Evaluation of Gianturco coils for closure of large (>=3.5 mm) patent ductus arteriosus

Objectives. This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (greater than or equal to 3.5 mm) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils. Background. Coil closure of PDAs has become increasingly popular, However, the technique has significant limitations when used to close large PDAs. This report evaluates patient characteristics, PDA anatomy, hemodynamic variables, delivery technique and coil geometry to determine predictors of success. Methods. Between January 1995 and January 1997, 16 of 118 patients undergoing catheterization for PDA closure were found to have large PDAs. Their median age and weight were 14 months (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respectively, The mean PDA diameter was 4.3 mm (range 3.5 to 5.9), Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096-cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynamic and technical variables between successes and failures were compared. Results. Eleven (69%) of 16 patients had successful closure of their PDA, Failures occurred only in patients <8 months of age with an indexed PDA diameter >7 mm/m and a pulmonary/systemic how ratio greater than or equal to 2.8:1. Use of 0.052-in. coils tended to reduce the incidence of embolization and the number of coils needed for closure, Conclusions. Patients >8 months of age can have successful closure of large PDAs with currently available Gianturco coils, The 0.052-in. Gianturco coils can be used safely to close large PDAs in infants as small as 6 kg. Increased experience and improved coil design may improve closure rates of large PDAs in infants. (C) 1997 by the American College of Cardiology.