PERCUTANEOUS CLOSURE OF THE SMALL (LESS-THAN-2.5 MM) PATENT DUCTUS-ARTERIOSUS USING COIL EMBOLIZATION

Persistently patent ductus arteriosus (PDA) is a common form of congenital heart disease, occurring between 0.01 to 0.08% of live births.1 Surgical ligation by lateral thoracotomy is effective, yet carries procedural risks (potential bleeding, recurrent laryngeal nerve injury, exposure to general anesthesia and death [<1%]).2 In 1971, Porstmann et al3 described the first nonsurgical PDA closure with an Ivalon plug with an 18Fr arterial conduit. More recently, the Rashkind PDA double disc occlusion system has undergone extensive evaluation, with flow occlusion accomplished in 72 to 88% of cases attempted.4-6 The smaller Rashkind occluder requires an 8Fr delivery system. Rao et al7 described an occluder which may be introduced through a 7Fr catheter and reduces the crossing profile required. Nevertheless, technical limitations persist in patients whose PDA internal diameter is <2.5 mm. Techniques to facilitate cannulation of the very small ductus by the Rashkind delivery system, involving arterial cannulation and rendezvous of an exchange wire from femoral vein to contralateral artery,8 and ductal dilation with balloon angioplasty,9 have been described. These techniques require additional manipulations and procedural time, and may potentially increase patient morbidity. This report describes experience with an alternative technique for transcatheter closure of the very small ductus arteriosus using stainless steel coil embolization. © 1992.