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Endothelialization of the coils used to occlude a persistent ductus arteriosus: an angiographic study
H Tomita1, S Fuse, K Hatakeyama
1Department of Pediatrics, Sapporo Medical University School of Medicine, Japan. tomitah@hsp.ncvc.go.jp
Insights
Coil occlusion effectively seals persistent ductus arteriosus (PDA). Complete endothelialization occurs within six months, significantly reducing risks of infective endocarditis and thromboembolism.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Persistent ductus arteriosus (PDA) is a common congenital heart defect.
- Coil occlusion is a widely used minimally invasive technique for PDA closure.
- Assessing the long-term endothelialization of coils is crucial for understanding device efficacy and safety.
Purpose of the Study:
- To evaluate the degree and timeline of endothelialization of coils used for PDA closure.
- To identify factors influencing the thickness of endothelial coverage.
- To assess the implications of endothelialization on potential complications.
Main Methods:
- Retrospective review of follow-up aortograms and pulmonary angiograms in 25 patients post-coil occlusion for PDA.
- Measurement of PDA dimensions and post-deployment coil-aorta distance.
- Assessment of endothelial coverage on follow-up imaging at 6-24 months.
Main Results:
- Complete separation of the coil from the contrast column (indicating endothelialization) was observed at the aortic end in all patients and the pulmonary end in 18/25.
- The thickness of this separation ranged from 0.4-1.3 mm (aortic) and 0.3-0.8 mm (pulmonary).
- PDA and ampulla length positively correlated with aortic end separation thickness; complete coverage was evident by 6 months.
Conclusions:
- Coil occlusion leads to robust endothelialization of PDA closure devices within six months.
- The extent of endothelialization is influenced by ductal anatomy.
- Full endothelial coverage likely mitigates risks of infective endocarditis and thromboembolism after PDA coil occlusion.
Abstract:
To assess the endothelialization of the coils used to close a persistent ductus arteriosus (PDA), the present study comprised a review of the follow-up aortograms and pulmonary angiograms in 25 patients who underwent coil occlusion. The minimal diameter and the length of the PDA were measured prior to the procedure, and the shortest distance between the aortic end of the deployed coil and the aortic end of the PDA was measured after coil deployment. Evidence of endothelial coverage of the coil was sought on follow-up angiograms performed 6-24 (15+/-5) months later and the factors that determined the thickness of the endothelial coverage on the aortic end were investigated. Separation of the coil and the contrast column were detected at the aortic end in all cases and at the pulmonary end in 18 of 25 cases. The thickness of the separation ranged from 0.4 to 1.3 (0.7+/-0.2) mm at the aortic end and 0.3 to 0.8 (0.6+/-0.2) mm at the pulmonary end. The length of the ductus and of the ampulla had a significant positive correlation with the thickness of the aortic end separation. Apparent endothelial coverage of the coil was completed by 6 months after coil occlusion. Infective endocarditis or thromboembolism is an unlikely complication once endothelium covers the implanted coil.