PDA Coil Occlusion
Retrograde Approach
Indication:
The JACKSON/Cook coil for PDA closure is designed for ducts smaller than 3.5 mm. Ducts up to 5 mm have been occluded using these coils. A routine diagnostic procedure is done to confirm that the duct is suitable for closure. An Aortogram must be done with a pigtail catheter and duct size (Length and diameter) is measured using the catheter calibration to compare the size.
Equipment:
Coils are manufactured of stainless steel and contain fibers of Dacron wool, which encourages thrombosis and aids occlusion. The coils of various sizes are supplied pre-loaded in a transparent plastic tube.
Sizes available
- 3 PDA 4= 3mm diameter coils, 4 loops
- 3 PDA 5= 3mm diameter coils, 5 loops
- 5 PDA 3= 5mm diameter coils, 3 loops
- 5 PDA 4= 5mm diameter coils, 4 loops
- 5 PDA 5= 5mm diameter coils, 5 loops
- 8 PDA 3= 8mm diameter coils, 3 loops
- 8 PDA 4= 8mm diameter coils, 4 loops
- 8 PDA 5= 8mm diameter coils, 5 loops
- JACKSON/Cook delivery system
- PDA TORCON Catheter.
- 4 Fr. or 5 Fr. Sheath
- Cefuroxime 15 mg/Kg.
Preparation:
- Remove the adapter for protection during shipment and storage.
- Advance the straightening mandrill to protrude through the thread of the delivery wire.
- Introduce the loaded straightening mandrill into the flared end of the coil loading cartridge and into the center of the threaded part of the coil.
- Advance the loading cartridge until the threads of the coil and delivery wire meet.
- Turn the loading cartridge clockwise to join the thread of the coil with the thread of the delivery wire, approximately 3 to 4 turns.
- To check the detachment mechanism, turn the loading cartridge counterclockwise to leave a gap of 1 mm between the thread of the delivery wire and the coil.
- To keep the coil straight, advance the mandrill until it reaches the tip of the coil.
Procedure:
Replace the pigtail catheter with an end hole the only catheter with an inner lumen of 0.038 mm using an exchange wire. Attach a bleed back hemostatic valve to end. Insert the prepared coil delivery system into the catheter up to the distal tip. The mandrill is withdrawn and the coil is advanced until a majority of coil loops are formed in the descending aorta. The catheter and delivery system, with the coil, partly extruded is withdrawn into the ampulla of the duct and the remaining coil is released. Advancing the catheter slightly will position the coil on the pulmonary side. Counter- Clockwise rotations to the delivery system will release the coil. If an arterial sheath has not been inserted, exchange the 20-g leader catheter for a 4 or 5 Fr sheath. After 15 minutes, the aortogram is then repeated to ascertain satisfactory occlusion of the duct. If the duct is not completely occluded, the duct is carefully probed with the guide wire and delivery catheter, being careful not to dislodge coil already deployed, and further coils are implanted. Injection Cefuroxime 15mg/Kg is given IV on the deployment of coils. Cardiac Interventions, Hardware, and Implants.
Post Procedure:
On completing of procedure all access lines are removed. Three further doses of antibiotics are recommended. An echocardiogram is done on the ward the following day to ascertain closure or residual shunting.
