Pediatric Cardiology and Cardiac Surgery
Vol.26 No.2 2010 (176-179)
Hideshi Tomita,1) Shigeru Uemura,1) Noriyuki Haneda,2) Takashi Soga,3) Takashi Matsuoka,3) Madoka Sawada,3) Takahiro Nishioka,3) Kinya Hatakeyama,4) and Motoki Takamuro4)
1)Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, 2)Pediatric Cardiology, Shimane Institute of Health Sciences, Shimane, 3)Children’s Medical Center, Showa University Northern Yokohama Hospital, Yokohama, 4) Department of Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
Background: In Japan, surgery is usually recommended for patent ductus arteiosus (PDA) in early infancy.
Purpose: The purpose of this study is to analyze the efficacy and safety of transcatheter occlusion of PDA in patients up to 6 months of age.
Subjects: We retrospectively analyzed the data of 16 patients up to 6 months of age in whom coil occlusion was attempted by Tomita or Haneda. The median age and weight were 3.9 months and 5.0 kg, respectively. The median minimum diameter was 3.3 mm, and there were 11 patients with type A, two each with types C and E, and one with type B. The median Qp/Qs was 2.4, while nine patients were complicated by pulmonary hypertension. In five patients, coil occlusion was attempted before introducing a 0.052-inch Gianturco coil, but in 11 patients, transcatheter occlusion was performed after introducing the coil. We determined whether any factor such as age, body weight, minimum PDA diameter, angiographic type, operator, or use of a 0.052-inch Gianturco coil was related to the occurrence of an adverse event.
Results: There were three major adverse events, and minor adverse events occurred in two patients. The PDA was completely closed in 13 patients who were not complicated by major adverse events (a clinical success rate of 81%). In nine patients whose minimum diameter was smaller than 3.5 mm, only one patient was complicated by a minor adverse event, but in seven patients whose minimum diameter was 3.5 mm or larger, there were three major adverse events and one minor event.
Conclusion: Transcatheter coil occlusion of a PDA is feasible in selected patients up to 6 months of age as long as the minimum diameter is less than 3.5 mm, while PDA with a minimum diameter of 3.5 mm or larger should be immediately sent for surgery.