Retrieval ofRetrieval of embolizedembolized PDAPDARetrieval of Retrieval of embolizedembolized PDA PDA coil using double wirecoil using double wirecoil using double wire coil using double wire

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ArjunArjun AdnaikAdnaik R, MD, DMR, MD, DMRajagopalRajagopal JambunathanJambunathan, MD, DM, MD, DMj g pj g p , ,, ,

IntroductionIntroductionIntroductionIntroduction

Hardware embolization during Hardware embolization during interventional procedure is not uncommon. interventional procedure is not uncommon. ppUsually, a snare or a bioptome is used for Usually, a snare or a bioptome is used for retrievalretrievalretrieval. retrieval. Here we present an unusual use of Here we present an unusual use of coronary guide wires for coil retrieval coronary guide wires for coil retrieval

Case HistoryCase HistoryCase HistoryCase History

A 10 year old girl with history of recurrent A 10 year old girl with history of recurrent respiratory infectionsrespiratory infectionsp yp yEcho: Echo:

Showed a restrictive PDA (3 mm) with left to rightShowed a restrictive PDA (3 mm) with left to rightShowed a restrictive PDA (3 mm) with left to right Showed a restrictive PDA (3 mm) with left to right shunt. shunt. Mildly dilated left atrium and left ventricleMildly dilated left atrium and left ventricleMildly dilated left atrium and left ventricle Mildly dilated left atrium and left ventricle

It was decided to deploy a coil across this PDAIt was decided to deploy a coil across this PDAIt was decided to deploy a coil across this PDAIt was decided to deploy a coil across this PDA

A 3A 3--5 PDA 5 PDA occluderoccluder coil was deployed across the PDA from coil was deployed across the PDA from the aortic end. the aortic end.

As there was nonAs there was non--availability of either the snare or the availability of either the snare or the bioptome we tried to entangle a floppy coronary wire intobioptome we tried to entangle a floppy coronary wire intobioptome, we tried to entangle a floppy coronary wire into bioptome, we tried to entangle a floppy coronary wire into the fibre mesh and extract the same the fibre mesh and extract the same

A second coronary wire was introduced and was successful A second coronary wire was introduced and was successful in anchoring on to one end of the coil in anchoring on to one end of the coil

The coil was pulled right up to the femoral venous sheath The coil was pulled right up to the femoral venous sheath and then extracted outside by a cutand then extracted outside by a cut--down on the vein. down on the vein.

The patient was taken up in the next The patient was taken up in the next sitting 1 month latersitting 1 month latergg

55 5 fli il d l d ith d5 fli il d l d ith d55--5 flipper coil was deployed with good 5 flipper coil was deployed with good resultresult

Conclusion:Conclusion:Conclusion:Conclusion:

Do not attemp Coil closure withoutDo not attemp Coil closure withoutDo not attemp Coil closure without Do not attemp Coil closure without appropriate hardwareappropriate hardwareN lN l llNever lose your Never lose your cool cool Always try to avoid the Surgeon’s knife onAlways try to avoid the Surgeon’s knife onAlways try to avoid the Surgeon s knife on Always try to avoid the Surgeon s knife on the chest. the chest.