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Baruteau AE, Fraisse A, Butera G, Bautista-Rodriguez C. The Transcatheter Closure of Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants: Technique and Results. J Cardiovasc Dev Dis 2023; 10:476. [PMID: 38132644 PMCID: PMC10744056 DOI: 10.3390/jcdd10120476] [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: 09/25/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered as first-line therapy, although it carries a limited success rate and potential severe adverse events. In recent years, transcatheter patent ductus arteriosus closure has fast developed and become widely accepted as a safe and efficient alternative to surgical ductal ligation in extremely low birth weight infants >700 g, using most often the dedicated Amplatzer Piccolo Occluder device. This article aims to provide an appraisal of the patients' selection process, and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, CHU Nantes, Nantes Université, FHU PRECICARE, F-44000 Nantes, France
- CIC FEA 1413, INSERM, CHU Nantes, Nantes Université, F-44000 Nantes, France
- L’institut du thorax, INSERM, CNRS, CHU Nantes, Nantes Université, F-44000 Nantes, France
- UMR 1280, PhAN, INRAE, Nantes Université, F-44000 Nantes, France
| | - Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
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Van Pelt E, Reo R, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed During Infancy. Cardiol Ther 2022; 11:523-530. [PMID: 36074260 PMCID: PMC9652175 DOI: 10.1007/s40119-022-00278-2] [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: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure during infancy. METHODS Chart review was performed on patients who had a PDA closure at not more than 1 year of age between January 1, 2002 and June 1, 2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE at least 3 months after procedure, or had a velocity greater than 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE at least 3 months after device placement. Time points included the first TTE after the procedure, first TTE at least 3 months after procedure, and the most recent TTE. RESULTS Total of 147 infants met the inclusion criteria. Age and weight at initial procedure were 141 ± 217 days and 4.2 ± 2.8 kg. There was no significant difference in DAo velocity between initial and most recent TTE. LPA velocity and left ventricular diastolic Z score significantly decreased between initial and most recent TTE. Seventy-eight patients had repeat echocardiograms more than 1 year after PDA procedure with no change in clinical management. No patient underwent an intervention on the LPA or DAo for stenosis. CONCLUSION In patients who underwent an uncomplicated PDA closure during infancy, TTE parameters either stayed stable or improved over time. These findings need to be corroborated in larger studies with longer follow-up. If verified, the long-term TTE guidelines may need to be simplified for this patient population.
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Affiliation(s)
- Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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Reo R, Van Pelt E, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy. Cardiol Ther 2022; 11:445-452. [PMID: 35780440 PMCID: PMC9381662 DOI: 10.1007/s40119-022-00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure after infancy. Methods Chart review was performed on patients who had a PDA closure ≥ 1 year of age between 1/1/2002 and 6/1/2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE ≥ 6 months after procedure, had a residual PDA or velocity > 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE ≥ 6 months after device placement. Time points included the initial TTE after the procedure, first TTE ≥ 6 months after procedure, and the most recent TTE. Results A total of 189 patients met the study criteria. The median age and weight at initial procedure were 2.7 (1.0–64.7) years and 12.5 (3.4–69.2) kg. Most recent TTE was performed 2.0 (0.4–17.0) years after PDA closure. There were no significant differences in fractional shortening (36.4 ± 5.0% vs. 36.9 ± 5.6%) or LPA velocity (1.1 ± 0.4 m/s vs. 1.1 ± 0.4 m/s) from initial to most recent TTE, respectively. Left ventricular internal diastolic diameter Z-score significantly decreased (1.4 ± 1.8 vs. − 0.01 ± 1.2, p < 0.01) and DAo peak velocity significantly increased (1.2 ± 0.3 m/s vs. 1.3 ± 0.3 m/s, p = 0.02) from initial to most recent TTE, respectively. No patient died or underwent an intervention on the LPA or DAo for stenosis. Seventy-five patients had a total of 208 repeat TTE > 1 year after PDA procedure with no change in clinical management. Conclusions In patients who underwent an uncomplicated PDA closure after infancy, TTE parameters improved or stayed within normal limits on the most recent TTE. Repeat lifetime TTEs after 1-year post-device placement in this population may not necessarily be needed if there are no clinical concerns.
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Affiliation(s)
- Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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Transcatheter Device Therapy and the Integration of Advanced Imaging in Congenital Heart Disease. CHILDREN 2022; 9:children9040497. [PMID: 35455541 PMCID: PMC9032030 DOI: 10.3390/children9040497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
Transcatheter device intervention is now offered as first line therapy for many congenital heart defects (CHD) which were traditionally treated with cardiac surgery. While off-label use of devices is common and appropriate, a growing number of devices are now specifically designed and approved for use in CHD. Advanced imaging is now an integral part of interventional procedures including pre-procedure planning, intra-procedural guidance, and post-procedure monitoring. There is robust societal and industrial support for research and development of CHD-specific devices, and the regulatory framework at the national and international level is patient friendly. It is against this backdrop that we review transcatheter implantable devices for CHD, the role and integration of advanced imaging, and explore the current regulatory framework for device approval.
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Haddad RN, Bonnet D, Malekzadeh-Milani S. Embolization of vascular abnormalities in children with congenital heart diseases using medtronic micro vascular plugs. Heart Vessels 2022; 37:1271-1282. [PMID: 35088203 DOI: 10.1007/s00380-021-02007-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022]
Abstract
This study aimed at evaluating our experience with Micro Vascular Plug (MVP) for embolization of vascular abnormalities in children with congenital heart diseases (CHDs). MVP is one of the most recent additions to the armamentarium for peripheral embolization. Data on its use in congenital cardiology are scarce. Medical records of children with CHDs who had embolizations with MVPs between April 2015 and September 2020 were reviewed. Immediate and follow-up data were assessed. A total of 153 patients underwent 172 procedures during which 240 embolizations using 259 MVPs were attempted. Median age and weight were 34.9 months (IQR, 4-75 months) and 12.5 kg (IQR, 4.8-19.4 kg), respectively. Targets were abnormal systemic arteries (n = 163), patent arterial ducts (n = 26), venous (n = 45), and coronary-cameral fistulas (n = 6). Median vessel diameter was 3.3 mm (IQR, 2.5-4 mm). Veins were larger than arteries (2.3 mm > 2.1 mm, p < 0.01). MVPs were implanted in narrower diameters compared to manufacturer's recommendations. Compared to veins, solitary implanted MVPs in arteries were additionally oversized at 12.4%, 5.1%, and 7.9% for MVP-3Q, 5Q, and 7Q, respectively. Additional occlusion material (16.7%) and 2 MVPs (5.8%) were needed at the same site for complete closure. Implantation and procedure success rates were 99.2% and 96.7%, respectively. Five complications were treated percutaneously (n = 4) and surgically (n = 1). Efficacy of vascular embolization using MVPs was demonstrated in the largest cohort of children with CHDs and a variety of clinical settings. Immediate and stable closure is obtained with a single device in most cases. Detailed device selection chart according to vessel type and diameter is proposed to achieve intended outcomes.
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Affiliation(s)
- Raymond N Haddad
- Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France.
| | - Damien Bonnet
- Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France.,Université de Paris, Paris, France
| | - Sophie Malekzadeh-Milani
- Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France
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Guyon P, Duster N, Katheria A, Heyden C, Griffin D, Steinbergs R, Moreno Rojas A, Ratnayaka K, El-Said HG. Institutional Trend in Device Selection for Transcatheter PDA Closure in Premature Infants. Pediatr Cardiol 2022; 43:1716-1722. [PMID: 35430709 PMCID: PMC9587941 DOI: 10.1007/s00246-022-02903-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the Microvascular Plug, "MVP" (Medtronic, Minneapolis, MN); Micro Plug Set, "Micro Plug" (KA Medical, Minneapolis, MN); and Amplatzer Piccolo Occluder, "Piccolo" (Abbot, Santa Clara, CA). We also report trends in device selection over time. Studies examining outcomes according to device selection for PDA closure in premature infants are lacking. We performed a retrospective review of all percutaneous PDA closures in premature infants at a single center (June 2018-May 2021). Patients were grouped by initial device selected for PDA closure (intention to treat). Institutional Review Board approval was obtained. 58 premature infants [MVP (n = 25), Micro Plug (n = 25), and Piccolo (n = 8)] underwent successful transcatheter PDA closure (mean gestational age 27 weeks 2 days; mean weight at procedure 1.4 kg; mean age at procedure 28 days). Pre-procedural demographics, procedural data, and follow-up data were similar between groups. There were no significant procedural adverse events. Three devices (2 MVP, 0 Micro Plug, 1 Piccolo p = 0.27) embolized after the procedure. One other device was removed for concern for aortic obstruction. Device selection evolved with a clear trend toward the Micro Plug device over time. Demographic, procedural, and follow-up data were similar between the MVP, Micro Plug, and Piccolo groups. The Micro Plug did not require exchange for suboptimal fitting or embolize and became our preferred device in most cases.
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Affiliation(s)
- Peter Guyon
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA.
| | - Nicole Duster
- Department of Pediatrics, Rady Children's Hospital | UC San Diego School of Medicine, San Diego, CA, USA
| | - Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Caitlyn Heyden
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Danica Griffin
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Ronald Steinbergs
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Andres Moreno Rojas
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
| | - Howaida G El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital | UC San Diego School of Medicine, 3020 Children's Way MC #5004, San Diego, CA, 92123, USA
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