PERCUTANEOUS CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH DETACHABLE COIL: EXPERIENCE ON 40 CONSECUTIVES PATIENTS:

The 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 of dacron.
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 PDA.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 months.
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.

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