Closure of residual leak after umbrella occlusion of the patent arterial duct, using Gianturco coils

Residual leak after transcatheter occlusion of the patent arterial duct (PDA) using the Rashkind double umbrella technique is a well documented problem. At our institution, there is a 15% incidence of persistent residual leak after 12 months. Since September 1994, 15 patients have undergone successful occlusion of the residual leak using single or multiple Gianturco coils. The median age of the patients was 48 months (range: 12–354 months). The median fluoroscopy time was 11 min (range: 4–14). There were no complications and no embolization of the coils. Eleven patients had total occlusion demonstrated on angiography 5–10 min after coil occlusion. A further three patients were demonstrated on colour Doppler echocardiography to have no residual leak before discharge the same day — despite a small leak on angiography. Only one of 15 patients had a small residual leak at the time of hospital discharge and this was finally occluded 1 year later with another coil. Coil occlusion of a residual leak on the umbrella device is effective and a safe and reliable procedure which appears to be an improvement on using a second umbrella device.