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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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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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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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Clinical Outcomes After Percutaneous Patent Ductus Arteriosus Closure in Adults. Can J Cardiol 2020; 36:837-843. [DOI: 10.1016/j.cjca.2019.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/05/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
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Transcatheter Closure of Patent Ductus Arteriosus in Elderly Patients: Initial and One-Year Follow-Up Results-Do We Have the Proper Device? J Interv Cardiol 2020; 2020:4585124. [PMID: 32410916 PMCID: PMC7206884 DOI: 10.1155/2020/4585124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Patent ductus arteriosus (PDA) in elderly patients is an uncommon anomaly, and the duct itself is often calcified and fragile; therefore, transcatheter closure is more difficult. The aim is to analyse periprocedural and one-year follow-up results of transcatheter closure of PDA in such patients. Methods and results. Retrospective analysis of 33 elective patients aged ≥55 years (median 63; 56-85; 29 women), in whom PDA was closed percutaneously between 2002 and 2018 in two tertiary centres. All but three patients were symptomatic, with most in NYHA II (n = 14) and III (n = 11) class; pulmonary hypertension (n = 22), arterial hypertension (n = 22), duct calcifications (n = 17), atrial fibrillation (n = 15), significant mitral regurgitation (n = 5), and decompensated renal failure (n = 2) were observed. Different devices were applied depending on PDA morphology; nitinol wire mesh occluders with symmetrical articulating discs have been the most used in recent years (n = 11). Follow-up was conducted at an outpatient clinic (28/33 patients). The procedure was successful in all patients. There was one embolisation, followed by implantation of a larger device. No major complications were noted. A small residual shunt was present in echocardiography in one patient after one year. NYHA class improved in all but two patients (with multiple comorbidities). Conclusions Transcatheter PDA closure in elderly patients is safe and efficient with a high complete closure rate and few complications. Amplatzer duct occluder type II is an attractive device in such patients.
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Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ. Transcatheter closure of calcified patent ductus arteriosus in older adult patients: Immediate and 12-month follow-up results. CONGENIT HEART DIS 2016; 12:289-293. [PMID: 27874259 DOI: 10.1111/chd.12437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Xinghua Gu
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Qiuwang Zhang
- Division of Cardiology; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto; Toronto Ontario Canada
| | - Hourong Sun
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Jianchun Fei
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Xiquan Zhang
- Department of Cardiovascular Surgery; Qilu Hospital of Shandong University; Jinan China
| | - Michael J. Kutryk
- Division of Cardiology; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto; Toronto Ontario Canada
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Sullivan MM, Theleman KP, Choi JW. Percutaneous closure of patent ductus arteriosus in an asymptomatic adult. Proc (Bayl Univ Med Cent) 2011; 21:386-8. [PMID: 18982080 DOI: 10.1080/08998280.2008.11928433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Margaret M Sullivan
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
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Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: shunt lesions. Can J Cardiol 2010; 26:e70-9. [PMID: 20352137 DOI: 10.1016/s0828-282x(10)70354-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with congenital heart disease, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part I of the guidelines includes recommendations for the care of patients with atrial septal defects, ventricular septal defects, atrioventricular septal defects and patent ductus arteriosus. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk, and follow-up requirements. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 627] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wang JK, Liau CS, Huang JJ, Hsu KL, Lo PH, Hung JS, Wu MH, Lee YT. Transcatheter closure of patent ductus arteriosus using Gianturco coils in adolescents and adults. Catheter Cardiovasc Interv 2002; 55:513-8. [PMID: 11948902 DOI: 10.1002/ccd.10090] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present the short- and intermediate-term results of transcatheter closure of patent ductus arteriosus with Gianturco coils in adolescents and adults. During a 5-year period, 55 patients (44 females, 11 males) with ages ranging from 14 to 72 years (median, 23) underwent attempted transcatheter closure of patent ductus with the Gianturco coils. The diameter of the narrowest segment of the ductus ranged from 0.8 to 7.6 mm (3.9 +/- 1.3 mm). The 55 patients were divided into three groups. Group I consisted of nine patients with a ductal diameter < or = 3 mm, group II consisted of 27 patients with a ductal diameter > 3 mm but < or = 4 mm, and group III consisted of 19 patients with a ductal diameter > 4 mm. Four- to five-loop Gianturco coils were used, which were deployed via retrograde aortic route. Multiple-coil technique was generally applied in group II patients. Balloon occlusion technique in combination with multiple-coil technique was generally used in group III patients. Deployment of coil was successful in 51 patients (93%) but failed in 4. The success rate of coil deployment in group I, II, and III were 100% (9/9), 96% (26/27), and 84% (16/19), respectively. A mean of 1.9 +/- 0.7 coils was deployed per patient. Of the four patients with unsuccessful coil deployment, three underwent surgery and one received implantation with Amplatzer duct occluder. Distal embolization of 21 coils occurred in 10 patients (3 in group II and 7 in group III), from whom 20 coils were retrieved with a gooseneck snare and 1 coil was removed during surgery. The mean diameter of ductus in the 10 patients with distal embolization was significantly larger than that in those without (5.2 +/- 1.4 vs. 3.7 +/- 1.1 mm; P < 0.01). Among the 51 patients with successful coil deployment, immediate complete closure was achieved in 20 (39%), while trivial to mild leak was present in 31 (61%). No significant complications were encountered. After a follow-up period ranging from 5 to 42 months, four patients had a small residual shunt and three underwent a second intervention with complete occlusion. None had left pulmonary artery stenosis documented with Doppler echocardiography. Transcatheter closure of ductus with the Gianturco coils is safe and feasible in the majority of adolescents and adults. Taking high embolization rate in patients with a ductus diameter > 4 mm into consideration, controlled-release coils, Buttoned device, or Amplatzer duct occluder can be a better choice.
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Affiliation(s)
- Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Affiliation(s)
- R Arora
- Department of Cardiology, GB Pant Hospital, New Delhi 110001, India
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Hwang B, Lee PC, Weng ZC, Fu YC, Hsing HP, Lu JH, Hsieh WH, Jan SL, Meng CC. Comparison of the one-and-a-half-year results of closure of patent ductus arteriosus by transcatheter coils placement with surgical ligation. Angiology 2000; 51:757-63. [PMID: 10999617 DOI: 10.1177/000331970005100908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patent ductus arteriosus (PDA) is a common type of congenital cardiovascular lesion. It usually needs surgical ligation in a full-term baby after 1 year of age. Transcatheter implantation of coils was introduced for the closure of small- to moderate-sized PDA in 1992. From November 1995 to November 1998, the authors closed the PDA in 153 patients by transcatheter implantation of coils and by surgical ligation in 10 patients. One hundred fourteen of them were studied for more than 1(1/2) years. The regular follow-up studies, including physical examination; electrocardiography; and pulsed, continuous-wave, and color Doppler flow mapping, were performed on day one and day 2, and 1 week, 1 month, 3 months, 6 months, and 1 year after the procedure. The results of the closure of PDA by surgical ligation or coil placement were compared and analyzed in all the patients.
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Affiliation(s)
- B Hwang
- Department of Pediatrics, National Yang-Ming University and Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
In the absence of irreversible pulmonary hypertension, closure of clinically detectable patent ductus arteriosus (PDA) is usually recommended in adults. Device closure obviates the need for general anesthesia and a surgical incision and eliminates postoperative pain, long convalescence, and lifelong scarring. Over the past 20 years, the efficacy and safety of transcatheter device closure of PDA in adults has been established. Even though the immediate success rate is lower with transcatheter device closure than with surgical closure, transcatheter reintervention for residual clinical shunts is very effective at abolishing residual leaks. The late complete closure rate, as determined by echocardiography, is very similar with surgical closure and with device closure. The clinical significance of silent residual shunts is unknown. In patients with silent residual shunts, the use of prophylactic antibiotics is as of yet recommended. Occlusion devices should be used whenever possible in adults, and surgical closure of patent ducts should be reserved for patients with larger ducts. The method of ductal closure should be selected on the basis of the quality of and experience with available interventional and surgical resources. Emerging minimally invasive surgical treatments seem promising, but further experience and follow-up are needed before widespread application of these techniques can be recommended.
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Schmaltz AA, Neudorf U, Sack S, Galal O. [Interventions in congenital heart disease and their sequelae in adults]. Herz 1999; 24:293-306. [PMID: 10444708 DOI: 10.1007/bf03043880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The advancements of cardiac surgery over the last decades led to larger numbers of patients with operated congenital heart diseases surviving into adulthood. In Germany it is estimated that over 120,000 adults have operated congenital heart diseases. Five to 7% of them will need yearly hospital admissions. Interventional procedures are additional tools used to treat these patients with various sequelae or residua (Table 1). In the following review we concentrate on 2 different interventional procedures: dilatation and stent implantations for treatment of stenosis and the different devices used for the closure of shunt lesions. For congenital valvular pulmonary stenosis, balloon dilatation is the therapy of choice regardless the age of the patient. Stent implantation for the treatment of peripheral pulmonary stenosis (e.g., after previous systemic pulmonary shunts) can decrease the need for redo surgery, which is accompanied with increased risk. Stent implantations proved also to be useful to treat stenoses after Mustard patch in patients with transposition of the great arteries, after Fontan procedures or dealing with the rare pulmonary venous stenosis. In contrast, dilatation of bioprosthesis and conduit stenosis are not promising. Balloon dilatation of valvular aortic stenosis is an accepted therapy in childhood up to adolescents. Table 2 compares a surgical series including many infants with critical aortic stenosis with a series of balloon dilatation in children and another one in adults regarding lethality, complications, and results. Table 3 illustrates the immediate and late results of balloon dilatation of aortic coarctation in 3 different studies. The high recurrence rate in infants made clinicians refrain from taking this age group for balloon dilatation. In children and adult patients, good results are reported (75% reduction of gradients). The complication rate is low (2.3 to 3.3%) and aneurysm formation rate seldom (1 to 7%). Stenosed aorto-pulmonary collaterals will rarely need balloon dilatation. Surgical closure of atrial septal defect is a low risk procedure with a very low rate of residual shunts (2%). Of the 5 available devices for transcatheter closure of atrial septal defect Type II, only 2 occluders are in use in Germany, the Clamshell and the Amplatzer device. The largest clinical studies of the different systems, their efficacy, complications and residual shunt rate are presented in Table 4. For the deployment of these occluders a TEE is always needed. There are many more systems in clinical use to close the patent arterial duct (PDA) (Table 5). The Ivalon plug as well as the Rashkind device have probably only historical value. Different types of coils (Gianturco, Cook detachable, PFM) are now in use worldwide. The reason for their widespread use, besides their easy application, is the fact that most coils are relatively cheap and need only small sheaths for deployment. Their further evaluation identified a residual shunt rate of 5% as well as a number of complications (embolization, hemolysis, stenosis of the left pulmonary artery) in 0 to 6%. For the large PDA the Amplatzer device has recently been introduced. An additional indication for the use of the different occluding devices are aorto-pulmonary collaterals, venovenous fistulae, pulmonary or coronary artery fistulae. Aorto-pulmonary collaterals are often associated with complex cardiac lesions and occasionally appear after palliative procedures. An excellent cooperation between adult and pediatric cardiologists is needed in order to offer the group of adults with congenital heart diseases an adequate and comprehensive management.
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Affiliation(s)
- A A Schmaltz
- Abteilung für Pädiatrische Kardiologie, Zentrum für Kinder- und Jugendmedizin, Universität Essen, Deutschland.
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Rao PS, Kim SH, Rey C, Onorato E, Sideris EB. Results of transvenous buttoned device occlusion of patent ductus arteriosus in adults. International Buttoned Device Trial Group. Am J Cardiol 1998; 82:827-9, A10. [PMID: 9761103 DOI: 10.1016/s0002-9149(98)00441-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Examination of the immediate and follow-up results of transvenous buttoned device occlusion of patent ductus arteriosus suggests that the method is feasible, safe, and effective irrespective of the size and shape of the ductus. Although residual shunts are present, they tend to disappear during follow-up, and complete occlusion at the time of implantation may be achieved by incorporation of a folding plug over the button loop of the device.
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Affiliation(s)
- P S Rao
- Division of Cardiology, Saint Louis University Health Sciences Center, Missouri, USA
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Ing FF, Mullins CE, Rose M, Shapir Y, Bierman FZ. Transcatheter closure of the patient ductus arteriosus in adults using the Gianturco coil. Clin Cardiol 1996; 19:875-9. [PMID: 8914781 DOI: 10.1002/clc.4960191107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risk. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. METHODS Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occlusion of the PDA using Gianturco coils. RESULTS Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. CONCLUSION Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.
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Affiliation(s)
- F F Ing
- Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston 77030, USA
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Sharafuddin MJ, Gu X, Titus JL, Sakinis AK, Pozza CH, Coleman CC, Cervera-Ceballos JJ, Aideyan OA, Amplatz K. Experimental evaluation of a new self-expanding patent ductus arteriosus occluder in a canine model. J Vasc Interv Radiol 1996; 7:877-87. [PMID: 8951756 DOI: 10.1016/s1051-0443(96)70866-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE A new self-expanding patent ductus arteriosus (PDA) occluder was designed. MATERIALS AND METHODS Percutaneous closure of surgically created aortopulmonary shunts was attempted in 19 dogs. The occlusion device consisted of a nitinol wire frame tightly woven into a cylinder with a flat retention disc. A polyester-filled frame was used in the last six procedures. A 6-F introducing sheath was advanced across the aortopulmonary conduit into the descending thoracic aorta. The prosthesis (attached on a stiff delivery cable) was advanced through the introducing sheath. The retention disc was first released in the descending thoracic aorta, then the cylindrical device frame was expanded within the conduit by withdrawing the sheath. RESULTS Subtotal misplacement into the descending aorta occurred in one procedure (overall technical success rate, 95%), and one animal died before the 1-week follow-up. Complete angiographic shunt closure was achieved in seven of 18 (39%) animals at 30 minutes, 12 of 17 (71%) animals at 1 week, 14 of 17 (82%) animals at 1 month, and 11 of 12 (92%) animals at 3 months. Significantly higher 30-minute closure rates occurred with polyester-filled occluders compared with nonfilled occluders (five of five [100%] vs one of 13 [15%]; P = .002). Persistent shunt at 3 months occurred in only one nonfilled device (6%). In the remaining 16 animals, both orifices of the shunt were covered by a smooth glistening neoendothelium at postmortem examination. CONCLUSION This device combines the advantages of small delivery system, easy placement, self-centering, and repositionability. Immediate shunt closure can be reliably accomplished with the polyester-filled prosthesis.
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Affiliation(s)
- M J Sharafuddin
- Department of Radiology, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA
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Harrison DA, Benson LN, Lazzam C, Walters JE, Siu S, McLaughlin PR. Percutaneous catheter closure of the persistently patent ductus arteriosus in the adult. Am J Cardiol 1996; 77:1094-7. [PMID: 8644664 DOI: 10.1016/s0002-9149(96)00139-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The USCI patent ductus occluder has been shown to be an effective nonsurgical technique for closure of the persistently patent ductus in a primarily pediatric population. Its clinical impact in the adult has been reported only within small subgroups of larger pediatric studies or for a small population. This study was conducted to determine the feasibility, success rate, and complications of device closure for the persistently patent ductus arteriosus (PDA) in the adult. The population consisted of 55 patients (4 men and 51 women; mean age 38.8 +/- 15.0 years) with follow-up of 2.2 +/- 2.1 years. All patients underwent echocardiography obtained as part of their follow-up assessment. The device was successfully placed in 54 patients, with 75% clinical and echocardiographic closure at the first follow-up assessment 2.4 +/- 2.6 months). One patient with initial clinical and echocardiographic evidence of closure was subsequently found to have an open ductus. Spontaneous closure (2 patients) or second implant (6 patients) resulted in 86% closure at the most recent assessment. Thus, the percutaneous PDA double-umbrella occluder device is a feasible and effective technique for closing persistent PDA in the adult and will result in occlusion of the shunt in most patients without the need for thoracotomy.
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Affiliation(s)
- D A Harrison
- Toronto Congential Cardiac Centre for Adults, Toronto Hospital, Department of Medicine, University of Toronto, Ontario, Canada
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Sievert H, Moor T, Ensslen R, Spies H, Scherer D. Transcatheter closure of oversized persistent ductus arteriosus by simultaneous delivery of two Rashkind umbrella devices. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:251-4. [PMID: 8542635 DOI: 10.1002/ccd.1810360313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Transcatheter closure of persistent ductus arteriosus (PDA) with a diameter of > 9 mm is considered to be impossible or at least difficult with the occlusion systems that are currently available. We report a simple technique for occluding oversized PDAs with two diameter of 13 mm was successfully occluded in a 40-year-old man. Complete closure without residual shunt was documented by echocardiogram and angiogram.
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Affiliation(s)
- H Sievert
- Bethanien Hospital, Department of Cardiology and Angiology, Frankfurt, Germany
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