Transcatheter coil occlusion of small patent ductus arteriosus: experience at Siriraj Hospital.

ABSTRACT

Transcatheter coil occlusion of small-to-moderate-size patent ductus arteriosus (PDA, < 3.5 mm) is well established as a procedure of first choice in many institutions. Its much lower cost compared with surgical ligation or other devices makes it an attractive option, especially in Thailand. PATIENTS AND METHOD: Between September 1995 and June 2000, all patients diagnosed with PDA with audible murmur and echo-Doppler confirmation of diameter less than 3.5 mm were scheduled for transcatheter coil occlusion at the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The hemodynamic studies were obtained both pre and post occlusion. The immediate and late outcome, including complication were assessed. RESULTS: A total of 77 cases, 78 procedures of transcatheter PDA coil occlusion were performed. Seventy cases (90.9%), comprised of 19 males (27.1%) and 51 females (72.9%) were successfully deployed with coils. The remainder were unsuccessfully deployed and later referred to surgery. The median age of the successful group was 6 years and 6 months and median weight was 16.5 kg. Twenty cases (28.6%) had other associated intra and extracardiac anomalies. All patients were asymptomatic, except one case having bronchopulmonary dysplasia (BPD) from prolonged ventilation. Single-coil occlusions were performed in 74.3 per cent and double-coil occlusions in 25.7 per cent. Conventional 0.038-inch Gianturco coils were deployed in 86.5 per cent. The mean procedure time was 78.1 +/- 35.1 minutes. The mean fluoroscopic time was 20.2 +/- 15.6 minutes. The total complete occlusion rate was 87.7 per cent. Tiny residual flow of PDA was demonstrated by follow-up echocardiogram in 12.3 per cent. Seven per cent of the patients were lost to follow-up. There was no significant difference in PDA size and hemodynamics between the groups of patients with complete occlusion and having residual shunt. Minor complications occurred in 12.9 per cent, including mild left pulmonary artery stenosis (10%), coil embolization to distal pulmonary artery (8.6%), slippage of catheter with coil (2.9%) and decreased dorsalis pedis pulse (1.4%). One late death was found in a BPD patient from pneumonia 2 months after the procedure. CONCLUSION: Transcatheter coil occlusion of PDA is as effective, feasible, safe and less costly than surgical ligation. With improvement in technique and device selection and appropriate case selection, there should be an increase rate of complete occlusion and a decrease in complications.