Oclusão Percutânea do Pequeno Canal Arterial com Molas de Gianturco: Impacto da Otimização da Seleção das Molas e dos Pacientes e da Não-Tolerância ao Fluxo Residual Significativo Imediato nos Resultados

INTRODUCTION: Percutaneous occlusion of the patent ductus arteriosus (PDA) by non-controlled retrogade release of Gianturco coils has been frequently employed. METHODS: Since January of 2001, we have applied this technique for patients with type A, D and E PDAs with < 3 mm and have not tolerated significant immediate residual leaks, implanting additional coils. In this paper we report the outcome of this approach. RESULTS: From January 2001, 178 patients (110 females; median age and weight: 5 years and 17 kg, respectively) underwent the procedure. The mean minimal diameter of the PDA was 1.8 ± 0.6 mm (0.5 to 3.0 mm) with 157, 9 and 12 being of types A, D and E, respectively. In 3 patients, there was initial embolization with percutaneous retrieval followed by coil re-implantation in 2 (success rate: 99.4%). More than one coil was required in 32 patients with PDAs significantly larger than the remainder (2.3 ± 0.5 versus 1.6 ± 0.5 mm; p < 0.001). Immediate occlusion was observed in 160 patients with 17 (9.6%) having discrete, diffuse, low velocity residual leaks. Pulse reduction and transfusion were complications observed in 2 patients. One patient with mild residual leak was lost to follow up. On echocardiography, all 176 patients had occlusion and none had flow disturbances in the aorta or in the pulmonary artery on follow up (average 6 months). CONCLUSION: Zero tolerance for significant immediate residual leaks and optimized selection of coils and patients probably explain these excellent outcomes. The procedure is easy to perform, cost effective, safe and highly efficient.