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Transcatheter occlusion of the patent ductus arteriosus with Cook detachable coils
A J Tometzki1, R Arnold, I Peart
1Royal Liverpool Children's Hospital.
Objective:
To report initial experience with a new occlusion device for native and residual patent ductus arteriosus.
Design:
Descriptive study of consecutive non-randomised patients undergoing a new method of patent ductus arteriosus closure with detachable coils.
Setting:
Tertiary centres for paediatric cardiology.
Patients:
71 consecutive patients, aged 1.2-22 years, with a patent ductus arteriosus (PDA) underwent elective transcatheter closure. 45 had native PDAs (group A) with a minimum diameter of 1.0 mm-5.0 mm (median 2.0 mm). A further 26 had undergone one or more previous occlusion attempts (group B).
Interventions:
A total of 133 detachable (Cook) spring coils were successfully implanted in 70 patients. The procedure was performed transvenously in 51 patients, retrograde arterially in 13, and by both routes in a further 6 patients. One 5 mm coil migrated but was successfully retrieved.
Main Outcome Measures:
In group A colour flow Doppler echocardiography showed that complete occlusion was achieved in 40/45 (89%) at 24 hours, 41/45 (91%) at 1 month, and 44/45 (98%) by 6 months post procedure. Occlusion rates in residual PDAs were 22/25 (88%) occluded at 24 hours, 23/25 (92%) at 1 month, and 24/25 (96%) at 6 months follow up.
Conclusions:
Transcatheter occlusion using detachable (Cook) spring coils is a safe and effective alternative to presently available devices. The delivery system allows full retrieval of the coil until a satisfactory position is obtained.