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Pediatric cardiologist Richard Ringel uses a slinkylike coil that can create a clot to close the abnormality in the heart that some children are born with.
Pediatric cardiologist Richard Ringel uses a slinkylike coil that can create a clot to close the abnormality in the heart that some children are born with.
heart illustration


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A Plug for a Hole in the Heart

The tiny blood vessel near the pulmonary artery in a developing fetus that forms the ductus arteriosus and supplies blood to the unborn infant’s lower body (bypassing the non-functioning lungs) closes naturally soon after most newborns take their first breath. But for reasons unknown, in a small percentage the duct remains open—or patent—exposing them to risks of endocarditis and congestive heart failure.

Pediatricians typically pick up a patent ductus in a child through a heart murmur. Cardiologists recommend watching the condition for a year to see if the abnormal blood vessel closes on its own—many do. If it remains open, the ductus typically has been tied off surgically in an open-chest procedure. Now, however, at a scattering of hospitals, surgeons are closing the abnormality through a much less traumatic cardiac catheterization approach, in use only since the mid-1990s. Recently, we observed as pediatric cardiologist Richard Ringel, M.D., performed one of these less-invasive procedures on 5-year-old Jordan Wool in the cardiac cath lab.

Staring at an X-ray monitor, Ringel fed a guidewire through the femoral artery in Jordan’s leg and then up the aorta, the main artery out of the heart. The tip of the wire bounced to the beat of the child’s heart as he prodded—retreating and advancing, feeling his way to the small hole. Intermittently, Ringel injected a radiographic dye around the arch of the aorta so he could visualize the opening on the monitor.

With the ductus revealed, Ringel entered it with the lead wire, then followed with a catheter that contained a thin metal slinkylike spring coil lined with dacron fibers—the vital element in this procedure. As the surgeon pushed the coil out of the catheter into the ductus, it immediately formed a fibrous knot, attracting blood cells and creating a clot that closed the opening.

“In two or three months you could open up the vessel and you might see a bump or bulge, but the coil and the clots would be covered by the lining tissue of the blood vessels,” Ringel told us. “The ductus would be totally excluded from circulation.” Young Jordan, he noted, should be running around in a couple of days.



—- GL



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