title: Bioptome-assisted coil occlusion of moderate-large patent ductus arteriosus in infants and small children.
abstract: 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.
authors.affiliation: Amrita Institute of Medical Sciences, Kochi, Kerala, India. rkrishnakumar@aimshospital.org
authors.forename: Raman Krishna
authors.initials: RK
authors.lastname: Kumar
authors.forename: Sivadasan Radha
authors.initials: SR
authors.lastname: Anil
authors.forename: Bhava R J
authors.initials: BR
authors.lastname: Kannan
authors.forename: Ancil
authors.initials: A
authors.lastname: Philip
authors.forename: Kothandam
authors.initials: K
authors.lastname: Sivakumar
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization; D002669:Child Welfare; D002675:Child, Preschool; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D020878:Device Removal; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018618:Echocardiography, Doppler, Color; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012720:Severity of Illness Index; D016896:Treatment Outcome