Coil closure of patent ductus arteriosus

Coil closure of patent ductus arteriosus

Coil closure of patent ductus arteriosus: Before closing patent ductus arteriosus (PDA), make sure that it is not an obligatory PDA  which is needed for maintaining a ductus dependent circulation which could be either systemic, pulmonary or combined. Closure of PDA in a ductus dependent circulation can be catastrophic.

Trans catheter closure of PDA can be either by a device specifically made for the purpose or using embolisation coils. Coil closure can be either a direct delivery of a coil or a bioptome assisted delivery. Special coils with delivery systems have also been used for closure of PDA.

In any case, the PDA is first confirmed by an angiogram. If an arterial puncture is made, the angiogram can be from the descending aorta using a pigtail catheter. If only venous entry is made to facilitate early hospital discharge, ductus can be crossed and check injections made. Coil delivery can be made from the venous side as well as the arterial side. In the venous route, the femoral vein is puncture by the standard percutaneous technique and sheath introduced. A multipurpose catheter with a guide wire can be used to cross the ductus from the pulmonary side. The standard guide wire is then replaced by a stiffer wire to guide the long sheath across the PDA. Once the sheath is across the PDA, the guide wire can be withdrawn. Then the embolisation coils are loaded either into a catheter for direct delivery or on a bioptome. In the direct delivery method, once the catheter loaded with the coil is across the PDA, it is withdrawn into the ampulla and the coil pushed out turn by turn so that most of it compacts in the ampulla and a portion is across the ductus and a short segment may even jut into the pulmonary artery. In bioptome assisted method the coil is allowed to fall out of the sheath by pushing and then the whole assembly is withdrawn so that most of coil compacts in the ampulla of the ductus while a short segment is across the ductus and into the pulmonary artery. Once the position is confirmed by check angio, which also confirms the proper closure of the ductus, the coil is released from the bioptome and the sheath withdrawn. Residual shunts can be closed by the delivery of additional coils. If needed, more than one coil can attached to the bioptome electively and delivered, if it is anticipated that one coil may not be enough to close the ductus. Residual shunts, unless trivial, should be closed to prevent hemolysis, which can occasionally occur. Urine colour is observed on follow up to look for discolouration suggesting hemoglobinuria due to hemolysis, which may occur rarely due to the jet across a residual PDA.