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Glynatsis MN, Economou M, Papadopoulou K, Mylona I. Pediatric Central Retinal Artery Occlusion Attributed to a Patent Ductus Arteriosus. Cureus 2024; 16:e61083. [PMID: 38919210 PMCID: PMC11196852 DOI: 10.7759/cureus.61083] [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] [Accepted: 05/25/2024] [Indexed: 06/27/2024] Open
Abstract
This report presents a rare case of a central retinal artery occlusion in an eight-year-old girl attributed to an undiagnosed patent ductus arteriosus (PDA). Despite intensive treatment, the patient's eyesight failed to improve. Cases of central retinal artery occlusion may occur in patients with undiagnosed, small PDA, with only symptomatic treatment being available.
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Affiliation(s)
- Mikes N Glynatsis
- Department of Ophthalmology, 'Hippokration' General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Marina Economou
- 1st Department of Pediatrics, 'Hippokration' General Hospital of Thessaloniki, Aristotle University, Thessaloniki, GRC
| | - Kalliopi Papadopoulou
- Department of Ophthalmology, 'Hippokration' General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Ioanna Mylona
- Department of Ophthalmology, General Hospital of Serres, Serres, GRC
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Souza GR, Barreto do Amaral A, Busch S, Villa Martignoni F. Natural History of a Disease: Patent Ductus Arteriosus Diagnosed on an Elderly Woman. Cureus 2023; 15:e49519. [PMID: 38156142 PMCID: PMC10753167 DOI: 10.7759/cureus.49519] [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] [Accepted: 11/26/2023] [Indexed: 12/30/2023] Open
Abstract
Patent ductus arteriosus (PDA) is a rare finding in adults. The ductus arteriosus (DA) is responsible for shunting blood from the pulmonary artery into the aorta bypassing the lungs in fetal life (the placenta is responsible for fetal oxygenated blood). Its closure happens after birth, once fetal circulation transitions to normal postnatal circulation and blood oxygenates in the lungs. If the DA does not close, the PDA may continue to shunt blood from the systemic (higher pressure) to the pulmonary (lower pressure) circulation causing remodeling of the left ventricle and eventually heart failure. A PDA is suspected when there is a systolic/diastolic murmur in the left sternal border; a transthoracic or transesophageal echocardiogram may visualize the shunt and measure the systemic/pulmonary shunt ratio. We described a case of an 84-year-old elderly woman who presented with an acute heart failure exacerbation as the first symptom of PDA and was found to have left ventricular hypertrophy, right ventricular hypertrophy, and pulmonary hypertension as the initial presentation.
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Affiliation(s)
| | | | - Sarah Busch
- Internal Medicine, University of Washington School of Medicine WWAMI, Lewistown, USA
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Najmafshar L, Abdolhosseini M, Tanasan A, Abdolhosseini M, Hosseini SK. Multimodality imaging in diagnosis and management of patent ductus arteriosus in an adult: a case report. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:272-277. [PMID: 37736355 PMCID: PMC10509450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Patent ductus arteriosus (PDA) is a congenital heart disorder in which a vascular structure between the pulmonary artery and the aorta remains open. PDA normally closes shortly after birth. The treatment in adults is surgical or transcatheter closure. A 47-year-old woman presented to our hospital with a diagnosis of PDA and was treated with transcatheter closure. Although the recovery period of adult patients is long, this patient recovered completely after one day.
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Affiliation(s)
- Leila Najmafshar
- Department of Cardiology, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
| | - Mansoreh Abdolhosseini
- Department of Molecular Medicine, School of Advanced Medical Technologies, Tehran University of Medical SciencesTehran, Iran
| | - Asadolah Tanasan
- Department of Pediatrics, Faculty of Medicine, Hamadan University of Medical SciencesHamadan, Iran
| | - Masoumeh Abdolhosseini
- Department of Cardiology, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
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Inuwa I, Ahmad J, Nurein T, Ishaq N, Miko Abdullahi M, Aliyu I. Patent ductus arteriosus in a Nigerian adult: A case report and overview of treatment modalities. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_332_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Saucedo-Orozco H, Vargas-Barrón J, Vázquez-Antona CA, Castillo-Castellón F. Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis. Anatol J Cardiol 2021; 25:774-780. [PMID: 34734810 DOI: 10.5152/anatoljcardiol.2021.36156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. METHODS A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. CONCLUSIONS Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.
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Affiliation(s)
- Huitzilihuitl Saucedo-Orozco
- Department of Cardioneumology, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social; Mexico City-México
| | - Jesús Vargas-Barrón
- Department of Pharmacology, Instituto Nacional de Cardiología Ignacio Chávez; Mexico City-México
| | - Clara A Vázquez-Antona
- Department of Pediatric Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez; Mexico City-México
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Domenighi LHH, Quoos GP, Braun SK, Vogel AAD, Dos Santos RB, Menegola VM. Alternative treatment for patent ductus arteriosus: a therapeutic challenge. J Vasc Bras 2021; 20:e20210085. [PMID: 34527037 PMCID: PMC8421033 DOI: 10.1590/1677-5449.210085] [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: 05/15/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022] Open
Abstract
The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency 3 months after birth is considered a congenital heart disease that, if untreated, can progress to serious cardiovascular complications. This report aims to review an alternative treatment with an aortic endoprosthesis in a 49-year-old man who presented with dyspnea on moderate exertion associated with a heart murmur. He was diagnosed with persistent ductus arteriosus (PDA) with cardiac complications. Clinical management was unsuccessful and surgical treatment was indicated. Endovascular treatment with a thoracic endoprosthesis was indicated and performed successfully. Percutaneous closure is the preferred method in adult patients. Endovascular intervention using an endoprosthesis is a safe and effective option, in addition to being applicable regardless of the anatomy of the PDA. This case demonstrates the natural history of the pathology and presents a safe and effective alternative for its management.
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Affiliation(s)
| | | | - Stela Karine Braun
- Universidade Franciscana - UFN, Santa Maria, RS, Brasil.,Hospital Universitário de Santa Maria - HUSM, Santa Maria, RS, Brasil.,Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brasil
| | | | | | - Vinícius Matos Menegola
- Universidade Franciscana - UFN, Santa Maria, RS, Brasil.,Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brasil
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Chinawa JM, Chukwu BF, Chinawa AT, Duru CO. The effects of ductal size on the severity of pulmonary hypertension in children with patent ductus arteriosus (PDA): a multi-center study. BMC Pulm Med 2021; 21:79. [PMID: 33663433 PMCID: PMC7934417 DOI: 10.1186/s12890-021-01449-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Patent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms. OBJECTIVES This study is therefore aimed at determining the relationship between gender, age, and size of PDA and pulmonary hypertension. This study also seeks to determine the prevalence of elevated pulmonary artery systolic pressure in children with PDA. PATIENTS AND METHODS A descriptive study of children with patent ductus arteriosus was carried out from 2016 to 2020 in three institutions. The data were analysed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago) RESULT: The mean ductal size was 3.78 (2.39) mm, with a minimum of 1.0 mm and a maximum size of 10.0 mm. The mean ductal size for males, 4.02 (2.53) mm was comparable with that of the females, 3.61 (2.28) mm (Student T-test = 0.8, 0.4). The mean pulmonary artery systolic pressure (PASP) of the patients was 43.36 (24.46) mmHg. Also the mean PASP was comparable among the males and the females, 48.37 (26.69) mmHg versus 39.63 (22.16) mmHg (Student T-test = 1.81, p = 0.07). There was no correlation between age and PASP (correlation coefficient = 0.009, p = 0.92). Sixty point two percent (60.2%) (62/103) of children with PDA had pulmonary hypertension. The proportion of males with pulmonary hypertension, 48.39% (30/62) was comparable with that of the females, 51.61% (32/62) (Chi2 = 2.05, p = 0.15) and females are 1.8 times more likely to have pulmonary hypertension as males (odds ratio 1.81, 95% CI 0.8-4.1). There was a positive correlation between ductal size and PASP (Pearson correlation coefficient = 0.26, p value = 0.007). Those with moderate and large sized duct tend to have moderate and severe pulmonary hypertension respectively and this is statistically significant. Chi2 = 17.85, p = 0.007 CONCLUSION: The prevalence of pulmonary hypertension in children with PDA is 60.2%. Moderate and large size duct presents with moderate and severe pulmonary hypertension respectively. Females are 1.8 times more likely to have pulmonary hypertension than the males.
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Affiliation(s)
- Josephat M. Chinawa
- Pediatric Cardiologist, College of Medicine, Department of Pediatrics, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
| | - Bartholomew F. Chukwu
- Department of Pediatrics, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Enugu State, Ituku-Ozalla, Nigeria
| | - Awoere T. Chinawa
- Enugu State University Teaching Hospital, Enugu, Enugu State Nigeria
| | - Chika O. Duru
- Department of Paediatrics and Child Health, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State Nigeria
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Tondas AE, Mulawarman R, Trifitriana M, Guyanto M, Pranata R, Komaria. Small residual patent ductus arteriosus after surgical ligation in young adult: to close or not to close - a dilemmatic case report. Pan Afr Med J 2021; 38:219. [PMID: 34046125 PMCID: PMC8140675 DOI: 10.11604/pamj.2021.38.219.22448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/10/2020] [Indexed: 11/11/2022] Open
Abstract
Percutaneous transcatheter closure has gained acceptance for patent ductus arteriosus (PDA) management ever since its introduction, including the management residual left-to-right shunts following surgical ligations. It is preferred than the more invasive surgical closure. While large PDA is closed to prevent heart failure, the decision to close a small hemodynamically insignificant PDA is still a debatable issue. We present a case of percutaneous transcatheter closure of small residual left-to-right shunt PDA using HeartR™ Lifetech PDA occluder with instantaneous closure in an asymptomatic adult patient. The justification of closure was made based on the previous history of infective endocarditis, followed by PDA ligation and endarterectomy surgery, at 1.5 year before admission.
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Affiliation(s)
- Alexander Edo Tondas
- Department of Cardiology and Vascular Medicine, Mohammad Hoesin General Hospital, Palembang, Sumatera Selatan, Indonesia.,Biomedicine Doctoral Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Rido Mulawarman
- Faculty of Medicine, Universitas Sriwijaya Palembang, Indonesia
| | | | - Moza Guyanto
- Faculty of Medicine, Universitas Sriwijaya Palembang, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Komaria
- Department of Cardiology and Vascular Medicine, Mohammad Hoesin General Hospital, Palembang, Sumatera Selatan, Indonesia
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Rat N, Muntean I, Opincariu D, Gozar L, Togănel R, Chițu M. Cardiovascular Imaging for Guiding Interventional Therapy in Structural Heart Diseases. Curr Med Imaging 2020; 16:111-122. [DOI: 10.2174/1573405614666180612081736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/05/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Development of interventional methods has revolutionized the treatment of structural
cardiac diseases. Given the complexity of structural interventions and the anatomical variability of
various structural defects, novel imaging techniques have been implemented in the current clinical
practice for guiding the interventional procedure and for selection of the device to be used. Three–
dimensional echocardiography is the most used imaging method that has improved the threedimensional
assessment of cardiac structures, and it has considerably reduced the cost of complications
derived from malalignment of interventional devices. Assessment of cardiac structures with
the use of angiography holds the advantage of providing images in real time, but it does not allow
an anatomical description. Transesophageal Echocardiography (TEE) and intracardiac ultrasonography
play major roles in guiding Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO)
closure and device follow-up, while TEE is the procedure of choice to assess the flow in the Left
Atrial Appendage (LAA) and the embolic risk associated with a decreased flow. On the other hand,
contrast CT and MRI have high specificity for providing a detailed description of structure, but
cannot assess the flow through the shunt or the valvular mobility. This review aims to present the
role of modern imaging techniques in pre-procedural assessment and intraprocedural guiding of
structural percutaneous interventions performed to close an ASD, a PFO, an LAA or a patent ductus
arteriosus.
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Affiliation(s)
- Nora Rat
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Iolanda Muntean
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Diana Opincariu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Liliana Gozar
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Rodica Togănel
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Monica Chițu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
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Amouzeshi A, Shakhsemampour B, Ganjifard M. A rare case of patent ductus arteriosus diagnosed during coronary artery bypass grafting operation in a 73-year-old man. ARYA ATHEROSCLEROSIS 2020; 15:250-252. [PMID: 31949452 PMCID: PMC6954356 DOI: 10.22122/arya.v15i5.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although patent ductus arteriosus (PDA) is more prevalent among infants and children, it might be seen among adults as well. It is not usually seen among adults, since it is often diagnosed and treated in childhood. CASE REPORT In the present case, a 73-year-old man referred to the hospital with symptoms including dyspnea, cold sweating, and chest pain with a burning nature which was lasting for 30 minutes. Angiography revealed coronary artery obstruction, so he became a coronary artery bypass grafting (CABG) candidate. Except for dilatation of the left atrium, no specific findings were reported in the patient's echocardiography report. When the pump was turned off by the surgeon, the patient's heart filled up and he was not able to get off the pump. Simultaneously, the patient started to have bloody respiratory secretions. With all that in mind, the surgeon suspected that he might suffer from a PDA, then he found an 8-mm PDA and closed it. Then, the patient was taken off the cardiorespiratory pump. CONCLUSION Although PDA is more common among children and infants, it can be found among adults according to previous cases and our case as well. Since patients with PDA refer to physicians for other clinical issues, it is recommended to apply more precision in diagnostic methods such as taking a good history, echocardiography, and electrocardiogram (ECG). Moreover, it is recommended that if a patient has conditions similar to our patient, the surgeon must be sure of a possible PDA.
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Affiliation(s)
- Ahmad Amouzeshi
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiac Surgery, Birjand University of Medical Sciences, Birjand, Iran
| | - Bibifatemeh Shakhsemampour
- Assistant Professor, Department of Anesthesiology, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmoud Ganjifard
- Assistant Professor, Department of Anesthesiology, Birjand University of Medical Sciences, Birjand, Iran
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Ambassa JC, Charles M, Jacques Cabral TT. Heart catheterization in adults in a sub-Saharan tertiary centre: 8 years' experience. Cardiovasc Diagn Ther 2019; 9:173-178. [PMID: 31143639 DOI: 10.21037/cdt.2018.11.07] [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: 11/06/2022]
Abstract
Background The goal of the investigation was to analyze the results of heart catheterization in the Cardiac centre Shisong from December 2010 till December 2017. Methods This retrospective study done in the Cardiac centre Shisong in adult patients that underwent a procedure in the catheterization laboratory from December 2010 till December 2017. Results Three hundred and sixty-five adult underwent a cardiac catheterization procedure during the study period. Among the patients, 126 were female while 239 were male. The mean age at presentation was 52.6±12.9 years old. Patients were coming from neighboring countries: Nigeria n=5 (1.3%), Tchad n=3 (0.8%), Equatorial Guinea n=4 (1%), Democratic republic of Congo n=2 (0.5%). Patients were also coming from all the ten regions of Cameroon: Littoral n=122 (33.2%), Centre n=127 (34.8%), North west n=47 (12.9%), South west n=17 (4.5%), West n=26 (7.1%), North n=7 (1.8%), Adamaoua n=8 (2.1%), Far North n=5 (1.3%), South n=2 (0.5%), East n=4 (1%). Depending on the type of procedures diagnostic coronarography in case with suspicion of coronary artery disease and presurgical coronarography were the main procedures done in 171 patients (46.8%) and in 146 patients (40%) respectively. Diagnostic coronarography was positive in 31 cases (8.4%). In patients with ischemic heart disease (IHD), percutaneous intervention with dilatation of the coronary arteries and implantation of stents was done in 19 cases (5.2%). The remaining 12 cases (3.2%) were having many lesions that could be managed only by coronary artery grafting surgery, done with success in all the cases. In grown up congenital heart disease patients, diagnostic catheterization was done in 48 cases meanwhile interventional catheterization: pulmonary artery valvuloplasty, patent ductus arteriosus (PDA) closure, atrial septal defect closure and decoarctation of the aorta were done in n=11 (3.4%), n=9 (2.4%), n=12 (3.2%), n=6 (1.6%) cases respectively. Conclusions Coronary heart disease was confirmed by angiography in 8.4% cases, and among grown up congenital heart disease 'patients, atrial septal defect was the pathology the most managed. Heart catheterization is done in the Cardiac centre Shisong with good results.
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Miraclin AT, Perumalla SK, Daniel J, Sathyendra S. Abiotrophia defectiva endarteritis with infective spondylodiscitis in an adult patient with patent ductus arteriosus. BMJ Case Rep 2017; 2017:bcr-2017-219295. [PMID: 28389466 DOI: 10.1136/bcr-2017-219295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Endarteritis is a major complication in patients with patent ductus arteriosus, causing significant morbidity and mortality. We report an adult patient with asymptomatic patent ductus arteriosus and endarteritis involving the main pulmonary artery and secondary infective spondylodiscitis at the L5-S1 intervertebral disc caused by Abiotrophia defectivaA. defectiva, commonly referred to as nutritionally variant streptococci, cannot be identified easily by conventional blood culture techniques from clinical specimens. Its isolation was confirmed by 16S ribosomal RNA sequencing. The patient was successfully managed with a combination of penicillin G and gentamicin, pending surgical repair of the patent ductus arteriosus.
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Affiliation(s)
- Angel T Miraclin
- Department of General Medicine, Christian Medical College and Hospital, Vellore, India
| | - Susmitha K Perumalla
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
| | - Jaifrin Daniel
- Department of General Medicine, Christian Medical College and Hospital, Vellore, India
| | - Sowmya Sathyendra
- Department of General Medicine, Christian Medical College and Hospital, Vellore, India
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A rare combination of left ventricular noncompaction, patent ductus arteriosus, and persistent left superior vena cava demonstrated by multidetector computed tomography and echocardiography. Heart Lung 2012; 41:e35-8. [DOI: 10.1016/j.hrtlng.2012.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 11/21/2022]
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Mathematical model of flow through the patent ductus arteriosus. J Math Biol 2012; 67:1487-506. [PMID: 23053537 DOI: 10.1007/s00285-012-0596-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 08/21/2012] [Indexed: 10/27/2022]
Abstract
The ductus arteriosus is one of several shunts in the cardiovascular system. It is a small vessel connecting the aortic arch and pulmonary artery that allows blood to bypass the pulmonary circulation. It is open during foetal development because the foetal lungs cannot function and oxygenation of the blood occurs by exchange with the maternal blood in the placenta. Normally it closes a few days after birth; however, in a small number of people closure does not occur, leading to a condition known as patent ductus arteriosus. In this paper our aim is to investigate the resulting cardiovascular effects. We develop a mathematical model of the haemodynamics in three different idealised geometries by assuming that the entry flow is irrotational and remains so in the core until at least the shunt position. We argue that separation or diffusion of vorticity into the core flow is delayed due to the high frequency associated with the pulsatile component of the flow profile. The analysis uses complex potential theory, Schwarz-Christoffel transformations, conformal mappings and Fourier series. The main results are based on the assumption that the flow in patients with patent ductus arteriosus is similar to the flow in healthy adults, and we apply this assumption using boundary conditions that are representative of physiological values in healthy adults. The model suggests that the pressures in the aorta and pulmonary artery are likely to equalise, that the shear stress increases near the edges of the shunt and that backflow of large volumes may occur from the pulmonary artery into the aorta or towards the ventricles due to the presence of the patent shunt. Our results strongly suggest that an abnormal compensatory physiology develops in patients with patent ductus arteriosus.
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Zhang XY, Cao TS, Yuan LJ, Liu J, Duan YY. Value of the echocardiographic suprasternal view for diagnosis of patent ductus arteriosus subtypes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1421-1427. [PMID: 22922622 DOI: 10.7863/jum.2012.31.9.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the value of the transthoracic echocardiographic suprasternal view in the diagnosis of patent ductus arteriosus subtypes. METHODS Sixty-five patients with a patent ductus arteriosus were examined using transthoracic echocardiographic suprasternal and parasternal views before ductus arteriosus closure. Diameters of the aortic and pulmonary sides of the ductus arteriosus were measured, and subtype diagnoses were made. The results were compared with those from digital subtraction angiography. RESULTS The mean diameters ± SD of the aortic side of the ductus arteriosus were 8.31 ± 2.76, 10.87 ± 3.26, and 11.15 ± 3.29 for the parasternal view, the suprasternal view, and digital subtraction angiography, respectively, whereas the diameters of the pulmonary side were 5.69 ± 2.82, 5.75 ± 2.63, and 6.09 ± 2.78 mm. Of the 65 cases, 12, 19, and 19 were the funnel-type patent ductus arteriosus as evaluated with the parasternal view, the suprasternal view, and digital subtraction angiography. Detection on the parasternal view was lower than that on the suprasternal view (χ(2) = 5.14; P < .025). CONCLUSIONS The diameter of the aortic side of a patent ductus arteriosus can be accurately detected on the superasternal view, which would be helpful for diagnosis of patent ductus arteriosus subtypes.
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Affiliation(s)
- Xiao-Yong Zhang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, 710038 Xi'an, China
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Navaratnarajah M, Mensah K, Balakrishnan M, Raja SG, Bahrami T. Large patent ductus arteriosus in an adult complicated by pulmonary endarteritis and embolic lung abscess. Heart Int 2011; 6:e16. [PMID: 22049313 PMCID: PMC3205782 DOI: 10.4081/hi.2011.e16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022] Open
Abstract
Patent ductus arteriosus in the adult is an extremely rare clinical phenomenon. We report the case of a 34-year old man who developed pulmonary endarteritis and subsequent embolic lung abscess secondary to a large patent ductus arteriosus. This brief report also provides an overview of the natural history, potential complications, optimal therapy, and diagnostic dilemmas associated with this persistent congenital cardiac defect in adults.
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Mazzotti G, Falconi M, Teti G, Zago M, Lanari M, Manzoli FA. The diagnosis of the cause of the death of Venerina. J Anat 2009; 216:271-4. [PMID: 19811565 DOI: 10.1111/j.1469-7580.2009.01151.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Venerina (little Venus) is the name given to a wax model representing a pregnant young woman that was created in Florence (Italy) by Clemente Susini (1754-1814) in 1782. It is currently located in the historic Science Museum of the University of Bologna. The model was constructed so as to enable removal of the thoracic and abdominal walls and various organs, exposing the heart, diaphragm and an opened uterus with a well-developed fetus. The woman is small, about 145 cm (4' 9') tall and of delicate build; she looks like a teenage girl. We know that Clemente Susini worked directly with the cadaver and copied the anatomical preparation exactly. This artist often represented the true structure using a wax mould; the existence of two other versions of this specimen suggests that this model was made in this way. Therefore, Venerina's body may be a faithful representation of a young woman who died while pregnant. Observation of the body confirms that the organs are normal, except for the heart and great vessels. The walls of both ventricles are of equal thickness and the ventricles themselves of approximately equal size. The arch of the aorta and the enlarged pulmonary trunk are connected by a short duct about 3.5 mm in diameter. If this structure represents an open arterial duct, we can deduce that the two ventricles worked under the same conditions of blood pressure, hence their equal wall thickness. If the young woman died from this congenital disease, the cause of death has been diagnosed on a wax model of her body after more than two centuries.
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Affiliation(s)
- Giovanni Mazzotti
- Department of Scienze Anatomiche Umane e Fisiopatologia dell'Apparato Locomotore, University of Bologna, Bologna, Italy.
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van der Wall EE. Case history: more than a beauty case!: A case for case histories. Neth Heart J 2008; 16:235-6. [PMID: 18711607 DOI: 10.1007/bf03086151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wiyono SA, Witsenburg M, de Jaegere PPT, Roos-Hesselink JW. Patent ductus arteriosus in adults: Case report and review illustrating the spectrum of the disease. Neth Heart J 2008; 16:255-9. [PMID: 18711613 PMCID: PMC2516289 DOI: 10.1007/bf03086157] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Patent ductus arteriosus (PDA) is a congenital heart defect in which the ductus arteriosus, a vascular structure between the pulmonary artery and the aorta that normally closes shortly after birth, remains open. We present two cases of adults with PDA. A 28-year-old lady had a small PDA without any symptoms or left heart overload. The PDA was closed for endocarditis prevention using a coil. In a 37-year-old lady with palpitations, collapse, dyspnoea and left heart overload caused by a large PDA, percutaneous closure of the PDA was performed with an Amplatzer device. Transcatheter closure has been established to be the method of choice for treating a PDA in adults. (Neth Heart J 2008;16:255-9.).
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Affiliation(s)
- S A Wiyono
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
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