Shim D, Fedderly R T, Beekman R H, Ludomirsky A, Young M L, Schork A, Lloyd T R
Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan 48109-0204, USA.
J Am Coll Cardiol. 1996 Jul;28(1):207-11. doi: 10.1016/0735-1097(96)00107-6.
We sought to determine the prevalence and fate of residual ductal shunting following coil occlusion of patent ductus arteriosus.
Although transcatheter coil occlusion of patent ductus arteriosus has gained popularity, few follow-up data have been reported.
A review of 75 patients who underwent coil occlusion was performed. Residual shunting was investigated by Doppler echocardiography in follow-up. Angiograms were reviewed to obtain minimal ductal diameter and ductal angiographic type.
Residual shunts were found in 31 patients (41%) on the day of the procedure, and of these, spontaneous closure was noted in 17 (55%) at 2 weeks to 20 months of follow-up. Of the 75 patients studied, 5 (7%) required a second coil procedure, and 10 (13%) remained with persistent residual shunts at most recent follow-up. Actuarial analysis estimated a 6 +/- 5% prevalence of residual shunts 20 months after a single coil procedure and 3 +/- 3% after all coil procedures. Minimal ductal diameter was associated with immediate complete ductal occlusion by a single coil. These patients had significantly smaller (p = 0.003) minimal ductal diameters (1.2 +/- 0.7 mm) than those who required two coils during their initial procedure to achieve immediate occlusion (1.9 +/- 0.7 mm), those who required a second coil procedure (2.0 +/- 0.9 mm), those who had spontaneous closure of residual shunts (1.9 +/- 0.7 mm) and those with persistent residual shunts (2.0 +/- 0.9 mm). No association was identified between ductal angiographic type and outcome of coil occlusion. No late adverse clinical events of coil occlusion or evidence of recanalization was found.
Small residual shunts are common after coil embolization of patent ductus arteriosus, but most close spontaneously. Actuarial analysis estimates complete closure in 94% at 20 months, and reintervention was required in only 7% of patients.
