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Rashid A, Lone A, Rather H, Hafeez I. Management of PDA device closure complicated by severe hemolysis by transcatheter retrieval and deployment of new device. Egypt Heart J 2023; 75:17. [PMID: 36897475 PMCID: PMC10006361 DOI: 10.1186/s43044-023-00343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/25/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Hemolysis after Patent ductus arteriosus (PDA) device closure is rare. Although in most cases, hemolysis settles on its own; however, in some cases it may not settle spontaneously and may require additional procedures like putting additional coils, gel foam or thrombin instillation, balloon occlusion, or removing it surgically. We report a case of adult PDA device closure who persisted with hemolysis and was managed by transcatheter retrieval. CASE PRESENTATION A 52-year-old gentleman presented to us with a diagnosis of large PDA with operable hemodynamics. Descending thoracic aortic Angio showed a large 11 mm PDA. Transcatheter device closure was done in the same sitting with a 16 × 14 Amplatzer Ductal Occluder I(ADO) device,;however, after device release, the aortic end of the device was not fully formed and there was residual flow. The next morning patient started with gross hematuria with persistent residual flow. We tried to manage with conservative means including hydration, and blood transfusion; however, residual flow persisted for 10 days and his hemoglobin dropped from 13 gm/dl preprocedural to 7 gm/dl, creatinine increased from 0.5 mg/dl to 1.9 mg/dl, bilirubin increased to 3.5 mg/dl & urine showed hemoglobinuria. As the patient continued to deteriorate it was planned to retrieve the device by transcatheter approach. 10 French amplatzer sheath was parked in the pulmonary artery near the ductus. We tried with a combination of multiple catheters and Gooseneck snare (10 mm) and finally, we successfully retrieved with a combination of Multipurpose (MP) catheter and 10 mm Gooseneck snare. After that, we closed the defect successfully with a double disk device (muscular Ventricular septal defect 14 mm Amplatzer). The patient's hematuria settled and was discharged after 2 days with normal hemoglobin and creatinine. CONCLUSIONS Patent ductus arteriosus ADO 1 device should not be released if the aortic end of the disk is not fully formed Patient should be carefully monitored for hemolysis if evidence of residual shunt and given supportive treatment. If conservative treatment fails, residual flow needs to be eliminated. Transcatheter retrieval although technically challenging is a feasible treatment. A muscular VSD device is a good alternative to the usual PDA device to close PDA, especially in adults.
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Affiliation(s)
- Aamir Rashid
- Department of Cardiology, SKIMS, Soura, Srinagar, J& K, India.
| | - Ajaz Lone
- Department of Cardiology, SKIMS, Soura, Srinagar, J& K, India
| | - Hilal Rather
- Department of Cardiology, SKIMS, Soura, Srinagar, J& K, India
| | - Imran Hafeez
- Department of Cardiology, SKIMS, Soura, Srinagar, J& K, India
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Naimi I, Jones TK, Steinberg Z. The Gore Cardioform Atrial Septal Defect Occluder: A novel solution to the management of severe hemolysis following transcatheter septal defect closure. Catheter Cardiovasc Interv 2022; 99:1679-1682. [PMID: 35253339 DOI: 10.1002/ccd.30144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/11/2022]
Abstract
Significant hemolysis is a recognized complication of transcatheter high-velocity shunt occlusion using some Amplatzer devices. We describe a case of severe hemolysis following occlusion of an iatrogenic Gerbode defect with an Amplatzer muscular ventricular septal defect occluder successfully managed by transcatheter device removal and reocclusion with a Gore Cardioform Atrial Septal Defect Occluder.
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Affiliation(s)
- Iman Naimi
- Department of Pediatric Cardiology, Stollery Children's Hospital, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas K Jones
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Cardiology, University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Zachary Steinberg
- Department of Cardiology, University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
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Alkhouli M, Farooq A, Go RS, Balla S, Berzingi C. Cardiac prostheses-related hemolytic anemia. Clin Cardiol 2019; 42:692-700. [PMID: 31039274 PMCID: PMC6605004 DOI: 10.1002/clc.23191] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022] Open
Abstract
Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis‐related hemolysis.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ali Farooq
- Division of Cardiology, Department of Medicine, West Virginia University, Charleston, West Virginia
| | - Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sudarshan Balla
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Chalak Berzingi
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
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Noble J, Amdani SM, Garcia RU, Arora R. Hematuria in an Adult with Congenital Heart Disease. J Emerg Med 2018; 54:e69-e71. [PMID: 29439889 DOI: 10.1016/j.jemermed.2017.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/17/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adults with congenital heart disease (CHD) in the United States now outnumber children with CHD, due in part to the improvement in surgical and medical management. This growing population may present postoperatively to the emergency department (ED) with nonspecific complaints from unforseen complications secondary to cardiac intervention. CASE REPORT We describe a 39-year-old male who presented to the ED with hematuria and dysuria after he underwent percutaneous device ventricular septal defect (VSD) closure 10 days before. Upon initial evaluation, laboratory results confirmed a urinary tract infection and hematuria. Given persistent red discoloration of urine and easy fatigability, further investigation and re-evaluation found him to be anemic secondary to intravascular hemolysis. Cardiac catheterization showed residual shunting through the VSD device margins causing the hemolysis. Although this is a rare complication of VSD device closure, the patient's initial presentation of hematuria and dysuria presented a unique diagnostic challenge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with underlying CHD require emergency physicians to consider a multidisciplinary approach to properly diagnose and facilitate treatment.
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Affiliation(s)
- Jennifer Noble
- Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Shahnawaz M Amdani
- Division of Cardiology, Children's Hospital of Michigan, Detroit, Michigan
| | - Richard U Garcia
- Division of Cardiology Critical Care, Children's Hospital of Michigan, Detroit, Michigan
| | - Rajan Arora
- Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
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Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ. Transcatheter closure of calcified patent ductus arteriosus in older adult patients: Immediate and 12-month follow-up results. CONGENIT HEART DIS 2016; 12:289-293. [PMID: 27874259 DOI: 10.1111/chd.12437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Xinghua Gu
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Qiuwang Zhang
- Division of Cardiology; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto; Toronto Ontario Canada
| | - Hourong Sun
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Jianchun Fei
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Xiquan Zhang
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Michael J. Kutryk
- Division of Cardiology; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto; Toronto Ontario Canada
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Abstract
More than three decades have passed since the introduction of transcatheter devices for closure of patent ductus arteriosus, and many occluders have been made available since then. The ideal requirements of any procedure are a user-friendly technique, optimum success rate, no residual anomaly, minimal morbidity/mortality, and comparability or superiority to the existing conventional modality of treatment. With various advancements in device design, delivery and assisted systems, the tremendous procedural safety and effectiveness, along with low cost and widespread availability of these devices makes transcatheter closure of patent ductus arteriosus a preferred therapeutic modality in all age groups, with decreasing demographic trends of surgical management.
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Affiliation(s)
- R Arora
- Metro Hospital and Heart Institute, G.B. Pant Hospital, New Delhi 110002, India.
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Forbes TJ, Turner DR. What is the optimal device for closure of a persistently patent ductus arteriosus? PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 492] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Transcatheter closure of patent ductus arteriosus (PDA) was one of the first interventions established in invasive cardiology and is now more than 30 years old. The challenges for successful closure with the first devices in children consisted of handling the rather large introducer sheaths and stiff application systems. Today, interventional closure can be performed with different types of plugs, occluders, and coils. Thus, beyond infancy, transcatheter closure can be successfully performed in almost all cases. Challenging from the technical standpoint can be the closure of window-type ducts, in which excessive protrusion of the device into the descending aorta should be avoided, as well as the closure of tubular ducts, in which secure anchoring of one or more devices in the vessel can be very difficult. For the combination of a coarctation and an open duct, different strategies can be considered. In selected cases, use of a covered stent can be helpful. From the physiological standpoint, open ducts in patients with pulmonary hypertension with or without concomitant congenital heart diseases can be challenging because testing of vasoreactivity with temporarily blocked duct and the option of subsequent treatment with vasodilators may be necessary prior to making the decision whether the patient may benefit from definitive duct occlusion or not. Large ducts in infants less than 8 kg can be difficult to treat due to a relative mismatch of introducers, plugs, or occluders to the small anatomic dimensions. The implantation of multiple coils can be associated with a higher risk of device embolization. Unfortunately, for the large group of preterm infants with very low body weights and large ducts of tubular shape there is currently no standardized interventional therapy available.
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Affiliation(s)
- P Ewert
- Department of Congenital Heart Diseases, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Spies C, Ujivari F, Schräder R. Transcatheter closure of a 22 mm patent ductus arteriosus with an Amplatzer atrial septal occluder. Catheter Cardiovasc Interv 2005; 64:352-5. [PMID: 15736250 DOI: 10.1002/ccd.20283] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transcatheter techniques for closure of patent ductus arteriosus (PDA) have been used for almost 40 years. We report a case of a 24-year-old female with a 22 mm PDA, congestive heart failure, and atrial fibrillation. She underwent transcatheter PDA closure with an Amplatzer atrial septal occluder (ASO). Following the procedure, she developed hemolysis due to a large residual shunt. However, the shunt gradually resolved until complete closure was achieved within 8 months. An attempt to restore sinus rhythm with electrical cardioversion was successful and the patient is now, 2 years after procedure, in New York Heart Association functional class I. Off-label use of an ASO for closure of a very large PDA yielded an excellent clinical result.
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Affiliation(s)
- Christian Spies
- Section of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Moore JW, Levi DS, Moore SD, Schneider DJ, Berdjis F. Interventional treatment of patent ductus arteriosus in 2004. Catheter Cardiovasc Interv 2004; 64:91-101. [PMID: 15619281 DOI: 10.1002/ccd.20243] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In 2004, the interventional treatment of patent ductus arteriosus (PDA) is definitive and curative. In current practice, coils are used for smaller PDA, and devices are employed for larger PDA. Developing technologies offer small improvements in control and results, but do not appear to promise major changes in practice. This review summarizes the current and emerging interventional technologies directed at PDA closures.
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Affiliation(s)
- John W Moore
- Division of Pediatric Cardiology, Mattel Children's Hospital, University of California, Los Angeles, CA 90095, USA.
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Aroney CN, Goh TH, Hourigan LA, Dyer W. Ventricular septal rupture following nonsurgical septal reduction for hypertrophic cardiomyopathy: Treatment with percutaneous closure. Catheter Cardiovasc Interv 2004; 61:411-4. [PMID: 14988906 DOI: 10.1002/ccd.10767] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An 82-year-old woman with severe symptomatic hypertrophic obstructive cardiomyopathy undergoes nonsurgical septal reduction, leading to immediate hemodynamic and functional improvement. Five weeks later, she presents with severe biventricular failure due to a large septal rupture with marked left-to-right shunting. The rupture is closed with an Amplatzer post-MI ventricular septal defect occluding device. Residual shunting through the device and a small residual shunt at its superior rim lead to severe hemolysis, which resolves spontaneously after 10 days of supportive therapy. A further self-limiting episode of hemolysis recurred 3 months later following a period of excessive anticoagulation.
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Arora R, Sengupta PP, Thakur AK, Mehta V, Trehan V. Device Closure of Patent Ductus Arteriosus. J Interv Cardiol 2003; 16:385-91. [PMID: 14603796 DOI: 10.1046/j.1540-8183.2003.01005.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ramesh Arora
- Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
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