Transcatheter Coil Embolization of Large-Size Patent Ductus Arteriosus in Adult Patients

Abstract

ranscatheter occlusion of a small ductus arteriosus is now commonly performed in children. However, there are only a small number of reports of transcatheter coil embolization of adult patent ductus arteriosus (PDAs). We attempted to occlude large PDAs in 3 adult patients with Cook detachable coils and we report the usefulness and problems of such a procedure. Case Reports Case 1A 58-year-old woman had exertional dyspnea and chest discomfort. On physical examination, she had a bounding peripheral pulse and a grade 2/6 continuous murmur at the left upper sternal border. Conventional 2-dimensional echocardiography demonstrated left ventricular and atrial enlargement, and a left ventricular ejection fraction of 71%. On color Doppler echocardiography, left-to-right PDA shunt flow was visible. On transesophageal echocardiography (TEE) the minimal diameter of the PDA was 5 mm. Informed consent for coil embolization was obtained.Right-and left-heart catheterization was performed and an oxygen step-up of the blood samples was detected at the pulmonary artery level.Aortography in the left anterior oblique projection revealed a funnel-shaped PDA (type A1) with a minimal diameter being 5.2 mm (Fig 1A). Following aortography, a 0.032-inch guidewire was advanced retrogradely from the aorta through the PDA into the pulmonary artery, and another guidewire of the same size was advanced anterogradely from the pulmonary artery through the PDA into the aorta. A 6F multipurpose catheter was advanced anterogradely and the guidewire was then removed. A 5-loop coil of 8 mm in diameter was delivered successfully into the PDA. Next, when another 6-F multipurpose catheter was inserted retrogradely, the prepositioned coil was dislodged into the main pulmonary artery. The coil was then successfully retrieved by a snare. Two multipurpose catheters were once more advanced through the PDA, one retrogradely and the other anterogradely. A 5-loop coil of 8 mm in diameter was delivered into the PDA anterogradely. Without detaching the coil, another 5-loop coil of 5 mm in diameter was sequentially delivered retrogradely. Aortography revealed slight residual flow (Fig 1B). Because of the risk of coil migration and the possibility of spontaneous complete closure of the PDA, no additional coiling was attempted and the 2 coils were then detached.The next day, a slight residual shunt was observed on color Doppler echocardiography. However, the patient's exertional dyspnea and chest discomfort disappeared. During her stay in hospital, her urine was not dark colored, and blood chemistry for hemolysis was not examined. Six months after the first procedure, a hematological examination revealed severe hemolytic anemia (Table 1). Transthoracic echocardiography demonstrated a smaller left ventricle and left atrium than that of 6 months previous (Table 2). On the transthoracic and transesophageal color Doppler echocardiography, a residual left-to-right PDA shunt flow was visible. The hemolysis was thought to be due to the shunt, and the patient underwent a sec...

Evaluation of a Novel Endoluminal Vascular Occlusion Device in a Porcine Model: Early and Late Follow-up

“…20 Additionally, when proximal occlusion occurs with coil embolization, repeat intervention via the same artery becomes difficult, if not impossible. 21,22 Our study of the new permanent Biomerix VOD demonstrated the safety and efficacy of this implant compared to fibered stainless steel coils. Only 1 device was used per vessel, with 100% acute angiographic occlusion in the test animals.…”

Coil Occlusion for Patent Ductus Arteriosus Larger Than 3 mm

“…A sclerotic aortic wall or PDA with calcification might explain the frequency of hemolysis. 29 Once hemolysis occurs, there is a chance of renal failure and renal shutdown, so leakage must be minimized to reduce the risk of hemolysis. Several approaches to hemolysis following ductus occlusion have been described.…”

Conservative Treatment of Hemolytic Complication Following Coil Embolization in Two Adult Cases of Patent Ductus Arteriosus.

“…In a large PDA, there is a greater possibility that the ductal shunt flow will remain even when multiple embolization coils are used and if this occurs, the placement of additional coils is recommended. 4,5,14,15 If the additional coils cannot be inserted, the arterial canal must be closed surgically. 7 Retrieval of the embolized coils through a catheter is another option, but is not recommended when multiple coils are implanted because of the high risk of migration of the coils.…”