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Hemolysis complicating coil occlusion of patent ductus arteriosus
1Department of Pediatrics, Sapporo Medical University School of Medicine, Japan. tomitah@sapmed.ac.jp
Insights
Coil occlusion for patent ductus arteriosus (PDA) can cause hemolysis if a significant residual leak occurs. Minimizing residual leaks with multiple coils is crucial to prevent this complication.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Coil occlusion is a common procedure for patent ductus arteriosus (PDA).
- Hemolysis is a potential complication following PDA coil occlusion.
- Residual shunts after coil embolization can be associated with adverse outcomes.
Purpose of the Study:
- To investigate the relationship between residual shunts and hemolysis after PDA coil occlusion.
- To identify factors associated with the development of persistent hemolysis post-procedure.
- To provide recommendations for minimizing hemolysis complications.
Main Methods:
- Retrospective case-control study comparing patients with and without post-procedural hemolysis.
- Analysis of patient data including presence of significant residual leak, heart murmur, and coil deployment parameters.
- Comparison of the coil-to-ductus diameter ratio (C/D) between groups.
Main Results:
- A significant residual leak and heart murmur were more frequent in the Hemolysis group.
- The mean C/D ratio was significantly smaller in patients who developed persistent hemolysis requiring re-intervention (2.2+/-0.4) compared to the No Hemolysis group (3.1+/-1.1).
- Persistent hemolysis was associated with significant residual shunts and smaller C/D ratios.
Conclusions:
- Persistent hemolysis after PDA coil occlusion is linked to significant residual shunts and suboptimal coil sizing (small C/D ratio).
- Careful attention to achieving complete closure or minimal residual leak is essential.
- The use of multiple coils to minimize residual leaks may help prevent post-procedural hemolysis.
Abstract:
We report on 5 patients who developed hemolysis (the Hemolysis group) following coil occlusion for PDA, and compare their data to 66 cases which were not complicated by hemolysis despite residual leak (the No Hemolysis group). A significant leak with a heart murmur was more frequent in the Hemolysis group than in the No Hemolysis group. The ratio of the sum of the loop diameter of coils to the minimal diameter of the ductus (C/D) in those who developed persistent hemolysis that needed a second intervention (2.2+/-0.4) was significantly smaller than in the No Hemolysis group (3.1+/-1.1). Persistent hemolysis can occur if a significant residual shunt remains after implantation of coils with small C/D. As this complication may be avoided by complete closure or, if not complete, a minimal leak, we should be careful to make residual leaks as small as possible by the use of multiple coils.