Transcatheter occlusion of patent ductus arteriosus in pre-term infants. Edwin Francis, Anil Kumar Singhi, Srinivas Lakshmivenkateshaiah, Rama Krishna Kumar kumar_rk@yahoo.com Report 8 infants. Weight at the time of procedure: 900 - 1700 (median 1100) g. Gestation: 27-32 wks. PDA size: 2 - 3.5 mm
Coil size: All coils were 0.038; 1 to 3 coils were placed in each patient.
PDA size - Coil size - Number of coils
2.5 mm 5-5 2
2.5 mm 5-5 2
2 mm 5-5 2
3.5 mm 5-6 3
2.5 mm 3-4 1
3 mm 3-4 2
2.5 mm 3-4 2
2.2 mm 3-4 2
Access: 4 Fr via Femoral vein (Arterial access only when already present or obtained accidentally)
Procedure has multiple nuances described.
Placement of sheath: 24 G cannula -> 0.014 coronary guide wire -> Insert the cannula well into fem. vein -> 0.018 short wire -> 4 Fr Micropuncture sheath (Cook) -> Exchange to 4 Fr (5 Fr in 1 pt,) short introducer sheath
4 Fr JR catheter. Place at junction of IVC-RA; 0.025 Terumo wire to advance to RV - PDA - DAo. (Online video)
Over Terumo wire, advance 4 Fr long sheath (25 cm; Cook) and place tip in DAo.
PDA angiogram via this long sheath after pulling back into PDA - with wire still in place (Note: No arterial access in a typical case).
Coils delivered using Bioptome. Coils tied with 3-0 Prolene, held in bioptome, pulled inside a 4 Fr loader (short) sheath...transfer from loader to 4 Fr long sheath...advance and deliver.
Fluoroscopy time: 8.1 (+/- 1.9) min, Range: 4.8 - 11.3 min
Complications: None. No embolizations.
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