A Strategic Approach to Transcatheter Closure of Patent Ductus: Gianturco Coils for Small-to-Moderate Ductus and Amplatzer Duct Occluder for Large Ductus
Resource
INTERNATIONAL JOURNAL OF CARDIOLOGY v.106 n.1 pp.10-15
Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Journal Volume
v.106
Journal Issue
n.1
Pages
10-15
Date Issued
2006
Date
2006
Author(s)
WANG, JOU-KOU
HWANG, JUEY-JEN
CHIANG, FU-TIEN
WU, MEI-HWAN
LIN, MING-TAI
LEE, WEN-LEEH
LUE, HUNG-CHI
Abstract
OBJECTIVE: To investigate the effectiveness of the strategy of transcatheter occlusion with the Gianturco coil for small -to-moderate sized ductus and with Amplatzer duct occluder ( ADO) for large ductus. PATIENT AND METHODS: For ductus closure, the following strategy was applied: ADO was used in large ductus: infants and young children weighing < 15 kg with a ductus diameter > or = 3 mm and in older children or adults with a ductus diameter > or = 4 mm and coils were employed in patients with small-to-moderate sized ductus. During a 3-year period, this strategy was applied in 136 patients. The results were compared between 214 patients ( group I) undergoing ductus closure using only coil before application of this strategy and strategic closure in 136 patients (group II). Each group was divided into 2 subgroups : subgroup A with large ductus and subgroup B with small-to- moderate ductus. There were 54 patients in subgroup IA, 160 in subgroup IB, 33 in subgroup IIA and 103 in subgroup IIB, respectively. RESULTS: In group I, PDA occlusion was successful in 207 (96.7%) and failed in 7 (6 of group IA and 1 of group IB ). In group II, ductus closure was successful in 134 patients (98.5%) (32/ 33 with ADO and 102/103 with coils).There was no significant difference in success rate between group I and II. Distal embolization occurred in 19 patients of group I and in 2 of group II, respectively (19/ 214 vs. 2/136, P < 0.01). There was no significant difference in success rate between group IA and IIA but the distal embolization rate was higher in group IA than IIA (13 /54 vs. 1/33, P=0.014). Left pulmonary artery stenosis was found exclusively in 9 patients of group I at the 6-month follow-up (P < 0 .05). Nine patients in group I required second intervention to achieve complete occlusion. CONCLUSIONS: The strategy of ductus closure worked well by reducing embolization rate, incidence of left pulmonary artery stenosis and the need of second intervention.
Subjects
patent ductus arteriosus
transcatheter closure
Chi-Square Distribution
Gianturco coil
Amplatzer duct occluder
Comparative Study
Type
journal article