A case of severe intravascular hemolysis following coil occlusion of the ductus

✍ Scribed by Kapoor, Aditya

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 11 KB
• Volume: 41
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/(sici)1097-0304(199708)41:4<467::aid-ccd28>3.0.co;2-h

✦ Synopsis

In response to two case reports that have appeared in this journal [1,2], I would like to make the following comments:

The authors state that there is no published report of hemolysis following coil embolization of the ductus arteriosus. This statement is factually incorrect. We have reported a case of severe intravascular hemolysis following coil occlusion of the ductus [3].

Our case had a 3.2 mm Type A ductus [4], which was successfully embolized using an 8 mm (5 cm length) Cook coil via the transvenous route. Post procedure, the patient had a trace residual shunt as demonstrated on aortography. The patient developed intravascular hemolysis on the following day. When the hemoglobin continued to decrease (from 10.2 to 6.3 gm%), she was taken up for a repeat coil embolization procedure on the third day after the onset of hemolysis. A repeat aortogram revealed only a trace residual shunt. Still, an attempt was made to deploy another 8 mm, 5 cm Cook coil. But this embolized to the left pulmonary artery, from where it was successfully retrieved percutaneously. Since the shunt was only trivial, we decided not to attempt any further coil deployment, and further monitored the clinical course of the patient. By the ninth day, the intravascular hemolysis subsided spontaneously, and the patient was subsequently discharged.

At a six-week follow-up, the patient was asymptomatic, and an echocardiogram did not reveal any evidence of shunting at the level of the ductus, nor any gradient at the level of the left pulmonary artery.