ABSTRACT
OBJECTIVES: This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (> or = 3.5 mm) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils. BACKGROUND: Coil closure of PDAs has become increasingly popular. However, the technique has significant limitations when used to close large PDAs. This report evaluates patient characteristics, PDA anatomy, hemodynamic variables, delivery technique and coil geometry to determine predictors of success. METHODS: Between January 1995 and January 1997, 16 of 118 patients undergoing catheterization for PDA closure were found to have large PDAs. Their median age and weight were 14 months (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respectively. The mean PDA diameter was 4.3 mm (range 3.5 to 5.9). Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096-cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynamic and technical variables between successes and failures were compared. RESULTS: Eleven (69%) of 16 patients had successful closure of their PDA. Failures occurred only in patients < 8 months of age with an indexed PDA diameter > 7 mm/m and a pulmonary/systemic flow ratio > or = 2.8:1. Use of 0.052-in. coils tended to reduce the incidence of embolization and the number of coils needed for closure. CONCLUSIONS: Patients > 8 months of age can have successful closure of large PDAs with currently available Gianturco coils. The 0.052-in. Gianturco coils can be used safely to close large PDAs in infants as small as 6 kg. Increased experience and improved coil design may improve closure rates of large PDAs in infants.
Subject(s)
Ductus Arteriosus, Patent/therapy , Embolization, Therapeutic/instrumentation , Cardiac Catheterization , Case-Control Studies , Ductus Arteriosus, Patent/physiopathology , Equipment Design , Evaluation Studies as Topic , Humans , Infant , Treatment OutcomeABSTRACT
Risk factor analysis in coronary artery disease was conducted in 303 patients who underwent coronary arteriography to identify associations between personal characteristics and the prevalence of coronary heart disease. Age, sex, obesity, smoking, alcohol intake, hypertension, diabetes mellitus, serum uric acid, total cholesterol, LDL- and HDL-cholesterol, triglyceride, and atherogenic indices were statistically analyzed. All 13 variables were first compared between patients with positive and negative ergonovine tests. Only total cholesterol was significantly different, while significant differences in age, sex, history of diabetes, total cholesterol, LDL- and HDL-cholesterol, triglyceride and atherosclerotic indices were observed between patients with and without organic coronary artery stenosis. A multivariate analysis was performed, and the resulting equation was tested using the remaining patients. Logistic analysis of all 13 variables identified 5 (age, sex, diabetes mellitus, LDL- and HDL-cholesterol) which accounted for the differences between patients with and without significant coronary artery disease and that were validated in the test group. The sensitivity for prediction of coronary artery disease was 75.8%, specificity 68.5%, and predictive accuracy 71.5% in the test group. Thus, risk factor analysis appears to be very valuable in screening subjects with high-risk organic coronary stenosis and in optimizing the preventive and therapeutic modalities, but not in predicting vasospastic subjects.
