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[Mid-term follow-up results of coil embolization for patent ductus arteriosus]
1Department of Pediatrics, Juntendo University School of Medicine, Tokyo.
Insights
Coil embolization is a safe and effective treatment for patent ductus arteriosus (PDA). While small residual shunts may occur initially, they typically close spontaneously within six months, with careful follow-up recommended.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Patent Ductus Arteriosus (PDA) is a common congenital heart defect requiring intervention.
- Coil embolization offers a minimally invasive treatment option for PDA.
Purpose of the Study:
- To evaluate the mid-term efficacy and safety of coil embolization for PDA.
- To assess the incidence of residual shunt, recanalization, and complications post-procedure.
Main Methods:
- Retrospective analysis of 19 pediatric patients undergoing coil embolization for PDA.
- Follow-up using color flow mapping and pulsed Doppler echocardiography.
- Evaluation of procedural approaches, coil types, and complication rates.
Main Results:
- Coil embolization was technically successful in all patients.
- Two instances of immediate coil migration were safely managed.
- Six patients (32%) had minimal residual shunts post-procedure, all spontaneously closed within 6 months.
- One case of recanalization occurred but resolved spontaneously by 1 year 6 months.
- No acquired left pulmonary artery stenosis was observed.
Conclusions:
- Coil embolization is an effective and safe therapeutic option for PDA in children.
- Initial residual shunts are common but usually resolve spontaneously.
- Careful echocardiographic follow-up is essential to monitor for recanalization.
Abstract:
Mid-term follow-up results of coil embolization for patent ductus arteriosus (PDA) were evaluated in 19 patients aged from 2 years 9 months to 13 years (median: 5 years and 10 months) who underwent coil embolization for PDA. The minimum diameter of PDA ranged from 1.0 to 3.5 mm (mean 2.3 +/- 0.8 mm). Coil embolization was performed by the retrograde approach in 16 patients and the anterograde approach in 3, using a Gianturco coil in 11 and a Jackson detachable coil system in 8. Sixteen patients underwent single coil embolization and three patients received two coils simultaneously with detachable coil systems. Follow-up evaluation was performed with color flow mapping and pulsed Doppler echo to identify residual shunt or acquired left pulmonary artery stenosis after embolization at 1 day, 1 week, 1, 3, 6 and 12 months, and every 6 months thereafter. In two patients, a coil had migrated into the distal left pulmonary artery immediately after implantation, and could be safely retrieved. Minimum residual shunt was found in six patients (32%) on the day after the procedure. Spontaneous closure was noted in all patients within 6 months. Recanalization of completely occluded PDA was observed in one patient at 1 month after embolization. However, spontaneous closure of the residual shunt was found at 1 year and 6 months of follow-up. There was no evidence of acquired left pulmonary artery stenosis during the follow-up period (14.5 +/- 5.8 months). Coil embolization is an effective and safe therapy for PDA. Small residual shunt may be observed immediately after the coil embolization, but will close spontaneously during the follow-up. Recanalization occurred after complete coil occlusion, so careful follow-up with color flow mapping is mandatory.