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Haddad RN, Bonnet D, Malekzadeh-Milani S. Early spontaneous closure of large arterial ducts in two term neonates with Ebstein anomaly after failed attempts of transcatheter closure. Cardiol Young 2023; 33:1726-1729. [PMID: 36918290 DOI: 10.1017/s1047951123000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
In neonatal Ebstein's anomaly of the tricuspid valve, prolonged ductal patency in patients without anatomic pulmonary valve atresia can be deleterious. Circular shunts may develop in patients with different degrees of pulmonary and tricuspid insufficiency. Closure of the arterial duct may result in haemodynamic improvement in particular scenarios. The transcatheter approach is a valuable closure alternative despite some technical difficulties in large-sized arterial ducts and low birth weight neonates. Herein, we report on two consecutive term newborns with Ebstein's anomaly and large arterial ducts in whom mechanical stimulus of the arterial duct during failed attempts of transcatheter closure led after two days to definitive closure followed by good clinical outcomes.
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Affiliation(s)
- Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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2
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Zhang X, Zhang N, Song HC, Ren YY. Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization: A case report. World J Clin Cases 2022; 10:13015-13021. [PMID: 36568995 PMCID: PMC9782928 DOI: 10.12998/wjcc.v10.i35.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/29/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum. In patients with ductal-dependent pulmonary blood flow, ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability, which need to be treated in perfect order.
CASE SUMMARY We present a male infant with a gestational age of 39 wk, and his fetal echocardiography showed pulmonary atresia. At 28 d of age, transcatheter pulmonary valvuloplasty with balloon dilatation was performed. Two hours after the operation, the patient's pulse oxygen saturation continued to decrease. The patient was then transferred to receive cardiac catheterization. During catheterization, the invasive blood pressure and pulse oxygen saturation suddenly decreased, and repeated aortography revealed partial occlusion of the ductus arteriosus. It no longer changed when pulse oxygen saturation rose to 51% after approximately 20 min of maintenance therapy. Therefore, a ductal stent was used for implantation. Hemodynamics and hypoxemia were improved.
CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization. Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.
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Affiliation(s)
- Xu Zhang
- Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Ning Zhang
- Department of Medical Technology, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Hai-Cheng Song
- Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Yue-Yi Ren
- Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
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Deniwar A, Brown M, Balaguru D. Spontaneous closure of patent ductus arteriosus in preterm babies after failed attempts at transcatheter device closure. Ann Pediatr Cardiol 2022; 15:219-221. [PMID: 36246760 PMCID: PMC9564407 DOI: 10.4103/apc.apc_117_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/11/2021] [Accepted: 04/05/2022] [Indexed: 11/04/2022] Open
Abstract
Transcatheter closure of patent ductus arteriosus (PDA) for preterm infants is increasingly performed after the Food and Drug Administration approval of the Amplatzer Piccolo Occluder device (Abbott Inc., Abbott Park, IL, USA) in the United States. We report three babies in whom transcatheter closure of PDA was unsuccessful; however, the PDA closed spontaneously in 1–5 days after the transcatheter attempt. The PDA remained closed during follow-up at 3 weeks, 10 weeks, and 17 months, respectively. Mechanical stimulation of the PDA by the wire during attempted device closure likely induced the PDA closure. Further studies are needed to evaluate whether this is a useful alternative therapy in this patient population.
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Méot M, Haddad RN, Patkai J, Abu Zahira I, Di Marzio A, Szezepanski I, Bajolle F, Kermorvant E, Lapillonne A, Bonnet D, Malekzadeh-Milani S. Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121138. [PMID: 34943334 PMCID: PMC8700662 DOI: 10.3390/children8121138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.
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Affiliation(s)
- Mathilde Méot
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
- Correspondence: ; Tel.: +33-144494357
| | - Raymond N. Haddad
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Juliana Patkai
- Neonatology Department, Port-Royal Hospital, 75014 Paris, France;
| | - Ibrahim Abu Zahira
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Anna Di Marzio
- Anesthesiology, Hôpital Necker-Enfants Malades, 75015 Paris, France;
| | - Isabelle Szezepanski
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Fanny Bajolle
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
| | - Elsa Kermorvant
- Neonatology Department, Hôpital Necker-Enfants Malades, 75015 Paris, France; (E.K.); (A.L.)
- UFR de Médecine, Université de Paris, Site Cordeliers, 75006 Paris, France
| | - Alexandre Lapillonne
- Neonatology Department, Hôpital Necker-Enfants Malades, 75015 Paris, France; (E.K.); (A.L.)
- UFR de Médecine, Université de Paris, Site Cordeliers, 75006 Paris, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
- UFR de Médecine, Université de Paris, Site Cordeliers, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Necker-Enfants Malades, 75015 Paris, France; (R.N.H.); (I.A.Z.); (I.S.); (F.B.); (D.B.); (S.M.-M.)
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Sathanandam S, Gutfinger D, Morray B, Berman D, Gillespie M, Forbes T, Johnson JN, Garg R, Malekzadeh-Milani S, Fraisse A, Baspinar O, Zahn EM. Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants. Pediatr Cardiol 2021; 42:1258-1274. [PMID: 34195869 PMCID: PMC8292293 DOI: 10.1007/s00246-021-02665-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022]
Abstract
Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.
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Affiliation(s)
- Shyam Sathanandam
- LeBonheur Children's Hospital, University of Tennessee, 848 Adams Avenue, Memphis, TN, 38103, USA.
| | | | | | | | | | | | - Jason N. Johnson
- LeBonheur Children’s Hospital, University of Tennessee, 848 Adams Avenue, Memphis, TN 38103 USA
| | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, CA USA
| | | | | | - Osman Baspinar
- Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Evan M. Zahn
- Cedars-Sinai Medical Center, Los Angeles, CA USA
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Uppal L, Rohit MK, Barwad P, Naganur S, Debi U, Kasinadhuni G, Santosh K, Cr P, Sahoo S. Comparison of isolated venous approach with the standard approach in children undergoing patent ductus arteriosus device closure. Egypt Heart J 2020; 72:65. [PMID: 32990909 PMCID: PMC7524916 DOI: 10.1186/s43044-020-00100-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Transcatheter device closure is a safe procedure recommended in children with patent ductus arteriosus (PDA). While the standard procedure uses arterial and venous femoral access, it poses risk of vascular complications especially in young infants. Isolated venous approach has been tried in a few studies and was found to be non-inferior to the standard technique. In this prospective observational study, we have compared the two vascular approaches of PDA device closure in pediatric patients and have also studied the feasibility of this approach in young children with weight < 6 kg. RESULTS PDA device occlusion was performed with either one of the approaches-venous alone (group I) or standard approach (group II) in a total of 135 children enrolled prospectively. The baseline data, procedural outcomes, vascular complications, and radiation dose were compared between the two groups. Fifty-two and 83 children were included in group I and group II, respectively. A total of 22 children (16%) (13 in group I; 9 in group II) had weight < 6 kg. In group II, 6 children (7.2%) had vascular site complications treated with heparin infusion with two children requiring thrombolysis. Another child in group II developed intravascular hemolysis following residual shunt, requiring surgical device retrieval and closure. No significant differences were observed in mean fluoroscopic time (p = 0.472) and air kerma between the two groups (p = 0.989). CONCLUSION Transcatheter PDA device closure without arterial access is a feasible and safe option in children including young infants. This technique avoids the risk of vascular complications although requires careful case selection.
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Affiliation(s)
- Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Parag Barwad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjeev Naganur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Uma Debi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pruthvi Cr
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Saroj Sahoo
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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O'Byrne ML, Smith CL, Gillespie MJ. Device Closure of Patent Ductus Arteriosus in Adults. Can J Cardiol 2020; 36:795-796. [PMID: 32173055 DOI: 10.1016/j.cjca.2019.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Daaboul DG, DiNardo JA, Nasr VG. Anesthesia for high-risk procedures in the catheterization laboratory. Paediatr Anaesth 2019; 29:491-498. [PMID: 30592354 DOI: 10.1111/pan.13571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 12/17/2022]
Abstract
Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus-dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic-related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.
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Affiliation(s)
- Dima G Daaboul
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Kang SL, Jivanji S, Mehta C, Tometzki AJ, Derrick G, Yates R, Khambadkone S, de Giovanni J, Stumper O, Dhillon R, Bhole V, Slavik Z, Rigby M, Noonan P, Smith B, Knight B, Richens T, Wilson N, Walsh K, James A, Thomson J, Bentham J, Hayes N, Nazir S, Adwani S, Shauq A, Ramaraj R, Duke C, Taliotis D, Kudumula V, Yong SF, Morgan G, Rosenthal E, Krasemann T, Qureshi S, Crossland D, Hermuzi T, Martin RP. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv 2017; 90:1135-1144. [PMID: 28799706 DOI: 10.1002/ccd.27212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 06/25/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to report our national experience with transcatheter patent ductus arteriosus (PDA) occlusion in infants weighing <6 kg. BACKGROUND The technique of transcatheter PDA closure has evolved in the past two decades and is increasingly used in smaller patients but data on safety and efficacy are limited. METHODS Patients weighing < 6 kg in whom transcatheter PDA occlusion was attempted in 13 tertiary paediatric cardiology units in the United Kingdom and Ireland were retrospectively analyzed to review the outcome and complications. RESULTS A total of 408 patients underwent attempted transcatheter PDA closure between January 2004 and December 2014. The mean weight at catheterization was 4.9 ± 1.0 kg and mean age was 5.7 ± 3.0 months. Successful device implantation was achieved in 374 (92%) patients without major complication and of these, complete occlusion was achieved in 356 (95%) patients at last available follow-up. Device embolization occurred in 20 cases (5%). The incidence of device related obstruction to the left pulmonary artery or aorta and access related peripheral vascular injury were low. There were no deaths related to the procedure. CONCLUSIONS Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.
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Affiliation(s)
- Sok-Leng Kang
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Salim Jivanji
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Chetan Mehta
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Andrew J Tometzki
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Graham Derrick
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Robert Yates
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Sachin Khambadkone
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Joseph de Giovanni
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Oliver Stumper
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Rami Dhillon
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Vinay Bhole
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Zdenek Slavik
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Michael Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Patrick Noonan
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Ben Smith
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Brodie Knight
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Trevor Richens
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Neil Wilson
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Kevin Walsh
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - Adam James
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - John Thomson
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Jamie Bentham
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Nicholas Hayes
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Sajid Nazir
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Satish Adwani
- Department of Paediatric Cardiology, Oxford University Hospitals, Oxford, England, United Kingdom
| | - Arjamand Shauq
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Ram Ramaraj
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Christopher Duke
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Demetris Taliotis
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Vikram Kudumula
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - San-Fui Yong
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Gareth Morgan
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Eric Rosenthal
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Shakeel Qureshi
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - David Crossland
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Tony Hermuzi
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Robin P Martin
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
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Abstract
Ductal spasm is a rare yet important complication of device occlusions of patent ductus arteriosus. Spasm may result in failure of the procedure, under-sizing of the device, or embolisation of the implanted device as the spasm resolves after the procedure. We describe a novel protocol that rapidly and completely reversed the spasm in eight prematurely born infants who experienced ductal spasm during cardiac catheterisations for patent ductus arteriosus occlusion. In total, eight infants born between 25 and 34 weeks of gestation presented for transcatheter patent ductus arteriosus occlusion between 13 and 87 months of age. All eight patients experienced ductal spasm either immediately before, during, or soon after induction of anaesthesia or only after entering the ductus arteriosus with a catheter. After detection of the spasm, the anaesthetist, in each case, changed the mode of anaesthesia from inhaled sevoflurane to total intravenous anaesthesia with propofol, reduced the inhaled oxygen fraction to 21%, and initiated a continuous intravenous infusion of prostaglandin E1. The first two steps (total intravenous anaesthesia and FiO2 0.21) resulted in only partial relaxation of the spasm. Complete relaxation was attained after intravenous prostaglandin E1 infusions of only 10-15 minutes' duration. While maintaining this protocol, six ducti were successfully occluded and two were considered to be unsuitable for device occlusion and were referred for surgery. Ductal spasm during transcatheter occlusion may be reliably resolved and the procedure safely completed by a simple anaesthetic protocol, including the continuous infusion of intravenous prostaglandin E1.
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