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Follow-up of coil occlusion of patent ductus arteriosus
D Shim1, R T Fedderly, R H Beekman
1Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan 48109-0204, USA.
Insights
Most patients with residual shunts after patent ductus arteriosus coil occlusion achieve spontaneous closure. Follow-up data show most residual shunts close, with a low reintervention rate.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Transcatheter coil occlusion is a popular method for patent ductus arteriosus closure.
- Limited follow-up data exist regarding the long-term outcomes of this procedure.
Purpose of the Study:
- To determine the prevalence of residual shunting after coil occlusion of patent ductus arteriosus.
- To investigate the natural course and fate of these residual shunts.
Main Methods:
- Retrospective review of 75 patients undergoing coil occlusion for patent ductus arteriosus.
- Doppler echocardiography used for follow-up assessment of residual shunting.
- Angiographic review to determine minimal ductal diameter and angiographic type.
Main Results:
- 41% of patients had residual shunts immediately post-procedure; 55% of these closed spontaneously.
- 7% required a second coil procedure, and 13% had persistent residual shunts at follow-up.
- Smaller minimal ductal diameter correlated with immediate complete occlusion; no association with angiographic type. No late adverse events or recanalization observed.
Conclusions:
- Small residual shunts are frequent after patent ductus arteriosus coil embolization but typically resolve spontaneously.
- Actuarial analysis suggests a 94% complete closure rate at 20 months.
- Reintervention is uncommon, occurring in only 7% of patients.
Objective:
We sought to determine the prevalence and fate of residual ductal shunting following coil occlusion of patent ductus arteriosus.
Background:
Although transcatheter coil occlusion of patent ductus arteriosus has gained popularity, few follow-up data have been reported.
Methods:
A review of 75 patients who underwent coil occlusion was performed. Residual shunting was investigated by Doppler echocardiography in follow-up. Angiograms were reviewed to obtain minimal ductal diameter and ductal angiographic type.
Results:
Residual shunts were found in 31 patients (41%) on the day of the procedure, and of these, spontaneous closure was noted in 17 (55%) at 2 weeks to 20 months of follow-up. Of the 75 patients studied, 5 (7%) required a second coil procedure, and 10 (13%) remained with persistent residual shunts at most recent follow-up. Actuarial analysis estimated a 6 +/- 5% prevalence of residual shunts 20 months after a single coil procedure and 3 +/- 3% after all coil procedures. Minimal ductal diameter was associated with immediate complete ductal occlusion by a single coil. These patients had significantly smaller (p = 0.003) minimal ductal diameters (1.2 +/- 0.7 mm) than those who required two coils during their initial procedure to achieve immediate occlusion (1.9 +/- 0.7 mm), those who required a second coil procedure (2.0 +/- 0.9 mm), those who had spontaneous closure of residual shunts (1.9 +/- 0.7 mm) and those with persistent residual shunts (2.0 +/- 0.9 mm). No association was identified between ductal angiographic type and outcome of coil occlusion. No late adverse clinical events of coil occlusion or evidence of recanalization was found.
Conclusions:
Small residual shunts are common after coil embolization of patent ductus arteriosus, but most close spontaneously. Actuarial analysis estimates complete closure in 94% at 20 months, and reintervention was required in only 7% of patients.