A good quality IVUS image was obtained in all patients using 3.8 Fr, 30 MHz catheters. The median PDA diameter measured by angiography was 2.8 mm (range 1.6Ð5.7 mm) and by IVUS was 3.2 mm (range 1.7Ð5.7). There was excellent agreement between IVUS and angiography (D IVUS = 0.25+0.97*D angio, r = 0.90, (D: diameter in mm). After closure, coils could be seen protruding into the aorta with a median percent coil protrusion of 17.3% (range 0.0Ð47%). Only one patient had the coil protruding into more than 1/2 the aorta. This coil was retrieved and another coil was placed successfully. On follow-up at a median interval of 2.4 yr. (range 1.1Ð3.2 yr), there has been no clinical evidence for thromboembolic events. We conclude that IVUS use to assess the size of PDA is accurate. On mid-term follow-up, coil protrusion into the aorta seems to be benign. Further follow-up is needed.