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Narvaez-Guerra OD, Herrera-Enriquez KB, Aurigemma GP, Tighe DA, Gentile BA. Multimodality Imaging of Patent Ductus Arteriosus Complicated by Severe Pulmonary Arterial Hypertension in a Pregnant Patient. CASE (PHILADELPHIA, PA.) 2024; 8:215-220. [PMID: 38524975 PMCID: PMC10954570 DOI: 10.1016/j.case.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Large uncorrected PDA may first be diagnosed during pregnancy. •Multimodality imaging may be safely utilized in these patients. •Multimodality imaging is safely utilized in these patients. •Multidisciplinary team approach is key for percutaneous closure of PDA in pregnancy.
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Affiliation(s)
- Offdan D. Narvaez-Guerra
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | | | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - Dennis A. Tighe
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - Bryon A. Gentile
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
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Francescato G, Doni D, Annoni G, Capolupo I, Ciarmoli E, Corsini I, Gatelli IF, Salvadori S, Testa A, Butera G. Transcatheter closure in preterm infants with patent ductus arteriosus: feasibility, results, hemodynamic monitoring and future prospectives. Ital J Pediatr 2023; 49:147. [PMID: 37932790 PMCID: PMC10629028 DOI: 10.1186/s13052-023-01552-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Ductal patency of preterm infants is potentially associated with long term morbidities related to either pulmonary overflow or systemic steal. When an interventional closure is needed, it can be achieved with either surgical ligation or a catheter-based approach.Transcatheter PDA closure is among the safest of interventional cardiac procedures and it is the first choice for ductal closure in adults, children, and infants weighing more than 6 kg. In preterm and very low birth weight infants, it is increasingly becoming a valid and safe alternative to ligation, especially for the high success rate and the minor invasiveness and side effects. Nevertheless, being it performed at increasingly lower weights and gestational ages, hemodynamic complications are possible events to be foreseen.Procedural steps, timing, results, possible complications and available monitoring systems, as well as future outlooks are here discussed.
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Affiliation(s)
- Gaia Francescato
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Daniela Doni
- Neonatal Intensive Care Unit Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Giuseppe Annoni
- Pediatric Cardiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elena Ciarmoli
- U.O. Di Neonatologia, Patologia Neonatale E Pediatria, ASST Della Brianza, P.O. Vimercate, Vimercate, Italy
| | - Iuri Corsini
- Division of Neonatalogy, Careggi University Hospital of Florence, Florence, Italy
| | - Italo Francesco Gatelli
- Division of Neonatology and Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sabrina Salvadori
- Women and Child Health Department, Neonatal Intensive Care Unit, Azienda Ospedaliera -Università Di Padova, Padua, Italy
| | - Alberto Testa
- Sapienza School for Advanced Studies, Sapienza University of Rome, Rome, Italy
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation; ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
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3
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Tan W, Stefanescu Schmidt AC, Horlick E, Aboulhosn J. Transcatheter Interventions in Patients With Adult Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100438. [PMID: 39132367 PMCID: PMC11307551 DOI: 10.1016/j.jscai.2022.100438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 08/13/2024]
Abstract
Patients with congenital heart disease now live well into adulthood because of advances in surgical techniques, improvements in medical management, and the development of novel therapeutic agents. As patients grow older into adults with congenital heart disease, many require catheter-based interventions for the treatment of residual defects, sequelae of their initial repair or palliation, or acquired heart disease. The past 3 decades have witnessed an exponential growth in both the type and number of transcatheter interventions in patients with congenital heart disease. With improvements in medical technology and device design, including the use of devices designed for the treatment of acquired valve stenosis or regurgitation, patients who previously would have required open-heart surgery for various conditions can now undergo percutaneous cardiac catheter-based procedures. Many of these procedures are complex and occur in complex patients who are best served by a multidisciplinary team. This review aims to highlight some of the currently available transcatheter interventional procedures for adults with congenital heart disease, the clinical outcomes of each intervention, and any special considerations so that the reader may better understand both the procedure and patients with adult congenital heart disease.
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Affiliation(s)
- Weiyi Tan
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ada C. Stefanescu Schmidt
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Horlick
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, California
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Reo R, Van Pelt E, Lovelace C, Eshelman A, Beckman B, Chisolm J, Boe B, Backes C, Cua CL. Utility of Follow-Up Echocardiograms in Uncomplicated PDA Device Closures Performed After Infancy. Cardiol Ther 2022; 11:445-452. [PMID: 35780440 PMCID: PMC9381662 DOI: 10.1007/s40119-022-00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a patent ductus arteriosus (PDA) device closure via catheterization. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated PDA device closure after infancy. Methods Chart review was performed on patients who had a PDA closure ≥ 1 year of age between 1/1/2002 and 6/1/2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE ≥ 6 months after procedure, had a residual PDA or velocity > 2.0 m/s in the left pulmonary artery (LPA) or descending aorta (DAo) on the first TTE ≥ 6 months after device placement. Time points included the initial TTE after the procedure, first TTE ≥ 6 months after procedure, and the most recent TTE. Results A total of 189 patients met the study criteria. The median age and weight at initial procedure were 2.7 (1.0–64.7) years and 12.5 (3.4–69.2) kg. Most recent TTE was performed 2.0 (0.4–17.0) years after PDA closure. There were no significant differences in fractional shortening (36.4 ± 5.0% vs. 36.9 ± 5.6%) or LPA velocity (1.1 ± 0.4 m/s vs. 1.1 ± 0.4 m/s) from initial to most recent TTE, respectively. Left ventricular internal diastolic diameter Z-score significantly decreased (1.4 ± 1.8 vs. − 0.01 ± 1.2, p < 0.01) and DAo peak velocity significantly increased (1.2 ± 0.3 m/s vs. 1.3 ± 0.3 m/s, p = 0.02) from initial to most recent TTE, respectively. No patient died or underwent an intervention on the LPA or DAo for stenosis. Seventy-five patients had a total of 208 repeat TTE > 1 year after PDA procedure with no change in clinical management. Conclusions In patients who underwent an uncomplicated PDA closure after infancy, TTE parameters improved or stayed within normal limits on the most recent TTE. Repeat lifetime TTEs after 1-year post-device placement in this population may not necessarily be needed if there are no clinical concerns.
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Affiliation(s)
- Rachel Reo
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Van Pelt
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Casey Lovelace
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anne Eshelman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Beckman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carl Backes
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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Wu W, Chen H, Chen T. Evaluation of Cardiac Function Characteristics after Patent Ductus Arteriosus Closure in Children and Adults by Echocardiographic Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1310841. [PMID: 35126616 PMCID: PMC8816572 DOI: 10.1155/2022/1310841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/19/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022]
Abstract
This study was to investigate the value of echocardiographic data in assessing changes in cardiac function before and after transcatheter closure in children and adult patients with patent ductus arteriosus (PDA). In this study, 150 patients with isolated PDA treated by cardiac catheterization and transcatheter closure were selected as the study sample. Real-time color Doppler echocardiography was used both after and after operation. The results showed that the left ventricle returned to normal in 75 patients one day after operation, with an average age of 10.95 ± 3.27 years; the left ventricle did not return to normal in 10 patients 360 days after operation, with an average age of 64.31 ± 7.05 years. Left ventricular end diastolic volume index (LVEDVI) and left ventricular end systolic volume index (LVESVI) of patients decreased significantly one day after operation and remained at 51.95 ± 9.55 mL/m2 and 20.36 ± 8.11 mL/m-2, respectively. In summary, echocardiographic data have a high reference value in assessing cardiac function characteristics in children and adult patients with PDA and are worthy of further promotion.
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Affiliation(s)
- Wenhai Wu
- Cardiac Color Doppler Ultrasound Room, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
| | - Hongwei Chen
- Cardiac Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
| | - Tianbao Chen
- Department of Internal Medicine-Cardiovascular, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
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Zhou Z, Gu Y, Zheng H, Li S, Xu L, Liu Q, Wan J, Lv J, Song H, Yan C, Hu H, Zhang G, Xu Z, Jin J. Transcatheter Closure of Patent Ductus Arteriosus via Different Approaches. Front Cardiovasc Med 2022; 8:797905. [PMID: 35083302 PMCID: PMC8784679 DOI: 10.3389/fcvm.2021.797905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background: There have been marked advances in devices such as Amplatzer Duct Occluder II (ADO-II) or vascular plug through 5Fr delivery sheath for closure of patent ductus arteriosus (PDA) in the past five decades, making it possible for cardiologists to deliver occluders via different approaches. However, comparisons of these different approaches have not been reported. Therefore, the aim of this study was to summarize and compare the advantages of different approaches for PDA closure, and to guide clinical strategies. Methods: This retrospective study included all patients undergoing transcatheter closure of PDA from 2019 to 2020. Patients were matched by 1:1 propensity score matching (PSM). The retrograde femoral artery approach (FAA) and simple vein approach (SVA) groups were compared with the conventional arteriovenous approach (CAA). Results: The average age of the 476 patients was 21.05 ± 21.15 years. Their average weight was 38.23 ± 24.1 kg and average height was 130.14 ± 34.45 cm. The mean diameter of the PDA was 4.29 ± 2.25 mm. There were 127 men and 349 women, comprising 205 adults and 271 children. Among them, 197 patients underwent CAA, 223 underwent SVA, and 56 underwent retrograde FAA. The diameter in the FAA group was smaller than that in the other two groups, but was similar in adults and children. In the PSM comparison of CAA and SVA, 136 patients with CAA and 136 patients with SVA were recruited. Simple vein approach was associated with markedly reduced length of hospital stay, length of operation, and contrast medium usage as compared with CAA (all P < 0.05). In the PSM comparison of FAA and CAA, 30 patients with CAA and 30 patients with FAA were recruited. The operation duration was longer in the CAA than in the FAA group. There were no significant differences in postoperative complications among groups. Conclusion: Patent ductus arteriosus closure by using the SVA and FAA is safe and effective, and has certain advantages in some respects as compared with CAA.
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Affiliation(s)
- Zeming Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuanrui Gu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Vascular Surgery, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hong Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- *Correspondence: Hong Zheng
| | - Shiguo Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Liang Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qiong Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Junyi Wan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jianhua Lv
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huijun Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chaowu Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Haibo Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Gejun Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhongying Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinglin Jin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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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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Windsor J, Mukundan C, Stopak J, Ramakrishna H. Analysis of the 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adults With Congenital Heart Disease (ACHD). J Cardiothorac Vasc Anesth 2021; 36:2738-2757. [PMID: 33985885 DOI: 10.1053/j.jvca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/02/2023]
Abstract
Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD in the USA alone, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript comprehensively reviewed the recent (2020) updated European Society of Cardiology Guidelines for the management of ACHD created by the Task Force for the management of adult congenital heart disease of the European Society of Cardiology, with perioperative implications for the adult cardiac anesthesiologist and intensivist who may be called upon to manage these complex patients.
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Affiliation(s)
- Jimmy Windsor
- Clinical Associate Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Chaitra Mukundan
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Joshua Stopak
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Harish Ramakrishna
- Professor of Anesthesiology, Mayo Clinic School of Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, 200 First Street SW, Rochester, MN 55905.
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9
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O'Byrne ML, Smith CL, Gillespie MJ. Device Closure of Patent Ductus Arteriosus in Adults. Can J Cardiol 2020; 36:795-796. [PMID: 32173055 DOI: 10.1016/j.cjca.2019.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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