Bioptome‐assisted simultaneous delivery of multiple coils for occlusion of the large patent ductus arteriosus

Abstract

We describe a novel method that allows bioptome-assisted delivery of multiple Gianturco coils simultaneously for occlusion of the large patent ductus arteriosus (PDA). Two or more coils were intertwined at one end and held by a bioptome (5.2 Fr) and pulled into a short introducer. The coils were then deployed in the PDA via a long sheath (7-11 Fr) previously placed across the duct via the femoral vein. Twelve patients (6 months to 64 years; median, 10.5 years) with large PDAs (4.7 +/- 1.3 mm; range, 3.1-8.4 mm; PA mean pressure, 40 +/- 17 mm Hg; pulse pressure 63 +/- 18 mm Hg) underwent bioptome-assisted occlusion with multiple coils at our institutions. The procedure was uneventful in nine patients (fluoroscopy time, 6-23 min) and prolonged in three patients (fluoroscopy time, 26, 72, and 120 min) because of dislodgment of the coil mass and embolization of an additional coil. Successful coil deployment was feasible in all patients. Three patients required repeat coil deployment for flow elimination (hemolysis occurred in two). Flow elimination was demonstrated on the last follow-up evaluation in all except two patients. One infant has developed significant left pulmonary artery stenosis. Bioptome-assisted PDA occlusion using multiple coils delivered simultaneously may be a promising alternative to devices for transcatheter closure of large PDAs. Cathet Cardiovasc Intervent 2001;54:95-100.

Transcatheter Occlusion of Patent Ductus Arteriosus in Pre-Term Infants

“…Medical treatment with indomethacin or ibuprofen was attempted in all these patients unless contraindicated. A thorough echocardiogram was performed, and views of the PDA were obtained as described previously (4,5). A number of considerations dictated suitability for coil occlusion.…”

“…However, the transcatheter procedure in small newborns is technically challenging with most currently available hardware. We had previously described a technique that allows occlusion of large PDAs in small infants (4,5). We also reported a modification of this technique to close an aorta-right atrial tunnel in a newborn (6).…”

Clinical course and management strategies for hemolysis after transcatheter closure of patent arterial ducts

“…Due to cost considerations, coil occlusion is the preferred method of PDA closure in our institution and the Amplatzer device or surgery is reserved for selected patients with very large ducts (Ͼ 6 mm) or large ducts (Ͼ 4 mm) with relatively small ampullae. The technique of coil occlusion used at our institute has been described in previous reports [7,8]. For ducts larger than 3 mm, bioptomeassisted coil occlusion using single or multiple coils delivered simultaneously was preferred [8,9].…”

“…The technique of coil occlusion used at our institute has been described in previous reports [7,8]. For ducts larger than 3 mm, bioptomeassisted coil occlusion using single or multiple coils delivered simultaneously was preferred [8,9]. Patients who had large ducts with PA systolic Ͼ 2/3 systemic underwent temporary balloon occlusion to ensure that a fall in PA pressure would occur after closure.…”

Transcatheter coil occlusion of perimembranous ventricular septal defects

“…When using coils to close a PDA, the maximum diameter of the PDA compatible with safe transcatheter coil occlusion is considered to be 6-8 mm [25,26]; consequently, we selected patients with a VSD diameter of less than about 6 mm to ensure safe transcatheter coil closure.…”