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HK J Paediatr (New Series)
Vol 3. No. 1,
1998
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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 YF Cheung, MP Leung, KT Chau Division of Paediatric Cardiology, Grantham Hospital, Department of Paediatrics, University of Hong Kong
| 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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