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Original ArticleOpen Access
Transcatheter Coil Occlusion of Small Patent Ductus Arteriosus : Experience at Siriraj Hospital
Laohaprasitipom D 
,
Nana A ,
Soongswang J ,
Durongpisitkul K ,
Kangkagate C ,
Rochanasiri W ,
Pooranawattanakul S
,
Nana A ,
Soongswang J ,
Durongpisitkul K ,
Kangkagate C ,
Rochanasiri W ,
Pooranawattanakul S APICHART NANA, M.D.*,
KRITVIKROM DURONGPISITKUL, M.D.*,
W ANDEE ROCHANASIRI, B.Sc.
**,
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 pro-
longed ventilation. Single-coil occlusions were performed in 74.3 per cent and double-coil occlu-
sions 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
เธ‘
35.1 minutes. The mean fluoroscopic time was 20.2
เธ‘
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.
Vol. 85 Suppl 2
TRANSCATHETER COIL OCCLUSION OF SMALL PATENT DUCTUS ARTERIOSUS
S631
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 complica-
tions.
Key word : Transcatheter Coil Occlusion of Patent Ductus Arteriosus
KRITVIKROM DURONGPISITKUL, M.D.*,
W ANDEE ROCHANASIRI, B.Sc.
**,
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 pro-
longed ventilation. Single-coil occlusions were performed in 74.3 per cent and double-coil occlu-
sions 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
เธ‘
35.1 minutes. The mean fluoroscopic time was 20.2
เธ‘
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.
Vol. 85 Suppl 2
TRANSCATHETER COIL OCCLUSION OF SMALL PATENT DUCTUS ARTERIOSUS
S631
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 complica-
tions.
Key word : Transcatheter Coil Occlusion of Patent Ductus Arteriosus
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