Table of Contents

HK J Paediatr (New Series)
Vol 3. No. 1, 1998

HK J Paediatr (New Series) 1998;3:76-77

Proceedings of Scientific Meeting

Percutaneous Coil Occlusion of Native and Residual Persistent Arterial Ducts

YF Cheung, MP Leung, KT Chau


HK J Paediatr (new series) 1998;3:74-79

Joint Scientific Meeting
Hong Kong College of Physicians & Hong Kong College of Paediatricians
8th November 1997

Objective: To determine the efficacy and safety of percutaneous occlusion of native and residual arterial ducts by coils.

Background: Coils are preferable to Rashkind umbrella and buttoned devices for transcatheter ductal occlusion in terms of delivery methodology and cost.

Patients and method: Fifty patients with arterial ducts underwent percutaneous coil occlusions between April 1995 and June 1997. Thirty-three patients had native ducts, while 17 patients had residual ductal shunting despite previous interventions: 10 after Rashkind umbrella placement, 5 after Sideris buttoned device occlusion and 2 after surgical ligation. The mean age and weight were 5.1±3.3 years and 16.8±7.2 kg, respectively. All procedures were performed under general anaesthesia with a mean procedural and screening time of respectively 113±46 minutes and 32±18 minutes. The follow-up duration was 9.4±8.2 months. Three types of coils were used: DuctOcclud coils, Cook simple embolization coils and Cook detachable coils. The results were assessed angiographically and by echocardiographic colour flow mapping and Doppler studies.

Results: The mean ductal dimension assessed angiographically was 2.4±0.9 mm, with no significant difference between the native and residual ducts (p=0.71). Coil placement was feasible in 88% (29/33) and 100% of native and residual ducts respectively (p=0.29). Ductal occlusion was achieved with 1 coil in 26 patients, 2 coils in 18 patients and 3 coils in 1 patient; one patient had both a coil and a Rashkind umbrella placed simultaneously. The prevalence of residual shunting decreased with time, with 38% within 24 hours of coil placement, 23% at 1 month, 15% at 12 months for native ducts; 44% within 24 hours, 38% at 1 month and 25% at 12 months for residual arterial ducts (p=0.17 by log rank test). Early complications included mechanical haemolysis (n=2) and dislodgement of the coils to the pulmonary artery (n=2). None had significant left pulmonary arterial stenosis on follow-up Doppler studies.

Conclusion: Percutaneous coil occlusion of both native and residual arterial ducts is safe and effective. The largest ductal size that permits coil occlusion remains to be determined.

 
 

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