Results of anterograde transcatheter closure of patent ductus arteriosus using single or multiple Gianturco coils

Unraveling of a Gianturco coil during reocclusion of a patent ductus arteriosus

The Gianturco spring coil has been employed in the settling of the small arterial duct and for reocclusion of residual shunts; the ability to manipulate the coil is advantageous for optimal results. This case study reports an associated complication of unraveling of the coil. Careful attention to coil appearance during manipulation and the use of 0.038-inch coils may reduce this risk.

Effectiveness of a thermal shape-memory patent ductus arteriosus occlusion coil

A new shape-memory coil for transcatheter closure of the PDA was developed and evaluated in a dog PDA model. The coil is sensitive to temperature (composed of thermal shape-memory nickel-titanium). The coil was delivered to and implanted in the PDA model with a 5F catheter through the femoral artery. The PDA model was made in 14 dogs by infrarenal aorta banding (diameter 2.0 +/- 0.6 mm; length 2.9 +/- 0.1 mm). Coils were implanted in 10 dogs, whereas the other 4 dogs served as controls. Complete occlusion of the PDA model was confirmed by angiography 24 hours after the coil implantation in 7 of 10 dogs, whereas small residual flow was noted even 2 weeks after the coil implantation in the other 3 dogs. The PDA model internal diameter in the dogs with complete occlusion (1.8 +/- 0.2 mm) was significantly smaller than the diameter in dogs with residual flow (2.9 +/- 0.4 mm, P < 0.05). In the 4 control dogs, the PDA model remained patent 2 weeks after the banding. We conclude that the transcatheter occlusion with the shape-memory coil was effective in the small-diameter PDA model.

Interventional cardiac catheterization therapy for combined coarctation of the aorta and patent ductus arteriosus: successful outcome in two infants

We report two infants each with coarctation of the aorta and small patent ductus arteriosus who had balloon angioplasty therapy for aortic obstruction at 3-6 months of age followed by anterograde placement of a single Gianturco coil to close the ductus at a separate catheterization. One infant developed recoarctation that resolved with repeat angioplasty prior to closure of the ductus. Follow-up evaluations have demonstrated a trivial aortic gradient, no aortic aneurysm, and no residual shunt.

Comparison of hospital charges for closure of patent ductus arteriosus by surgery and by transcatheter coil occlusion

Hospital charges for coil occlusion were significantly less than for surgical closure of patent ductus arteriosus, and were reduced over time as experience permitted refinement of the coil occlusion protocol. The expected hospital charges for closure by a coil occlusion strategy, including the charges for surgical closure in patients with failed coil occlusion, was less than the hospital charges for surgical closure strategy under any reasonable estimate of coil occlusion efficacy.

Transcatheter closure of the patent ductus arteriosus: comparison between the Rashkind occluder device and the anterograde Gianturco coils technique

Thirty-five patients (mean age 43.7 months, mean weight 13 kg) underwent anterograde patent ductus arteriosus (PDA) occlusion with Gianturco coils (coil group). These patients were compared with 35 age- and weight-matched patients who underwent closure of their PDA with the Rashkind umbrella device (device group). The mean PDA diameter at its narrowest point was 2.8 mm in the coil group and 2.7 mm in the device group. There was immediate closure angiographically in 20 (57%) of 35 in the coil group compared with 9 (26%) of 35 for the device group. Color flow mapping before discharge revealed complete closure in 30 (86%) of 35 in the coil group compared with 18 (51%) of 35 in the device group (chi square = 9.5455, p < 0.005). Mean fluoroscopy time was 18.5 minutes (median 13.5 minutes) and 14.7 minutes (median 13 minutes) for the coil and device, respectively. Four coils and one device embolized down the pulmonary artery; all were successfully retrieved in the catheterization lab. Coil closure of the small to moderate PDA is safe and effective. It is more effective in achieving immediate closure than the Rashkind device. More clinical trials with the coil technique are warranted to establish the long-term results of this technique.

New forceps delivery technique for coil occlusion of patent ductus arteriosus

We remain very enthusiastic about transcatheter coil occlusion of the PDA. However, surgical ligation has been performed successfully and with relatively low risk of complications. Therefore, an alternative nonsurgical technique must demonstrate comparable success and safety. We believe that this new forceps delivery technique has significant advantages over previously reported PDA coil occlusion techniques and should warrant further clinical investigation.

Transcatheter closure of residual patent ductus arteriosus shunting after the Rashkind occluder device using single or multiple Gianturco coils

Transcatheter closure of a patent ductus arteriosus (PDA) using the Rashkind occluder or the buttoned device is accompanied with a 7-38% incidence of residual shunt. Closure of the residual shunt with a second device is expensive, associated with possible morbidity, can be technically challenging, and occasionally does not completely eliminate the shunt. Our objective was to assess the immediate and short-term results of transcatheter closure of residual PDA after the Rashkind device using single or multiple Gianturco coils. Five patients (one male/four female) underwent transcatheter closure of residual PDA at a median age of 8.4 yr (range 2-10.1 yr) and median weight of 23 kg (range 11.8-32 kg). A 4F catheter was used for delivery of the coils in all patients. Three patients underwent multiple coil and two single coil closure with complete elimination of the shunt. There was complete elimination of the shunt as documented by repeat angiography immediately after the coil closure. The median fluoroscopy time was 24 min (range, 22-55 min). All patients were discharged home on the same day. There were no complications Follow-up evaluation was performed with color flow mapping of the main pulmonary artery within 4 hr after closure and 6 weeks later with echocardiography and chest radiography. We conclude that transcatheter closure is an effective therapy for patients with residual PDA after the Rashkind device using the single or multiple coil technique. This technique can be performed on an out-patient basis without the need for general anesthesia and at a lower expense than a repeat occluder device or surgery.

Transcatheter embolization coil closure of patent ductus arteriosus--modified delivery for enhanced control during coil positioning

The use of Gianturco coils (Cook, Inc., Bloomington, IN) has been recently described as a method of occluding restrictive patent ductus arteriosus (PDA). Precise control of the coil during positioning or withdrawal is difficult. We designed an inexpensive and readily available system to control the coil during delivery and repositioning. A 5 French Mallincrodt vertebral catheter was heat tapered to allow slight, but definite resistance of a 0.035" guide wire when it was passed through the catheter. The delivery system has been used to successfully coil occlude restrictive PDAs in seven patients. The system has added no additional costs to the procedure and has provided improved control of the coil position prior to release of the coil.

Transcatheter closure of residual atrial septal defect following implantation of buttoned device

We report a case in which residual shunting after a buttoned device occlusion of atrial septal defect (ASD) was eliminated by transcatheter retrieval of a portion of the device, followed by implantation of a second device. This method may be helpful for those patients with residual ASDs who decline surgical device retrieval and defect closure.