Transcatheter closure of patent arterial ducts using controlled-release coils

Objective: To determine the efficacy of transcatheter closure of patent arterial ducts using controlled-release coils. Design: Transcatheter closure of patent arterial ducts was attempted in 52 patients using controlled-release coils. Setting: For the study, four tertiary paediatric cardiology units were used, two of which were in the U.K., one in Italy and one in Turkey. Patients: The 52 patients ranged in age between 3.5 months and 61 years (median 3.5 years), and weighed between 4.5 kg and 62 kg. The duct diameters were 1 mm to 6.5 mm. Results: In four patients the ducts were too large for safe release of the coils. In the remaining 48, one coil was inserted in 33 patients, two coils in nine, three coils in four and four coils in two patients. Immediately at the end of the procedure, the duct was completely occluded in 26/47 (55%) patients. Haemolysis occurred in one patient, in whom the coil was removed by a snare catheter and a large umbrella device was implanted with resolution of the haemolysis. Coil embolization to the pulmonary artery occurred in five (10%) patients. All were easily retrieved and replaced by larger coils. At the latest follow-up by colour Doppler echocardiography, the duct was completely occluded in 44/47 (94%) patients. Conclusions: Transcatheter closure of patent arterial ducts by controlled-release coils is effective and safe. Even when more than one coil is inserted the technique is still less cumbersome and considerably cheaper than transcatheter umbrella closure.