Coarctation of the aorta following coil occlusion of a patent ductus arteriosus

Transcatheter closure of symptomatic arterial duct in infants younger than 1 year old

Transcatheter closure is currently considered the first-choice therapeutic option in patent arterial duct (AD), although this approach remains challenging in younger patients. To evaluate feasibility, safety, and mid-term efficacy of percutaneous AD closure using different devices in symptomatic infants <12 months old. Among the 483 patients who underwent transcatheter AD closure at our institution from April 2000 to January 2012, 69 were <12 months old. All patients showed cardiac overload at echocardiography, and 72 % of them were on anticongestive therapy. Based on ductal morphology and local anatomy, AD closure was attempted using detachable coils in 24 cases (group A) or the Amplatzer Duct Occluder (AGA Medical, Golden Valley, MN) device in 45 cases (group B). Procedural feasibility was 95.7 % without any difference between groups (95.8 % vs. 95.6 %, p = NS) as were fluoroscopy and procedural times. AD size was 2.5 ± 0.9 mm, and QP/QS ratio was 2.2 ± 1.1, with both being significantly higher in group B [2.1 ± 0.9 vs. 2.6 ± 0.9 mm (p = 0.04) and 1.7 ± 0.8 vs. 2.5 ± 1.2 (p = 0.009), respectively]. Overall complication rate was 1.5 %, without any difference between groups, as was the occlusion rate at hospital discharge (86 %) and over midterm follow-up (55 ± 36 months) (98.5 %). Percutaneous closure of symptomatic AD might be considered effective and safe in very young infants by tailoring the device choice to ductal morphology and local anatomy. In this setting, the controlled-release coil option was shown to be as effective as the ADO device during midterm follow-up.

Fetal hydrops associated with spontaneous premature closure of ductus arteriosus

A 36-year-old woman presenting with fetal growth restriction in the 25th week of gestation was referred to Kobe University Hospital where hydrops fetalis was detected. A stillborn fetus, 2012 g in weight and 40 cm in height, was delivered in the 33rd week of gestation. The mother had no past history of non-steroidal anti-inflammatory drug (NSAID) use during the pregnancy. The male fetus showed maceration without macroscopic anomalies, but it was markedly edematous with bilateral pleural effusion and massive ascites. The autopsy revealed an enlarged heart and aortic coarctation in the region of the ductus arteriosus. A mild form of aortic coarctation and premature closure of the ductus arteriosus with fibrous thickening of the wall were observed. The lungs were atelectatic with vascular dilatation and congestion. This is the first documented case of hydrops fetalis caused by spontaneous premature closure of the ductus arteriosus concomitant with aortic coarctation. The findings suggest that some form of idiopathic, or spontaneous, closure of the ductus arteriosus can be one of the causes of chronic fetal heart failure, coarctation of the aorta, and fetal hydrops.

Obstruction of the Aorta and Left Pulmonary Artery After Gianturco Coil Occlusion of Patent Ductus Arteriosus

We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

Bioptome-assisted coil occlusion of moderate-large patent ductus arteriosus in infants and small children

Coil occlusion of patent ductus arteriosus (PDA), although inexpensive, is technically challenging for the moderate-large ducts in small children. Bioptome assistance allows better control and precision. We describe case selection strategies, technique, immediate and short-term results of bioptome-assisted closure of moderate-large (>/= 3 mm) PDA in 86 infants and children </= 10 kg (age, 18 days to 3 years; median, 8 months; weight, 6.6 +/- 1.9 kg; duct size, 3.6 +/- 0.8 mm; pulmonary artery mean pressures, 33 +/- 12 mm Hg). Patients with PDA > 6 mm (> 4 mm for children under 5 kg) and/or shallow ampullae (by echocardiography) underwent operation (n = 41). Specific technical modifications included use of long sheaths (5.5-8 Fr) for duct delineation and coil delivery, cutting of coils turns (51 patients) to accommodate the coils in the ampulla, and simultaneous delivery of multiple coils (n = 43). As far as possible, coils were deployed entirely in the ampulla. Median fluoroscopy time was 7.3 min (1.2-42 min). Successful deployment was feasible in all (final pulmonary artery mean pressures, 20 +/- 4.6 mm Hg). Coils embolized in 14 (16%) patients (all retrieved). Complete occlusion occurred immediately in 63 patients (73%) and in 77 patients (89%) at 24 hr. Three patients had new gradients in the left pulmonary artery. Follow-up (62 patients; median duration, 13 months) revealed small residual Doppler flows in 11 patients (18%) at the most recent visit. Bioptome-assisted coil occlusion of moderate-large PDA in selected infants and small children is feasible with encouraging results.

The modern approach to patent ductus arteriosus treatment: complementary roles of video-assisted thoracoscopic surgery and interventional cardiology coil occlusion

BACKGROUND

In an effort to analyze our experience and develop treatment guidelines, we reviewed all our patients with patent ductus arteriosus (PDA) treated with video-assisted thoracoscopic surgery (VATS) or interventional cardiology coil occlusion.

METHODS

One hundred patients underwent 102 cardiac catheterizations. Forty-five children underwent VATS. The entire cohort of patients is 141 because 4 patients underwent both catheterization and VATS.

RESULTS

Successful PDA coil occlusion occurred in 91 patients (91 of 100; 91%); 8 had unsuccessful attempts at coil occlusion and 1 was referred for surgical ligation after catheterization without any attempt at coil placement. Thirty-nine children had successful VATS PDA closure. Six children required conversion to thoracotomy because of inadequate exposure during VATS. Hospital stay for children more than 45 days of age was as follows: VATS median stay, 1 day, mean, 1.4 days; thoracotomy median stay, 4 days, mean, 4.6 days. One patient treated with PDA coil occlusion developed a recurrent PDA and required reembolization. Three children underwent initial catheterization without successful coil placement with subsequent successful VATS. All VATS patients left the operating theater with echocardiography documenting no residual PDA. Two children who underwent successful VATS with no residual PDA at hospital discharge were found on outpatient follow-up to have developed tiny recurrent PDAs and both were successfully coil occluded; 1 of these 2 children is 1 of the 3 children initially evaluated by catheterization and then referred for VATS.

CONCLUSIONS

Video-assisted thoracoscopic surgery and coil occlusion represent complementary techniques for PDA treatment. A rationale for selection of the appropriate treatment modality can be based upon the size and age of the patient and the size and morphology of the PDA.

Arterial duct closure with detachable coils: application in the small child

Transcatheter closure of patent ductus arteriosus using controlled-release coils was performed in 16 patients weighing < 10 kg. No embolization occurred. Procedure-related complications occurred in 3 patients (18.8%): massive femoral hemorrhage in 1 and femoral artery thrombosis in 2. The ductus recanalized in 1 of them because of mechanical hemolysis caused by streptokinase treatment. This was the only patient who underwent another occlusion procedure. Complete occlusion was achieved in 7 patients (43.8%) immediately, in 13 (81.2%) the following day, and in all 15 patients who had completed the 6-month follow-up. During follow-up, flow velocities between the left and the main pulmonary arteries and between the descending and the ascending aortae did not differ significantly. Flow velocity was > 2 m x sec(-1) in 3 patients in the left pulmonary artery and in 1 in the descending aorta. Protrusion of the coil was seen in 3 of these patients. Flow velocity was also high in the main pulmonary artery in the 4th patient. In conclusion, coil occlusion of ductus arteriosus is feasible in the small child, but no more than half a loop of the coil should be left at the pulmonary site. High flow velocity does not always mean obstruction.

Iatrogenic coarctation after coil occlusion of arterial duct

Coil occlusion of a patent ductus arteriosus was performed in an 8.5-month-old girl with a large left-to-right shunt through a wide arterial duct. Post-occlusion echocardiography revealed iatrogenic obstruction of the aorta caused by protrusion of the loops of the Jackson coil into the descending aorta. The problem resolved spontaneously during follow-up.

Closure of prosthetic paravalvular mitral regurgitation with the Gianturco-Grifka vascular occlusion device

Paravalvular regurgitation associated with prothetic mitral valves is often a consequence of infectious endocarditis. The condition is usually treated with debridement and repeat surgical valve replacement. However, repeated operations are associated with high risk. This report describes a case of successful transcatheter treatment of severe paravalvular mitral regurgitation and pulmonary edema in a patient in whom repeat mitral valve replacement was not believed possible.

Gianturco-Grifka vascular occlusion device for closure of patent ductus arteriosus

We retrospectively reviewed the results of catheter closure of patent ductus areteriosus using the Ginaturco-Grifka vascular occlusion device in our institution. All patients in whom it was attempted had successful implantation, complete closure on follow-up, and no complications.

Early experience with the Amplatzer ductal occluder for closure of the persistently patent ductus arteriosus

Using an Amplatzer duct occluder, 106 patients (weight 21 +/- 18 kg) underwent an attempt at catheter closure of a persistently patent ductus arteriosus (PDA). Their age ranged from 22 days to 48 years. The PDA measured between 1.2 to 8.1 mm at its narrowest diameter. The device was successfully implanted in 105 patients. The immediate closure rate was 70% and gradually increased to 100% at 1-month follow-up. There was no clinical evidence of hemolysis and no incidence of device embolization or bacterial arteritis. Doppler evaluation showed no evidence of aortic arch or pulmonary artery obstruction. The device, which is currently undergoing multicenter clinical trial in the United States, is proving to be a safe and effective device for closure of the persistently PDA.

Giant aneurysm following coil occlusion of patent ductus arteriosus

A case is described in which a giant aneurysm developed following successful PDA coil occlusion in an infant with Marfan syndrome. This rare and severe complication brings into question the need for careful evaluation of these children before and after transcatheter occlusion.

Anterograde coil closure of patent ductus arteriosus using a modified bioptome delivery technique

Three consecutive patients are presented who underwent successful anterograde catheter coil occlusion of a patent ductus arteriosus using a modified bioptome-assisted technique. Two of the three patients were infants and the procedures were performed without the need for arterial access.