CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH DETACHABLE COIL: EXPERIENCE
ON 40 CONSECUTIVES PATIENTS:
percutaneous closure of patent ductus arteriosus (PDA) was boosted
by the use of detachable coil (Detachable Coil Cook Cardiology).
The coil is made of a stainless steel wire, coated with filament
The coil is produced in several sizes which differ on the number
(3 or 5) and the diameter of the coils (3 5 6,5 8 mm)The
coil causes the closure of the PDA inducing the formation of a thrombus.
Patients: between november 95 and june 2000, 40 patients (aged 0,5
to 16 years, mean 5 years) underwent cardiac catheterization for
the closure of a PDA diagnosed at ecoDoppler. Methods: under general
anaesthesia, two 5 Fr catheters are introduced in right femoral
artery and vein.
After emodynamics statements, a biplane descending aortogram is
performed to evaluate the morphology and the narrowest size of the
appropiate coil, which diameter is twice the size of the PDA, is
introduced and advanced into the catheter and then pushed out through
the PDA. If the position and the occlusion are satisfactories on
the aortogram, the coil is unscrewed from the the releasing system.
Ten minutes later a repeat aortogram is performed to asses the degree
of residual shunt. The day after the patient undergoes a complete
ecoDoppler study and chest radiography. The patient is discharged
with the recommendation to observe bacterial endocarditid for 6
Results: in 4 cases the closure with the coil was not performed:
in 2 cases because of the shape of the PDA (type B) and because
of the size (5 mm) of the PDA, which suggested the use of another
device, in 2 other cases. In 2 patients the procedure was not completed
because of the impossibility of obtaining coil stability in the
ductus (type E ductus). The coil was released in 34 patients (24
M, 10 F), mean age 4,5 years ( 1,5 - 16 years) and mean weight 19,5
kg (9,8 65 kg).
The ductus was type A in 24 cases, type C in 2, type D in 2 and
type E in 6. The mean narrowest diameter was 1,9 mm (1 3,9 mm).
In 33 cases 1 coil was released, in one case 2 coils. Complete closure,
evaluated by ecoDoppler at 6 months, was obtained in 97% (33/34).
The average time of the procedure was 65 minutes. No complications.
Follow-up: it range fro 4 to 60 months (mean 35,6 months) with assessment
at 1 month, 6 months and six-monthly. No case of coil migration,
ductal recanalization or hemolysis. In the patient with residual
shunt a second coil was released achieving complete closure. Conclusions:
Detachables coils have a high rate (97%) of closure of patent ductus
arteriosus and are safe of significant complications; for the high
rate of succes, the
easiness of performance, the low risk of complication and cost percutaneous
closure with detachables coils represents the treament of choice
for parent ductus arteriosus.