Transcatheter closure of a calcified patent ductus arteriosus in an elderly man

Comparison of transcatheter patent ductus arteriosus closure between children and adults

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.

Acute ascending aortic dissection due to transcatheter patent ductus arteriosus closure in the elderly: An extremely rare complication of transcatheter patent ductus arteriosus closure

It is well known that patent ductus arteriosus (PDA) in adults, especially in the elderly, differs from that in pediatric patients. A 68-year-old woman with a PDA with focal calcification at the aortic orifice of the ampulla with a minimum diameter of 4.0 mm and length of 14.8 mm, was treated with a 10/8-mm Amplatzer duct occluder (ADO) (St. Jude Medical Corp, St. Paul, MN, USA). After device implantation, systolic blood pressure (BP) increased to approximately 220 mmHg from 130 mmHg. She experienced transient dyspnea from hypertensive heart failure, which improved through continuous infusion of anti-hypertensive agents. She suddenly felt pressure on her chest 12 h post-procedure and collapsed. Surgical thoracotomy revealed an ascending aortic dissection into the pericardial space. In retrospective review, the ADO may have been slightly deformed by fluoroscopy. The complication may have been triggered by the resilience caused by device deformation, damage to the aortic wall due to the aortic side of the device, uneven elasticity of the arterial wall, and uncontrolled excessively high blood pressure. <Learning objective: Although transcatheter patent ductus arteriosus (PDA) closure is an established, safe, and effective procedure when treating PDA of the elderly, wall damage due to the device may occur because of atherosclerotic changes different from that of younger patients and blood pressure will rise after closure. Therefore, it is necessary to carefully select the type and size of the device and to strictly control blood pressure in patients with a history of hypertension.>.

Surgical closure of the patent ductus arteriosus with an intravascular prosthesis: clinical experience

The authors developed a new prosthesis for patent ductus arteriosus (PDA) closure, using a delivery device inserted through the main pulmonary artery (MPA) avoiding ductal dissection and use of cardiopulmonary bypass. The prosthesis was inserted in 19 consecutive patients between 1985 and 1992. They have been followed for a mean of 4.8 years (minimum 30 days, maximum 7.5 years). There were 14 women (72%) and the average age was 11 years (16 months to 38 years). All patients presented with pulmonary hypertension (4 severe, 5 moderate, and 10 mild). Simultaneous surgical procedures for congenital heart disease were performed in two cases. One patient had a diffuse calcified PDA. The average diameter of the inserted prosthesis was 7.5 mm (3.5 to 12.5 mm). Neither hemorrhage nor prosthesis dislocation/embolization occurred during the implantation or in the postoperative period. In a newborn (30 days) with severe cardiomegaly and thin MPA, we decided to ligate the ductus. Chronic cor pulmonale contributed to death in one patient 3.7 years after operation. The remaining patients recovered well, without clinical evidence of residual shunt. Therefore, we recommend the use of this new prosthesis for PDA closure in cases of large ductus or ductus complicated with calcification, pulmonary hypertension, and when associated open heart surgery is required.

Combined aortic valve replacement and closure of patent ductus arteriosus in the elderly

Two cases of patent ductus arteriosus (PDA) and aortic stenosis are presented. Both were diagnosed at routine cardiac catheterization and significant aortic gradient was concomitantly encountered. The first patient had subacute bacterial endocarditis due to B. cereus infection. Eventually it was proven to be localized on the PDA on the pulmonary artery side. Both patients underwent closure of PDA through endopulmonary closure and aortic valve replacement. Postoperative courses were uneventful. These cases demonstrated the technically easy closure of the PDA in the elderly. The literature has documented only six cases including our two cases.

Transcatheter occlusion of patent ductus arteriosus in adults

This study examines whether transcatheter closure of a patent ductus arteriosus (PDA) using a Rashkind PDA occluder device is safe and effective in adults, or if adults have complications not sited in children owing to prolonged aorticopulmonary communication, high surgical risks or calcified PDAs. Fifteen patients aged 22 to 76 years (mean 42 +/- 14) were referred for transcatheter PDA occlusion. Exercise intolerance was the most frequent clinical manifestation. Eleven of 15 patients had surgical risk factors that included left ventricular failure (n = 10), biventricular failure (n = 1), elevated pulmonary pressures (n = 1), and a calcified PDA (n = 5). Twelve millimeter devices were placed in 4 PDAs < or = 3 mm in diameter; 17 mm devices were placed in 11 PDAs 3 to 6 mm in diameter. Seven (47%) were occluded angiographically shortly after device placement; another 5 PDAs (33%) were occluded echocardiographically within 24 hours of the procedure. Completed occlusion in this time interval was more likely to occur in PDAs < 5 mm in diameter (p = 0.0009). Of the 3 remaining PDAs with follow-up ranging from 9 to 38 months, 2 have demonstrated gradual diminution of shunting and have trivial leaks by color/Doppler flow. The other patient with a residual PDA has no ductal flow after placement of a second device. No complications related to device implantation or closure of the PDA occurred in any patient. No complications were reported in the follow-up patients who received evaluation (14 of 15 patients; range 1 to 38 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Patent ductus arteriosus involving three generations--a case history

The authors present a family with patent ductus arteriosus (PDA) involving three generations, in the absence of consanguinity.

The clinical features, management and outcome of persistence of the arterial duct presenting in adult life

We have reviewed the 25 patients who, between 1973 and 1988, presented to the Brompton Hospital in adulthood with persistence of the arterial duct (ductus arteriosus). As pulmonary arteriolar resistance is the main determinant of management and prognosis in this condition, the patients were divided into groups with either normal or mild elevation of resistance (less than 10 units/m2: 19 patients) or with severe elevation (greater than 10 units/m2: 6 patients). Patients with normal pressures or mild elevation tended to be older (mean age 45 years). Many (70%) were asymptomatic, but dyspnoea with signs of left heart failure was the commonest presenting complaint. Surgical closure of the duct was performed in 16 with good result in all. Survival for the entire group, however, was long. There was a symptomatic indication for surgery (due to hyperdynamic circulation) in 5. In those with severely elevated pulmonary arteriolar resistance, the mean age of presentation was 31 years and the survival short. The commonest presenting symptom was dyspnoea. Surgical closure of the duct was attempted in two patients but with a poor outcome in both. All patients with an elevated resistance had developed this complication by the third decade of life. Significant elevation was not a feature of older patients, suggesting that, in this age group, the risk of elevation is slight. Surgery, nonetheless, may be indicated for relief of symptoms due to a large systemic to pulmonary shunt.