Comparison between the safety profile and clinical results of the Cook detachable and Gianturco coils for transcatheter closure of patent ductus arteriosus in 272 patients.

OBJECTIVES: We evaluated the occlusion rate and safety of Cook detachable coils versus Gianturco coils in transcatheter closure of patent ductus arteriosus (PDA). BACKGROUND: The Cook detachable coil recently was introduced in an attempt to improve the safety of transcatheter closure of PDA. METHODS: Between January 1994 and September 1998, 272 patients underwent transcatheter PDA closure. Cook detachable coils were used in 137 patients, with a mean age of 43.9 months and weight of 13.8 kg. In 135 patients, Gianturco coils were used, with a mean age of 56.8 months and weight of 17.8 kg. The mean narrowest diameter of the PDA in the Cook detachable coil group was 2.85 mm versus 2.32 mm for the Gianturco coil group. RESULTS: The Cook detachable coil group was younger and weighed less than the Gianturco group (P < 0.05 and 0.02, respectively). Their narrowest PDA diameter was larger (P < 0.01). Embolization rate was significantly lower in the Cook coil group (9[6.5%] of 137 vs 22 (16.3%) of 135; P = < 0.013). The mean follow-up for the Cook coil group was significantly shorter (0.55 years) than for the Gianturco coil group (1.18 years; P < 0.001). On an intention-to-treat basis, complete occlusion by echocardiography was achieved in 99 (72.3%) of 137 patients in the Cook detachable coil group, which was significantly less than the Gianturco coil group (114 [84.4%] of 135; P = 0.008). CONCLUSION: Cook detachable coils for transcatheter closures of the PDA are safer than Gianturco coils. Hence, children with large ductal can be treated earlier in life. Short-term complete occlusion rate was lower in the Cook detachable coil group. This rate can be explained by a shorter follow-up time, larger ductal diameter, and the different materials used for the detachable coils.

Problems encountered during introduction of Gianturco coils for transcatheter occlusion of the patent arterial duct.

OBJECTIVE: To define the problems encountered during transcatheter occlusion of the patent arterial duct using Gianturco coils. METHODS: Between January 1994 and November 1995, 93 patients were admitted in whom it was intended to occlude the patent arterial duct using Gianturco coils. Anterograde transcatheter coil occlusion was performed via the femoral vein in 81 patients. In the remaining 12 the procedure was done via the femoral artery. RESULTS: Coils were implanted successfully in 82/93 (88%) patients. In 11 patients the procedure was a failure. In 19/93 patients (20%), inadvertent embolization of the coil occurred. The coils were retrieved in all except one patient. In 17 of these patients, new coils were then reimplanted successfully. Doppler echocardiography after the procedure showed that in 9/82 (11%) patients the left pulmonary artery Doppler peak velocity exceeded 1.5 m.s-1 (mean 1.2 m.s-1) raising concern about left pulmonary artery branch stenosis. The complete occlusion rate at discharge from hospital was 72/82 (88%). Follow-up ranges from 1 day to 14 months (mean 2/12 months) in the 82 patients in whom successful deployment of coils was possible. In two patients, the arterial duct became occluded at follow-up. One additional patient had complete occlusion after reocclusion using another coil. Thus, after short-term follow-up a total of 75/82 patients (91.4%) have a completely occluded arterial duct after coil implantation. CONCLUSION: Transcatheter occlusion of the patent arterial duct using Gianturco coils is an effective and safe technique. In the learning curve there is a relatively high rate of inadvertent embolization, but the coils can be retrieved in the vast majority of patients. The complication rate is offset by the high early occlusion rate and the inexpensiveness of the procedure.

The role of surgical ligation of patent ductus arteriosus in the era of the Rashkind device.

BACKGROUND: The role of surgery in managing patent ductus arteriosus (PDA) was studied in the era of the Rashkind double-umbrella device. METHODS: All 354 patients with PDA referred to our center in a 5-year period were included in this report. Of the 354 patients, 236 underwent cardiac catheterization with the intent of transcatheter PDA closure, and 118 had surgical intervention. RESULTS: In 46 (19.5%) of the 236 patients having cardiac catheterization, the procedure either was abandoned or failed. Color Doppler echocardiography demonstrated total occlusion of the ductus after 24 hours in 97 patients (41%) in the cardiac catheterization group. An additional 20 patients had no residual leaks at follow-up. Twenty other patients underwent reocclusion because of a residual shunt. Thus, of the 236 patients, 137 (58%) had successful complete closure of the PDA. Surgical PDA ligation was performed in 118 patients as the initial procedure and in 26 of the 46 patients in whom transcatheter closure was abandoned. If the remaining 20 patients in whom transcatheter closure failed are added to the 144 patients who underwent PDA ligation, the percentage having surgical intervention versus transcatheter occlusion is higher than 46%. CONCLUSIONS: Our data suggest that surgery plays a major role in the management of patients with PDA despite the advent of new interventional catheterization techniques.

Re-occlusion of residual leaks after transcatheter occlusion of patent ductus arteriosus.

Between March 1990 and November 1993 175 patients underwent successful closure of patent ductus arteriosus using the Rashkind double umbrella device. Of those patients seen on follow up, 13 (9 female, 4 male) had a residual leak and were admitted for implantation of a second device alongside the first device. The interval between the procedures ranged from 6 to 22 months. The mean age at the first procedure was 73.9 months (range 24-204 months) and the mean weight was 18.9kg (range 8.4-64). The mean age at the second procedure was 86.9 months (30-213) and the mean weight was 21.4 kg (8.6-64). The first device was 17 mm in 11 patients and 12 mm in two. The second device was 17 mm in four patients and 12 mm in nine. Four patients required two 17 mm devices in total. There was no difference in the two procedures regarding the fluoroscopy time, procedure time, complications and length of hospital stay. The second procedure was uneventful; however, in one patient the residual ductus had to be dilated before successfully deploying a 12 mm device. Ten patients had immediate total occlusion and three had a trivial leak on echocardiography 24 h later. One of the three patients was found to have total occlusion on Doppler echocardiography 1 year later. The other patients are yet to be seen for follow-up. Hence a total occlusion rate was in 11/13 patients (85%).(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital aneurysm of the muscular interventricular septum.

Cardiac aneurysms are rare in the paediatric age group, and are classified as congenital when the aetiology cannot be demonstrated. We report a 1-year-old patient with a congenital aneurysm of the muscular interventricular septum. Ventricular septal aneurysmectomy was performed successfully.