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Transcatheter occlusion of patent ductus arteriosus using coil embolization
J L Jacob1, W M Coelho, N C Machado
1Instituto de Moléstias Cardiovasculares de São José do Rio Preto, São Paulo, Brazil.
Insights
Coil embolization is a simple, effective procedure for closing the ductus arteriosus in children. However, potential complications like coil migration and residual shunts can occur days after the procedure.
Area of Science:
- Interventional Cardiology
- Pediatric Cardiology
- Vascular Surgery
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Coil embolization offers a minimally invasive alternative to surgical closure.
- Evaluating the safety and efficacy of coil embolization for PDA is crucial.
Purpose of the Study:
- To assess the success rate of coil embolization for ductus arteriosus occlusion.
- To identify early and late complications associated with the procedure.
- To determine the long-term efficacy of coil embolization in pediatric patients.
Main Methods:
- Retrospective analysis of 31 coil embolization procedures in 29 pediatric patients.
- Femoral artery approach with Judkin right coronary catheter for coil delivery.
- Aortography and echocardiography used for procedural guidance and follow-up.
Main Results:
- Successful coil placement in 29 procedures (93.5%).
- Early residual shunts observed in 9 patients (29%), decreasing to 3.8% at 30 days.
- Complications included coil migration (1 case) and severe hemolysis (1 case).
Conclusions:
- Coil embolization is a technically simple and effective method for ductus arteriosus occlusion in children.
- Potential complications, including residual shunts and device migration, require careful monitoring post-procedure.
- Long-term follow-up is essential to assess the durability of coil occlusion and detect late complications.
Abstract:
We studied 31 procedures of coil embolization for occlusion of ductus arteriosus, attempted in 29 patients. The mean age was 4.8+/-3.4 years (1-16 years) and the mean diameter of ductus was 1.8+/-0.7 mm (0.8-3.1 mm). Femoral artery approach was used and aortogram in 90 degrees lateral view was performed. Through a Judkin right coronary catheter, the coil was delivered for occlusion of the ductus. In 5 cases, 2 coils were delivered using retrograde and anterograde techniques. Successful placement of coil was accomplished in 29 procedures. Coils 0.038 inch (diameter)-5 cm (length)-5 mm (helical diameter) (Cook, Inc) were used in 16 procedures, coils 0.035 inch-5 cm-5 mm in 9, coil 0.038 inch-8 cm-8 mm in 1, two coils 0.038 inch-5 cm-5 mm in 2, coils 0.038 inch-5 cm-5 mm+0.038 inch-5 cm-8 mm in 1, and 2 coils 0.035 inch-5 cm-5 mm in 2. Aortogram 20 min after the occlusion, showed residual shunt in 9. Coil migration occurred in a ductus type B in the following day. One patient developed severe haemolysis, due to a change in the coil position, 12 h after the procedure. Echodopplercardiogram 4 to 6 h after the procedure showed a residual shunt in 5 patients, 24 h after in 3 and 30 days after, in 1(3.8%). Heparin therapy started 10 days after occlusion of the ductus, caused reappearance of the shunt in 1 patient. This technique is simple and effective, but complications may occur hours or days after successful ductus occlusion.