1
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Pinto FF. Percutaneous closure of patent ductus arteriosus: A standard procedure with new perspectives. Rev Port Cardiol 2021; 40:569-571. [PMID: 34392899 DOI: 10.1016/j.repce.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fátima F Pinto
- Universidade NOVA de Lisboa, Serviço de Cardiologia Pediátrica, Centro de Referência de Cardiopatias Congénitas, CHULC, EPE - Hospital de Santa Marta, Portugal.
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2
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Blissett S, Agrawal H, Kheiwa A, Caughron H, Harris IS, Agarwal A, Foster E, Mallawaarachchi I, Mahadevan VS. Cardiac remodeling in adults following percutaneous PDA closure: A meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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3
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Percutaneous patent ductus arteriosus closure: Twelve years of experience. Rev Port Cardiol 2021; 40:561-568. [PMID: 34392898 DOI: 10.1016/j.repce.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Patent ductus arteriosus, a persistent communication between the descending thoracic aorta and the pulmonary artery, is one of the most common congenital heart defects. Transcatheter occlusion is an effective alternative to surgery and is currently standard of care for most patients. The authors present the results from a single center after twelve years of experience using this technique. METHODS Retrospective analysis of medical records from all patients referred to a tertiary center for percutaneous ductus closure between January 2006 and September 2018. RESULTS A total of 221 patients were referred, with a mean age of 5.5 years-old (16 patients were infants, with the youngest aged four months). A Nit-Occlud® coil was used 139 times (62.9%), an Amplatzer™ duct occluder 79 times (35.7%), and vascular plugs were used three times. Percutaneous closure was achieved in every treated patient, with 1.4% maintaining residual shunting. Although higher overall coil device implantation was noted, duct occluder usage has been greater since 2011. Of all the coils, 55% were either 4x4 or 5x4 mm, and 73% of all Amplatzer duct occluders were either 6x4 or 8x6 mm, which correlates to the majority of patients having a small to moderately sized ductus. No complications were noted during the procedure, with a 1.8% post-procedure complication rate (one device embolization after 48 hours and three cases of loss of arterial pulse). CONCLUSIONS Percutaneous patent ductus arteriosus closure was safe and effective in this setting, with a low global complication rate and similar outcomes to most equivalent centers.
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4
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Khajali Z, Firouzi A, Shakerian F, Alemzadeh-Ansari MJ, Ghobadi E, Khalilipur E, Khalili Y, Rezaei L, Hosseini Z. Cardiac Reverse Remodeling After Transcatheter Patent Ductus Arteriosus Closure in Adults. Curr Probl Cardiol 2021; 47:100938. [PMID: 34400002 DOI: 10.1016/j.cpcardiol.2021.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
Whereas most patent ductus arteriosus (PDAs) are identified and treated in the childhood, and the long term outcome studies have approved the outstanding results (positive cardiac reverse remodeling) in these group of patients, the outcome of percutaneous PDA closure in adults is not comprehensible. The aim of this retrospective cohort study which consecutively recruited 121 adult patients (age >16 years) who underwent the transcatheter closure (TCC) of PDAs between 2012 and 2018 is, evaluation at least 1-year follow-up of adult patients after PDA closure and compare the hemodynamic and the cardiac reverse remodeling findings with the previous studies in adults and children.
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Affiliation(s)
- Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Shakerian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ghobadi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Khalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Rezaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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5
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Pinto FF. Percutaneous closure of patent ductus arteriosus: A standard procedure with new perspectives. Rev Port Cardiol 2021. [PMID: 34303579 DOI: 10.1016/j.repc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Fátima F Pinto
- Universidade NOVA de Lisboa, Serviço de Cardiologia Pediátrica, Centro de Referência de Cardiopatias Congénitas, CHULC, EPE - Hospital de Santa Marta, Portugal.
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6
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Antunes Sarmento J, Correia-Costa A, Gonçalves E, Baptista MJ, Silva JC, Moreira J. Percutaneous patent ductus arteriosus closure: Twelve years of experience. Rev Port Cardiol 2021. [PMID: 33994045 DOI: 10.1016/j.repc.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patent ductus arteriosus, a persistent communication between the descending thoracic aorta and the pulmonary artery, is one of the most common congenital heart defects. Transcatheter occlusion is an effective alternative to surgery and is currently standard of care for most patients. The authors present the results from a single center after twelve years of experience using this technique. METHODS Retrospective analysis of medical records from all patients referred to a tertiary center for percutaneous ductus closure between January 2006 and September 2018. RESULTS A total of 221 patients were referred, with a mean age of 5.5 years-old (16 patients were infants, with the youngest aged four months). A Nit-Occlud® coil was used 139 times (62.9%), an Amplatzer™ duct occluder 79 times (35.7%), and vascular plugs were used three times. Percutaneous closure was achieved in every treated patient, with 1.4% maintaining residual shunting. Although higher overall coil device implantation was noted, duct occluder usage has been greater since 2011. Of all the coils, 55% were either 4x4 or 5x4 mm, and 73% of all Amplatzer duct occluders were either 6x4 or 8x6 mm, which correlates to the majority of patients having a small to moderately sized ductus. No complications were noted during the procedure, with a 1.8% post-procedure complication rate (one device embolization after 48 hours and three cases of loss of arterial pulse). CONCLUSIONS Percutaneous patent ductus arteriosus closure was safe and effective in this setting, with a low global complication rate and similar outcomes to most equivalent centers.
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Affiliation(s)
- João Antunes Sarmento
- Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Ana Correia-Costa
- Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Edite Gonçalves
- Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Maria João Baptista
- Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - João Carlos Silva
- Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Jorge Moreira
- Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
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Yasuhara J, Kuno T, Kumamoto T, Kojima T, Shimizu H, Yoshiba S, Kobayashi T, Sumitomo N. Comparison of transcatheter patent ductus arteriosus closure between children and adults. Heart Vessels 2020; 35:1605-1613. [PMID: 32494943 DOI: 10.1007/s00380-020-01639-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
The data comparing the characteristics and effect of transcatheter patent ductus arteriosus (PDA) closure between children and adults is scarce. We analyzed 54 consecutive patients who underwent transcatheter PDA closures. We divided the patients into 2 groups of < 18 years and ≥ 18 years and compared the hemodynamic changes before and after the PDA closure. Adults had a higher incidence of heart failure on admission, diagnoses by heart failure and incidental echocardiography, PDA calcifications, and procedural complications than children (all P < 0.05). The left ventricular end-diastolic volume index (LVEDVI), left atrial diameter index (LADI), and LV mass index (LVMI) decreased after the PDA closure in children but not in adults. The LV ejection fraction (LVEF) significantly decreased 1 day after the PDA closure in both groups but remained low at 6 months after the procedure in only adults. The percent change in the LVEDVI, LADI, LVMI, and LVEF from baseline to 6 months after the procedure was significantly lesser in adults than children (LVEDVI: - 5.2 ± 29.1% vs. - 34.9 ± 18.9%, LADI: - 7.0 ± 13.2% vs. - 22.1 ± 18.9%, LVMI: - 11.0 ± 16.5% vs. - 34.1 ± 15.7%, LVEF: - 5.9 ± 7.6% vs. 6.1 ± 9.1%, all P < 0.05). Transcatheter PDA closure was not associated with a reduction in the LV and LA volume as well as an improvement in the LV hypertrophy and LV function in adults as compared to children. We suggested that an early diagnosis and transcatheter PDA closure during childhood might provide clinical benefit before progressive LV remodeling and heart failure.
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Affiliation(s)
- Jun Yasuhara
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Center for Cardiovascular Research and Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Takashi Kumamoto
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Department of Pediatrics, Saga University Hospital, Saga, Japan
| | - Takuro Kojima
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Hiroyuki Shimizu
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Department of Intensive Care, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Shigeki Yoshiba
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.
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P S, Jose J, George OK. Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults. Indian Heart J 2017; 70:308-315. [PMID: 29716712 PMCID: PMC5993916 DOI: 10.1016/j.ihj.2017.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/18/2017] [Accepted: 08/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. Methods This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Results Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. Conclusions In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.
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Affiliation(s)
- Sudhakar P
- Department of Cardiology, Christian Medical College Hospital, Vellore, India.
| | - John Jose
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
| | - Oommen K George
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
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Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome. Cardiol Young 2017; 27:26-36. [PMID: 27133447 DOI: 10.1017/s1047951115002772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients with large patent arterial ducts and severe pulmonary hypertension, the natural history of progression of pulmonary hypertension is very variable. Whether to close or not to close is often a difficult decision, as there are no established haemodynamic parameters predicting reversibility. OBJECTIVES The objectives of this study were to evaluate the results of device closure of large patent arterial ducts with severe pulmonary hypertension after 2 years of age and to determine haemodynamic variables associated with its regression during long-term follow-up. METHODS A total of 45 patients, with median age of 10 (2-27) years, with large patent arterial ducts and severe pulmonary hypertension, were considered. Haemodynamic variables were assessed in air, oxygen, and after occlusion. The follow-up was performed to assess regression of pulmonary hypertension. RESULTS Device closure was successful in 43 (96%) patients. Pulmonary artery systolic and mean pressures decreased from 79 to 67 mmHg and from 59 to 50 mmHg, respectively (p25% (both in oxygen) (p=0.007). CONCLUSIONS Device closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.
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10
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Feng J, Kong X, Sheng Y, Yang R. Patent ductus arteriosus with persistent pulmonary artery hypertension after transcatheter closure. Ther Clin Risk Manag 2016; 12:1609-1613. [PMID: 27843323 PMCID: PMC5098547 DOI: 10.2147/tcrm.s112400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To observe the change in pulmonary artery systolic pressure (PASP) of patients with persistent pulmonary arterial hypertension (PAH) after patent ductus arteriosus (PDA) occlusion. Background After occlusion of PDA in patients with PAH, some patients still tend to suffer from persistent PAH. Methods A chest X-ray, an electrocardiogram, and an echocardiogram were performed on nine patients at 24 hours, 1 and 6 months, and 1 year serially. Results There was a significant fall (P<0.05) in mean PASP after occlusion (to 59.3±12.7 mmHg). However, the aortic pressure and systemic arterial oxygen saturation changed slightly (P>0.05). During the follow up, there was a further fall in the PASP in five patients (No 1, 5, 6, 7, and 8). Four patients (No 2, 3, 4, and 8) showed the evidence of worsening PAH and were treated with sildenafil. Patient 2 died from acute right heart failure after a period of 11 months from the time of transcatheter closure, triggered by pulmonary infection. Conclusion Some patients with borderline hemodynamic data with PDA and PAH can deteriorate or keep sustained PAH after PDA closure. The treatment of permanent closure to these patients must be cautious.
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Affiliation(s)
- Jianqi Feng
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu; Department of Cardiology, the Second Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, People's Republic of China
| | - Xiangqing Kong
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Yanhui Sheng
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Rong Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
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Tefera E, Qureshi SA, Bermudez-Cañete R, Rubio L. Percutaneous closure of patent arterial ducts in patients from high altitude: a sub-Saharan experience. Ann Pediatr Cardiol 2015; 8:196-201. [PMID: 26556965 PMCID: PMC4608196 DOI: 10.4103/0974-2069.164690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: At high altitude, patent arterial ducts tend to be larger and associated with pulmonary hypertension. Patent ductus arteriosus device closure in this background could be challenging. Objectives: We report our experience with percutaneous closure of patent arterial ducts using a variety of devices in patients residing in a high altitude. Patients and Methods: This is a retrospective review of the case records of 145 patients (age 9 months-20 years, mean 5.6 ± 3.9 years, and weight 7-54 kg, mean 17.7 ± 9.4) with duct sizes ranging between 2 and 21 mm, (mean, 5.8 ± 2.7) who underwent percutaneous closure of patent arterial ducts. One hundred thirty-six (93.8%) of the patients were from a geographic area of 2100-2800 m above sea level. Results: Successful device closure was achieved in 143 cases. It was difficult to achieve device stability in two patients with expansile ducts. Therefore, they were treated surgically. The devices used were various types of duct occluder devices in 131 patients, while atrial and ventricular septal occluders were used in eight patients. For the group, mean systolic pulmonary artery (PA) pressure decreased from 47.0 ± 16.7 mmHg before occlusion to 29.0 ± 7.4 mmHg after occlusion (P ≤ 0.001)., mean diastolic PA pressure from 25.0 ± 10.9 mmHg to 14.8 ± 6.0 mmHg and the average mean PA pressure decreased from 35.9 ± 13.5 mmHg to 21.1 ± 6.5 mmHg. Complications (4.8%) included device and coil embolization, bleeding, and pulse loss. On follow-up (mean duration of 36.1 ± 12.1 months, range 12-62 months), 137 patients were in functional class 1, 3 had residual shunt, 2 had device migration and one patient had persisting pulse loss. Conclusions: Successful duct closure was achieved in the vast majority of patients, even though the ducts were larger and significant number of them had pulmonary hypertension in this high altitude group. There was a relatively higher incidence of residual shunts and device migration in this series, generally due to the nonavailability of optimal device and surgical support. Long-term follow-up is required before we can draw conclusions with regard to the sustainability of drop in PA pressures. Septal Occluder devices may be a possible alternative for large tubular or window-type ducts with severe pulmonary hypertension, where there may be concerns about the size and stability of duct occluder devices.
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Affiliation(s)
- Endale Tefera
- Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University and Cardiac Center, Addis Ababa, Ethiopia
| | - Shakeel A Qureshi
- Department of Pediatric Cardiology, Evelina London Children's Hospital, Guys and St. Thomas' Foundation Trust, London, UK
| | - Ramòn Bermudez-Cañete
- Department of Pediatric Cardiology, Ramon y Cajal University Hospital, Madrid, Spain
| | - Lola Rubio
- Department of Pediatric Cardiology, La Paz Hospital, Madrid, Spain
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Behjati-Ardakani M, Rafiei M, Behjati-Ardakani MA, Vafaeenasab M, Sarebanhassanabadi M. Long-term Results of Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults with Amplatzer Duct Occluder. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:208-11. [PMID: 26110132 PMCID: PMC4462816 DOI: 10.4103/1947-2714.157478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter closure of patent ductus arteriosus (PDA) with the Amplatzer ductal occluder (ADO) has become a standard procedure in most pediatric patients. However, experience in adults and adolescents is limited. Our experience of transcatheter closure of PDA with ADO in adolescents and adults is presented in this study. AIMS The aim of this study was to investigate long-term outcomes of transcatheter closure of PDA in adolescents and adults with ADO. MATERIALS AND METHODS In this study, 69 patients (52 females and 17 males) with PDA underwent transcatheter closure between May 2004 and October 2012. The procedure was performed under fluoroscopic guidance. Chest radiograph, electrocardiogram, transthoracic echocardiography (TTE), and clinical assessment of the patients were conducted before the procedure. Clinical and echocardiographic follow-ups were performed on day 1 of the 1st month, 6(th) month, and 12(th) month and then yearly after the procedure. RESULTS The mean and standard deviation age of the patients was 18.08 ± 7.25 years (ranging 10-38 years). The mean and standard deviation angiographic diameter of PDA was 7.78 ± 2.78 mm. The mean and standard deviation size of the implanted device was 9.3 ± 2.9. The mean and standard deviation average pulmonary artery pressure was 32.1 ± 14.2 mmHg. The mean pulmonary flow/systemic flow ratio was 2.2 ± 0.61. The devices were successfully implanted in all patients (100%). Immediately after device implantation, 47 patients had residual shunts. The residual shunts disappeared in all the patients, except for one that lingered until 24 h after the procedure. No severe complication occurred at the immediate and long-term follow-ups. CONCLUSIONS The long-term results suggested that transcatheter closure of PDA with ADO is a safe and effective treatment for adolescents and adults with PDA. Low complication rates and short hospital stays make this procedure the treatment of choice in most cardiovascular centers worldwide.
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Affiliation(s)
| | - Mansour Rafiei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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13
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Behjati-Ardakani M, Behjati-Ardakani MA, Hadadzadeh M, Moshtaghion SH, Sarebanhassanabadi M. Experience with percutaneous closure of ductus arteriosus using the Amplatzer duct occluder in 243 consecutive patients and long-term results-A single centre study. Niger Med J 2014; 55:394-8. [PMID: 25298604 PMCID: PMC4178336 DOI: 10.4103/0300-1652.140379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Percutaneous closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder (ADO) has become increasingly popular in many cardiovascular centres. This study analysed the long-term results of percutaneous closure of PDA with ADO in a single centre. Materials and Methods: Between May 2004 and January 2013, 243 patients with median age of 2.5 years (range = 30 months to 38 years) and median weight of 10 Kg (range 4.5–80.5 Kg) underwent percutaneous closure of PDA using the ADO. The devices were implanted under fluoroscopic guidance. Patients were followed-up for any complications. Results: The mean diameter of narrow part of PDA was 6.4 ± 2.2 mm. The mean diameter of devices was 7.8 ± 2.3 mm. The devices were successfully implanted in 239 (98.3%) cases. At immediate, 1 day, 1, 6, 12 months and late follow-up, the complete occlusion rate was 33% (79 case), 97.1% (236 case), 97.5% (237 case), 98.3% (238 case), 98.3% (238 case) and 98.3% (238 case), respectively. Residual shunt remained in one case at late follow-up. The device embolisation occurred in five patients. The devices were successful retrieved in three patient and second larger devices were inserted. Two other devices were surgically retrieved and PDAs were ligated. Moderate left pulmonary artery stenosis (LPA) in one child and mild LPA stenosis in one infant were detected. Mild aortic obstruction occurred in one infant. Conclusions: Long-term follow-up of patients indicate that percutaneous closure of PDA using ADO is a safe and effective procedure. However, some complications, including device embolisation, left pulmonary stenosis and aortic obstruction may be observed in some cases.
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Affiliation(s)
| | | | - Mehdi Hadadzadeh
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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14
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Zhang DZ, Zhu XY, Lv B, Cui CS, Han XM, Sheng XT, Wang QG, Zhang P. Trial Occlusion to Assess the Risk of Persistent Pulmonary Arterial Hypertension After Closure of a Large Patent Ductus Arteriosus in Adolescents and Adults With Elevated Pulmonary Artery Pressure. Circ Cardiovasc Interv 2014; 7:473-81. [PMID: 25097200 DOI: 10.1161/circinterventions.113.001135] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Duan-zhen Zhang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xian-yang Zhu
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Bei Lv
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Chun-sheng Cui
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xiu-min Han
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xiao-tang Sheng
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Qi-guang Wang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Po Zhang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
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Xu XD, Bai Y, Chen XL, Liu SX, Zhao XX, Qin YW. Simultaneous transcatheter treatment of perimembranous ventricular septal defect and other congenital cardiopathies. Heart Lung Circ 2014; 23:1169-74. [PMID: 24998101 DOI: 10.1016/j.hlc.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/17/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of simultaneous transcatheter corrections of perimembranous ventricular septal defect (VSD) and other congenital cardiopathies. PATIENTS/METHODS From 2004 to 2012, 56 patients (25 male, 31 female), aged 14.2±10.1, with compound congenital cardiovascular abnormalities underwent simultaneous transcatheter interventional procedure. Of the 56 patients, 32 had VSD and atrial septal defects (ASD); 17 had VSD and patent ductus arteriosus (PDA); and seven had VSD and pulmonary valve stenosis (PS). Percutaneous balloon pulmonary valvuloplasty (PBPV) was performed before the closure of VSD, PDA, or ASD. RESULTS The combined transcatheter interventional procedure was successfully performed in all patients. Among these, two occluders were implanted in each of 49 patients, seven patients with VSD combined with PS underwent successfully balloon valvuloplasty and VSD closure. The size of VSD, ASD and PDA detected by TTE was 4.8±1.7 mm, 9.0±5.0 mm and 4.5±2.5 mm, respectively. The occluder diameter of VSD, ASD and PDA was 7.6±2.2 mm, 14.3±6.2 mm and 7.9±3.2 mm, respectively. The peak-to-peak transpulmonary gradient decreased from 60.4±19.7 mmHg to 15.0±5.0 mmHg (p<0.001) in seven patients with VSD combined with PS. One patient with VSD and ASD had a permanent pacemaker implanted because of third-degree atrioventricular block two months after the procedure. There were not serious adverse events in relation to the combined procedures during the 23.8±20.7 months of follow-up in other 55 patients. CONCLUSION The simultaneous treatment of VSD and other congenital cardiopathies using transcatheter-based procedures is safe and effective, which can provide satisfactory results.
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Affiliation(s)
- Xu-Dong Xu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China
| | - Yuan Bai
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China
| | - Xiao-Li Chen
- Department of Cardiology, First People's Hospital of Nantong, Nantong 226001, Jiangsu Province, PR China
| | - Su-Xuan Liu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China
| | - Xian-Xian Zhao
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
| | - Yong-Wen Qin
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
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Karakurt C, Elkıran O, Celik SF, Koçak G. Transcatheter closure of a large patent ductus arteriosus with severe pulmonary arterial hypertension in a child. Herz 2013; 38:685-8. [PMID: 23861127 DOI: 10.1007/s00059-012-3738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 11/23/2012] [Accepted: 12/02/2012] [Indexed: 11/28/2022]
Affiliation(s)
- C Karakurt
- Department of Pediatric Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey,
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Li P, Chen F, Zhao X, Zheng X, Wu H, Chen S, Qin Y. Occurrence and clinical significance of in-hospital acquired thrombocytopenia in patients undergoing transcatheter device closure for congenital heart defect. Thromb Res 2012; 130:882-8. [PMID: 23026381 DOI: 10.1016/j.thromres.2012.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/12/2012] [Accepted: 09/03/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acquired thrombocytopenia in patients treated by percutaneous coronary intervention is associated with hemorrhagic complications and prolonged in-hospital stay. This study sought to study the prevalence of thrombocytopenia in patients who underwent transcatheter device closure for congenital heart defect (CHD) and its relationship with clinical consequences. METHODS AND RESULTS 299 patients with CHD who underwent successful transcatheter closure were prospectively studied. Thrombocytopenia developed in 135 (45.2%) patients; n=100 (33.4%) mild (100-150 × 10(9)/L), n=25 (8.4%) moderate (50-100 × 10(9)/L), and n=10 (3.3%) severe (P<50 × 10(9)/L), respectively. From baseline, platelet counts tended to decrease on the 1st day after the procedure and reached a nadir level on the 3rd day, then gradually recovered to baseline values on the 9th day. By multivariate analysis, severe thrombocytopenia developed more frequently in patients who had larger device size (OR 2.755, P=0.000), and residue shunt (OR 2.069, P=0.009). Patients who developed thrombocytopenia, compared with those who did not, had higher in-hospital rates of hemorrhagic complications (11.9% vs. 3.0%, P<0.003), greater requirement for elevating platelet medical treatment or platelet transfusion (4.4% vs. 0, P=0.021), longer hospital stay (median 14 vs. 9 days, P<0.001). Severe thrombocytopenia was an independent predictor of hemorrhagic complications (hazard ratio 8.083, 95% CI 4.021-16.237, P=0.001). Compare with patients without thrombocytopenia, bleeding events were markedly increased (11.9% vs. 3.0%, P=0.003) in those with thrombocytopenia during hospitalization. CONCLUSION The size of occluder and other risk factors are independently associated with thrombocytopenia. Thrombocytopenia provides prognostic information, related to increased bleeding events.
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Affiliation(s)
- Pan Li
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Mori Y, Takahashi K, Nakanishi T. Complications of cardiac catheterization in adults and children with congenital heart disease in the current era. Heart Vessels 2012; 28:352-9. [PMID: 22457096 DOI: 10.1007/s00380-012-0241-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/17/2012] [Indexed: 12/13/2022]
Abstract
The number of adults with congenital heart disease (CHD) requiring diagnostic and/or therapeutic cardiac catheterization has been increasing. However, there have been few studies on the complications of performing cardiac catheterization in adults with CHD. The aim of this study was to determine the incidence of complications during congenital cardiac catheterization in both adults and pediatric patients. A total of 2134 consecutive cardiac catheterizations performed between 2003 and 2008 were prospectively analyzed. Complications were graded from 1 to 5 based on severity and these, with ≥ grade 3 being defined as major. During the study period, 576 procedures (393 diagnostic, 90 interventional, and 93 electrophysiological) were performed in adult patients (≥ 18 years). Complex heart disease was present in 435 of 576 procedures (75.6 %). A total of 65 complications (11.3 %) with 13 major complications including 1 death (2.3 %) were encountered. The most common complications were arrhythmias. The majority of complications were successfully treated or temporary, and all but one of the patients were without residua. Of the 1558 pediatric procedures performed during the same period, we found a total of 229 complications (14.7 %), of which 89 (5.7 %) were major complications including 5 deaths. The safety of performing cardiac catheterization for adult CHD appears to be similar to that for pediatric patients. The complication rates in adults with CHD are low, but not negligible.
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Affiliation(s)
- Yoshiki Mori
- Department of Pediatric Cardiology, The Heart Institute, Tokyo Women's Medical University, Tokyo, Japan.
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Hayman M, Forrest P, Kam P. Anesthesia for Interventional Cardiology. J Cardiothorac Vasc Anesth 2012; 26:134-47. [DOI: 10.1053/j.jvca.2011.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Indexed: 01/17/2023]
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Numasawa Y, Kawamura A, Hashimoto S, Endo A, Yuasa S, Maekawa Y, Kuribayashi S, Fukuda K. Successful percutaneous coil embolization of coronary-pulmonary, -carotid, and -internal mammary artery fistulas. Heart Vessels 2011; 27:331-6. [PMID: 21735204 DOI: 10.1007/s00380-011-0172-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 06/17/2011] [Indexed: 01/01/2023]
Abstract
We herein describe a 57-year-old man with coronary-pulmonary artery fistulas that had abnormal connections between the left common carotid artery and the left internal mammary artery. The patient was treated with percutaneous coil embolization using antegrade (via the coronary artery) and retrograde (via the pulmonary artery) approaches. Coronary artery fistulas have diverse anatomical variations, and it is important to thoroughly evaluate the anatomy before beginning any mode of treatment, surgical or endovascular. In the case reported herein, multislice computed tomography played a pivotal role in the preprocedure evaluation.
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Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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Wei Y, Wang X, Zhang S, Hou L, Wang Y, Xu Y, Sun Q, Zhao H. Transcatheter closure of perimembranous ventricular septal defects (VSD) with VSD occluder: early and mid-term results. Heart Vessels 2011; 27:398-404. [PMID: 21618026 DOI: 10.1007/s00380-011-0153-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 04/22/2011] [Indexed: 01/09/2023]
Abstract
Results of perimembranous ventricular septal defects (pmVSD) transcatheter closure have been reported in the literature, mostly with the Amplatzer VSD device (muscular or eccentric) (AGA Medical Corp., Golden Valley, MN, USA). However, the data of percutaneous closure of pmVSD with VSD occluder (VSD-O) made in China are still limited. We sought to analyze the safety, efficacy, and follow-up results of percutaneous closure of pmVSD with VSD-O made in China. Seventy-eight patients underwent percutaneous closure of pmVSD at our institution between February 2005 and June 2007. A VSD device made in china (Huayishengjie Medical Corp., Beijing, China) was used in all subjects. The mean age at closure was 11 years (range 2.5-44 years). The attempt to place the device was successful in 74 patients (94.9%). The median device size used was 8 mm (range 5-16 mm). No deaths occurred. Total occlusion rate was 62.8% at completion of the procedure, rising to 87.2% at discharge and 99% during the follow-up. A total of eight early complications occurred (10.3%), but in all subjects these were transient. The median follow-up was 32 months. The most significant complication was complete atrioventricular block (cAVB) in the early phase (five subjects, 6.4%) and during the follow-up (one subject, 1.3%), and there was no need for pacemaker implantation in six subjects. Logistic regression analysis showed that the only variable significantly associated with the occurrence of this complication was age at the time of the procedure (p = 0.025; OR 0.22). All subjects experiencing this problem were <5 years old. Percutaneous pmVSD closure used VSD-O made in China is associated with excellent success and closure rates, no mortality, and low morbidity. Nowadays, pmVSD percutaneous closure is a valuable alternative to surgery. Longer follow-up data and improvements in device characteristics are needed to reduce the risk of cAVB.
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Affiliation(s)
- Yidong Wei
- Department of Cardiology, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Road, Shanghai 200072, China.
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