Heart 1998;79:220-222 ( March )
Residual and recurrent shunts after implantation of Cook detachable duct occlusion coils
Department of Paediatric Cardiology, Killingbeck
Hospital, York Road, Leeds LS14 6UQ, UK
Correspondence to: Dr Gibbs.
Accepted for publication 24 November 1997
Objective
To assess the presence and
outcome of Doppler detectable shunts following implantation of the Cook
detachable PDA coil.
DesignProspective study.
SettingTertiary paediatric cardiac centre.
Patients76 consecutive patients
undergoing coil implantation (80 procedures).
Main outcome measuresDetection and
colour Doppler echocardiographic appearance of residual or recurrent
shunts, the timing of the appearance of recurrent shunts, and the time
taken for spontaneous resolution of these shunts.
ResultsImmediate occlusion was
achieved in 52 patients. At one month 63 patients had complete
occlusion and after three months the duct was completely occluded in 67 patients. In 27 cases small residual shunts were detected on
echocardiography 10 minutes after the completion of the implantation
procedure; 15 of these had resolved by 24 hours and 20 had resolved by
three months. Recurrent shunts were detected after apparent initial
complete occlusion in 11 cases 24 hours after coil implantation and in
two cases one month after the procedure. Six recurrent shunts resolved
on later follow up. Residual shunts appeared as single jets after implantation of a single coil, but up to three separate jets were detected after implantation of multiple coils.
ConclusionsSpontaneous resolution of
small residual shunts occurs in most patients. The recurrence of small
shunts after apparent complete occlusion suggests that recanalisation
of the duct may occur in a small percentage of patients up to one month
after occlusion. Residual shunts may take the form of multiple residual
jets that may require implantation of further coils to achieve complete duct occlusion.
© 1998 by Heart
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