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Duboue PM, Padovani P, Bouteiller XP, Martin-Kabore F, Benbrik N, Gronier CG, Bouissou A, Garnier E, Mitanchez D, Flamant C, Rozé JC, Baruteau AE, Lefort B. Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study. Eur J Pediatr 2024; 183:2193-2201. [PMID: 38381375 DOI: 10.1007/s00431-024-05481-y] [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] [Received: 12/17/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24 h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000 g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2 weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.
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MESH Headings
- Humans
- Ductus Arteriosus, Patent/surgery
- Retrospective Studies
- Infant, Newborn
- Female
- Ligation/methods
- Ligation/adverse effects
- Male
- Cardiac Catheterization/methods
- Cardiac Catheterization/adverse effects
- Infant, Premature
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Infant, Low Birth Weight
- Incidence
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/methods
- Syndrome
- Propensity Score
- Septal Occluder Device
- Risk Factors
- Infant, Premature, Diseases/surgery
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/therapy
- Infant, Premature, Diseases/epidemiology
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Affiliation(s)
| | - Paul Padovani
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Xavier Paul Bouteiller
- Department of Cardiology, Electrophysiology and Heart Modelling Institute, CHU Bordeaux, IHU Liryc, Bordeaux University Foundation, Pessac, France
| | | | - Nadir Benbrik
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Céline Grunenwald Gronier
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Antoine Bouissou
- Department of Neonatology, CHU Tours, Tours University, Tours, France
| | - Elodie Garnier
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France
| | - Delphine Mitanchez
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- INSERM UMR_S 938 Centre de Recherche Saint Antoine, Paris, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes University, Nantes, France
| | | | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
- CNRS, INSERM, L'institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Bruno Lefort
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France.
- UMR 1069, INSERM, Tours University, Tours, France.
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Clocheville Hospital, CHRU Tours, 49, Boulevard Béranger, 37000, Tours, France.
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Steiner K, Sjöberg G, Karsenty C, Bianco L, Bautista-Rodriguez C, Fraisse A. Mind the gap-missing device on the shelf? Retrospective experience with 5/7 Occlutech duct Occluder. Acta Paediatr 2024; 113:812-817. [PMID: 38149770 DOI: 10.1111/apa.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
AIM To describe our initial experience with the indications and results of the 5/7 Occlutech® duct Occluder (ODO, Occlutech International AB, Helsingborg, Sweden). A small incremental increase in occluder sizes is of utmost importance for successful outcomes, especially in smaller patients in whom protrusion of the distal disk towards the aorta should be minimised. METHODS Retrospective study of all patients undergoing PDA closure with the 5/7 ODO in three institutions since 2018. RESULTS The 5/7 ODO was used in 18 patients with median age and weight at the time of the procedure of 17.5 months (interquartile range 25th to 75th percentile 8 months- 4.4 years) and 13.6 kg (interquartile range 25th to 75th percentile 6.4-22.5 kg) respectively. All cases were successful. There were no cases of device embolisation, haemolysis, or flow disturbance of the LPA or the aorta. CONCLUSIONS This small retrospective study demonstrated an excellent outcome of transcatheter PDA closure with the 5/7 ODO. The device is a beneficial complement to the existing sizes of PDA devices, filling the gap between the 4/6 and 6/8 ODO and avoiding protrusion of a larger disk in the aortic isthmus.
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Affiliation(s)
- Kristoffer Steiner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Clément Karsenty
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse, France
| | - Lisa Bianco
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, London, UK
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, London, UK
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, London, UK
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3
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Mumtaz ZA, Sagar P, Sivakumar K, Mohakud AR, Rajendran M, Pavithran S. Risk factors associated with device embolisation or malposition during transcatheter closure of patent ductus arteriosus. Cardiol Young 2023; 33:2041-2048. [PMID: 36515000 DOI: 10.1017/s1047951122003973] [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: 12/15/2022]
Abstract
BACKGROUND Device embolisation is a serious adverse event during transcatheter duct closure. This study analyses risk factors for embolisation. METHODS Demographic parameters, echocardiographic anatomy, haemodynamics, and procedural characteristics of consecutive duct closures in a tertiary centre over 8 years were analysed. Procedures complicated by embolisation were compared to uncomplicated procedures. RESULTS Fifteen embolisations occurred during 376 procedures. All except one embolisation were in infants. The pulmonary artery: aortic pressure ratio was 0.78 ± 0.22. Embolisation was seen significantly more commonly in Type C tubular ducts. Vascular plugs were more significantly associated with embolisations. Logistic regression analysis showed device embolisation was significantly higher in age group of < 6 months compared to 6-12 months (p = 0.02), higher in those with tubular ducts versus conical ducts (p = 0.003), use of vascular plugs compared to conventional duct occluders (p = 0.05), and in duct closure with undersized devices (p = 0.001). There was no in-hospital mortality. Three patients needed surgical retrieval while others were successfully managed in catheterisation laboratory. CONCLUSIONS Device embolisation complicates 4% of transcatheter duct closures, with need for surgery in one-fifth of them. Larger ducts with high pulmonary artery pressures in younger and smaller infants are more often associated with device embolisation. Tubular ducts are more prone for embolisation compared to usual conical ducts. Softer vascular plugs are often associated with embolisations. Intentional device undersizing to avoid vascular obstruction in small patients is a frequent risk factor for embolisation. Precise echocardiographic measurements, correct occluder choice, proper technique and additional care in patients with high pulmonary artery pressures are mandatory to minimise embolisations.
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Affiliation(s)
- Zeeshan A Mumtaz
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Asish R Mohakud
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Monica Rajendran
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
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Bruckheimer E, Steiner K, Barak-Corren Y, Slanovic L, Levinzon M, Lowenthal A, Amir G, Dagan T, Birk E. The Amplatzer duct occluder (ADOII) and Piccolo devices for patent ductus arteriosus closure: a large single institution series. Front Cardiovasc Med 2023; 10:1158227. [PMID: 37215550 PMCID: PMC10193946 DOI: 10.3389/fcvm.2023.1158227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose Evaluate Piccolo and ADOII devices for transcatheter patent ductus arteriosus (PDA) closure. Piccolo has smaller retention discs reducing risk of flow disturbance but residual leak and embolization risk may increase. Methods Retrospective review of all patients undergoing PDA closure with an Amplatzer device between January 2008 and April 2022 in our institution. Data from the procedure and 6 months follow-up were collected. Results 762 patients, median age 2.6 years (range 0-46.7) years and median weight 13 kg (range 3.5-92) were referred for PDA closure. Overall, 758 (99.5%) had successful implantation: 296 (38.8%) with ADOII, 418 (54.8%) with Piccolo, and 44 (5.8%) with AVPII. The ADOII patients were smaller than the Piccolo patients (15.8 vs. 20.5 kg, p < 0.001) and with larger PDA diameters (2.3 vs. 1.9 mm, p < 0.001). Mean device diameter was similar for both groups. Closure rate at follow-up was similar for all devices ADOII 295/296 (99.6%), Piccolo 417/418 (99.7%), and AVPII 44/44 (100%). Four intraprocedural embolizations occurred during the study time period: two ADOII and two Piccolo. Following retrieval the PDA was closed with an AVPII in two cases, ADOI in one case and with surgery in the fourth case. Mild stenosis of the left pulmonary artery (LPA) occurred in three patients with ADOII devices (1%) and one patient with Piccolo device (0.2%). Severe LPA stenosis occurred in one patient with ADOII (0.3%) and one with AVPII device (2.2%). Conclusions ADOII and Piccolo are safe and effective for PDA closure with a tendency to less LPA stenosis with Piccolo. There were no cases of aortic coarctation related to a PDA device in this study.
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Affiliation(s)
- Elchanan Bruckheimer
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Kristoffer Steiner
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Yuval Barak-Corren
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Leonel Slanovic
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Michael Levinzon
- Section of Pediatric Anesthesiology, Schneider Children’s, Medical Center of Israel, Petach Tikva, Israel
| | - Alexander Lowenthal
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Gabriel Amir
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Tamir Dagan
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Einat Birk
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
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Ezemba N, Chinawa JM, Adiele DK, Arodiwe IO, Ujunwa FA, Okorie CO. Outcomes of Surgical Management for Patent Ductus Arteriosus in Infants in Nigeria. Tex Heart Inst J 2022; 49:489125. [PMID: 36511942 PMCID: PMC9809069 DOI: 10.14503/thij-21-7633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income countries, such as Nigeria, obtaining cardiovascular surgical care for infants remains difficult. In recent years, especially with the assistance of international voluntary cardiac organizations, efforts have increased to provide cardiac surgical services to this underserved population. METHODS In this case series, the authors describe outcomes in 30 infants surgically treated for patent ductus arteriosus between 2013 and 2019 at an emerging cardiac center in Nigeria (9 male [30%] and 21 female [70%]; mean [SD] age, 8.2 [3.01] months; mean [SD] weight, 5.3 [1.52] kg; mean [range] weight deficit, 34.5% [15%-60%]). RESULTS All the infants presented with patent ductus arteriosus as the main cardiac lesion, and 4 (13%) were syndromic. The mean (SD) patent ductus arteriosus diameter was 4.73 (1.46) mm. Surgical closure was completed in 29 infants; 1 died before surgery. No procedure-related deaths occurred, but 2 cases of trivial residual patent ductus arteriosus were recorded. CONCLUSION Overall, surgical outcomes were excellent, with acceptable mortality rates. Perioperative care will continue to improve as the center is built to a self-sustaining capacity. Findings of this research at this emerging cardiac center in a developing country are a testament to the positive contribution made by international voluntary cardiac missions.
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Affiliation(s)
- Ndubueze Ezemba
- Division of Cardiothoracic Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Josephat M. Chinawa
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Daberechi K. Adiele
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Ijeoma O. Arodiwe
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Fortune A. Ujunwa
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Chukwuemeka O. Okorie
- Division of Anesthesiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
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Grunenwald Gronier C, Benbrik N, Romefort B, Prigent S, Hauet Q, Baruteau AE. Off-label use of Lifetech KONAR-MF™ ventricular septal defect occluder for large patent ductus arteriosus closure in <6 kg infants. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2021.100316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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7
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Salam A, Bautista-Rodriguez C, Karsenty C, Bouvaist H, Piccinelli E, Fraisse A. Transcatheter closure of tubular patent ductus arteriosus using muscular ventricular septal defect devices in infants and small children with congestive heart failure. Arch Cardiovasc Dis 2022; 115:134-141. [DOI: 10.1016/j.acvd.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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Transcatheter patent ductus arteriosus closure in extremely premature infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101366] [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: 11/19/2022]
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9
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Percutaneous Closure of Patent Ductus Arteriosus in Infants 1.5 kg or Less: A Meta-Analysis. J Pediatr 2021; 230:84-92.e14. [PMID: 33098843 DOI: 10.1016/j.jpeds.2020.10.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. STUDY DESIGN A systematic review and meta-analysis was performed. Data sources included Scopus, Web of Science, Embase, CINAHL, Cochrane, and PubMed from inception to April 2020. Publications were included if they had a clear definition of the intervention as percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. Data extraction was independently performed by multiple observers. Primary outcome was technical success and secondary outcomes were adverse events (AEs). Subgroup analysis was performed in infants ≤6.0 kg. Data were pooled by using a random-effects model. RESULTS We included 28 studies, including 373 infants ≤1.5 kg and 69 studies enrolling 1794 infants ≤6.0 kg. In patients ≤1.5 kg, technical success was 96% (95% CI, 93%-98%; P = .16; I2 = 23%). The overall incidence of AE was 27% (95% CI, 17%-38%; P < .001; I2 = 70%) and major AEs was 8% (95% CI, 5%-10%; P = .63; I2 = 0%). There were 5 deaths related to the procedure (2%; 95% CI, 1%-4%; P = .99; I2 = 0%); 4 of these deaths occurred in infants <0.8 kg. The probability of technical failure was inversely related to age at the time of the procedure (OR, 0.9; 95% CI, 0.830-0.974; P = .009). Weight at intervention has decreased over time and procedural success has increased. CONCLUSIONS Percutaneous patent ductus arteriosus closure is feasible in infants ≤1.5 kg with few major AEs. The procedural success rate is high, despite performing the intervention in smaller patients. PROSPERO REGISTRATION CRD42020145230.
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Prabhu S, Tiwari R, Mehra S, Maiya S, Shetty R, Murthy K. Late Complication of Amplatzer Duct Occluder: Erosion and Pseudoaneurysm. Ann Thorac Surg 2020; 110:e531-e533. [PMID: 32492442 DOI: 10.1016/j.athoracsur.2020.04.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022]
Abstract
We are presenting a delayed complication of an Amplatzer duct occluder (ADO) in which a patient presented with increasing hemoptysis owing to ADO eroding the vessel wall and forming a pseudoaneurysm that communicated with the left main bronchus. Although ADO is considered as the safest for catheter-based patent ductus arteriosus closures, isolated complication as reported can occur. Just like atrial septal defect device closures, which were considered safe initially and found to be having an erosion incidence of 0.1% to 0.3%, this case could represent an isolated event (the index case) or a long-term complication occurring at a very low incidence.
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Affiliation(s)
- Sudesh Prabhu
- Department of Pediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India.
| | - Rishi Tiwari
- Department of Pediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Siddhant Mehra
- Department of Pediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Shreesha Maiya
- Department of Pediatric Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Riyan Shetty
- Anesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Keshava Murthy
- Anesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
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11
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Prabhu S, Maiya S, Shetty R, Murthy K, Ramachandra P, Tiwari R. Hybrid approach for aortic embolization of Amplatzer duct occluder. Ann Pediatr Cardiol 2020; 13:227-229. [PMID: 32863658 PMCID: PMC7437625 DOI: 10.4103/apc.apc_13_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
Embolization of the patent ductus arteriosus (PDA) device is a known adverse event of percutaneous PDA closure, which can lead to complications. Embolization can occur into the pulmonary artery or into the aorta. Device embolization can be moderate adverse event (when retrieved percutaneously) or major adverse event (when retrieved surgically). We are describing a hybrid approach for aortic embolization of PDA device when the percutaneous retrieval fails, where device retrieval and PDA ligation can be done through thoracotomy incision, thus decreasing the complications.
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Affiliation(s)
- Sudesh Prabhu
- Department of Paediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Shreesha Maiya
- Department of Paediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Riyan Shetty
- Paediatric Critical Care Unit, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Keshava Murthy
- Department of Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Prakash Ramachandra
- Department of Paediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Rishi Tiwari
- Department of Paediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
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12
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Farooqi M, Stickley J, Dhillon R, Barron DJ, Stumper O, Jones TJ, Clift PF, Brawn WJ, Drury NE. Trends in surgical and catheter interventions for isolated congenital shunt lesions in the UK and Ireland. Heart 2019; 105:1103-1108. [PMID: 30772822 PMCID: PMC6613741 DOI: 10.1136/heartjnl-2018-314428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate time trends in the use of catheter and surgical procedures, and associated survival in isolated congenital shunt lesions. METHODS Nationwide, retrospective observational study of the UK National Congenital Heart Disease Audit database from 2000 to 2016. Patients undergoing surgical or catheter procedures for atrial septal defect (including sinus venosus defect), patent foramen ovale, ventricular septal defect and patent arterial duct were included. Temporal changes in the frequency of procedures, and survival at 30 days and 1 year were determined. RESULTS 40 911 procedures were performed, 16 604 surgical operations and 24 307 catheter-based interventions. Transcatheter procedures increased over time, overtaking surgical repair in 2003-2004, while the number of operations remained stable. Trends in interventions differed according to defect type and patient age. Catheter closure of atrial septal defects is now more common in children and adults, although surgical interventions have also increased. Patent foramen ovale closure in adults peaked in 2009-2010 before falling significantly since. Surgery remains the mainstay for ventricular septal defect in infants and children. Duct ligation is most common in neonates and infants, while transcatheter intervention is predominant in older children. Excluding duct ligation, survival following surgery was 99.4% and ≈98.7%, and following catheter interventions was 99.7% and ≈99.2%, at 30 days and 1 year, respectively. CONCLUSIONS Trends in catheter and surgical techniques for isolated congenital shunt lesions plot the evolution of the specialty over the last 16 years, reflecting changes in clinical guidelines, technology, expertise and reimbursement, with distinct patterns according to lesion and patient age.
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Affiliation(s)
- Mehreen Farooqi
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - John Stickley
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Rami Dhillon
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - David J Barron
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Oliver Stumper
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Timothy J Jones
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Paul F Clift
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Adult Congenital Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - William J Brawn
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Nigel E Drury
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Arkhipov AN, Omelchenko AY, Zubritskiy AV, Khapaev TS, Soynov IA, Ivantsov SM, Pavlushin PM, Bogachev-Prokophiev AV, Karaskov AM. [Thoracoscopic clipping of patent ductus arteriosus: position of surgery in the era of transcatheter procedures]. Khirurgiia (Mosk) 2019:5-12. [PMID: 30855584 DOI: 10.17116/hirurgia20190215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To describe single-center evolution of the procedure and to evaluate the results of thoracoscopic clipping of patent ductus arteriosus (PDA) with diameter over 3,0 mm in term infants weighting over 4,0 kg. MATERIAL AND METHODS Thoracoscopic clipping of PDA has been performed in 140 patients for the period from March 2012 to March 2018 in Meshalkin National Medical Research Center. Mean age was 4.0 years (range 3 months - 13 years), mean body mass index - 15.4±2.2 kg/m2. INCLUSION CRITERIA PDA size 3.5-10 mm, Qp/Qs >1,3/1,0, weight 4.0-40 kg. Mean PDA size was 4.6±0.9 mm (range 3.5-8.0 mm), mean pulmonary artery pressure - 34.3±5.8 mm Hg, mean systemic/pulmonary flow Qp/Qs - 1.6±0.3. All patients underwent successful PDA closure through four-port technique under endotracheal general anesthesia and no need for pleural drainage. RESULTS Mean procedure time was 24.5±15.5 min. In 29 (20,7%) cases we used titanium clips, in 11 (79.3%) - polymer locking ligating clips. There was 1 conversion to mini-thoracotomy. There were no deaths, bleeding or any other life-threatening complications. 94 (67.1%) patients were weaned from ventilator within operating theatre, in other 46 (32.9%) patients mean ventilation time in ICU was 1.3±1.0 hours. In-hospital postoperative complications: pneumothorax - 2 (1.4%) cases, recurrent laryngeal nerve dysfunction - 1 (0.7%), false croup - 1 (0.7%). There were 2 residual leakages in 2 (1.4%) patients in 10 and 6 months after titanium clip deployment. Both of them underwent transcatheter closure using the coil. Considering these cases all following patients underwent PDA closure by polymer locking ligating clips with no cases of residual leakage. CONCLUSION Thoracoscopic PDA closure by polymer locking ligating clip is safe and effective technique for surgical management of PDA with diameter over 3.0 mm in term infants weighting over 4.0 kg.
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Affiliation(s)
- A N Arkhipov
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A Yu Omelchenko
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A V Zubritskiy
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - T S Khapaev
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - I A Soynov
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - S M Ivantsov
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - P M Pavlushin
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A V Bogachev-Prokophiev
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A M Karaskov
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
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Teixeirense PT, Sousa VDM, Toledo JFBD, Gubolino LA. Case 6 / 2018 - Percutaneous Occlusion of a Large Ductus Arteriosus in a Low Weight Infant, with Immediate Clinical and Radiographic Improvement. Arq Bras Cardiol 2018; 111:753-754. [PMID: 30484518 PMCID: PMC6248250 DOI: 10.5935/abc.20180219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 11/20/2022] Open
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Choi GJ, Song J, Kim YS, Lee H, Huh J, Kang IS. Outcomes of transcatheter closure of ductus arteriosus in infants less than 6 months of age: a single-center experience. KOREAN JOURNAL OF PEDIATRICS 2018; 61:397-402. [PMID: 30304903 PMCID: PMC6313084 DOI: 10.3345/kjp.2018.06548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. METHODS We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6-12 months in the same study period were reviewed. RESULTS A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was 3.3±1.5 months, and weight was 5.7±1.3 kg. The duct diameter at the narrowest point was 3.0±0.8 mm as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6-12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P<0.01). CONCLUSION A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.
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Affiliation(s)
- Gwang-Jun Choi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Seul Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heirim Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Interventionelle Kinderkardiologie – Entwicklungen, Trends und Grenzen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Liu J, Gao L, Tan HL, Zheng QH, Liu L, Wang Z. Transcatheter closure through single venous approach for young children with patent ductus arteriosus: A retrospective study of 686 cases. Medicine (Baltimore) 2018; 97:e11958. [PMID: 30170394 PMCID: PMC6393149 DOI: 10.1097/md.0000000000011958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective is to explore the feasibility and safety of transcatheter closure of patent ductus arteriosus (PDA) through single venous approach in Chinese young children.A total of 1088 patients aged between 9 months old to 3 years old who underwent transcatheter closure of PDA from May 2004 to May 2015 were retrospectively reviewed. All the procedures were under ultrasound monitoring. The shape and size of PDA as well as immediate therapeutic results were recorded by angiography and ultrasonography. The size of occluder was individually selected according to the smallest diameter of the PDAs. Echocardiography was respectively performed 3 days, 1month, 6 months, and 12 months after the procedure to evaluate the outcomes.Among the total 1088 children, transcatheter closure of PDA was accomplished through single venous approach that was performed in 686 cases. The average weight and age of the children were 10.9 ± 3.6 kg (5.0-14.3 kg) and 1.8 ± 1.6 years (9 months-3 years), respectively. The fluoroscopic time was about 5.1 to 11.6 minutes. Successful device placement with the initially selected occluder was achieved in 662 cases. In other 14 cases, the procedure was eventually completed after being replaced with a larger occluder; while in the other 10 cases, smaller occluders were applied to replace the initial ones. Technically, all the procedures were successfully performed. All the patients were followed up for 15.6 ± 8.2 years. No serious complications and death were observed during the follow-up.Transcatheter closure of PDA with occluder by single venous approach is an effective and reliable method in vast majority of young children.
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Abstract
The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.
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Affiliation(s)
- Sok-Leng Kang
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada.,Department of Pediatric Cardiology, Bristol Royal Hospital for Children, Bristol, BS2 OJJ, UK
| | - Lee Benson
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada
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