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Zampi JD, Sower CT, Lancaster TS, Sood V, Romano JC. Hybrid Interventions in Congenital Heart Disease: A Review of Current Practice and Rationale for Use. Ann Thorac Surg 2024; 118:329-337. [PMID: 38462049 DOI: 10.1016/j.athoracsur.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Hybrid interventions have become a common option in the management for a variety of patients with congenital heart disease. In this review, we discuss the data that have driven decision making about hybrid interventions to date. METHODS The existing literature on various hybrid approaches was reviewed and summarized. In addition, the key tenants to creating a successful hybrid program within a congenital heart center are elucidated. RESULTS Hybrid strategies for single-ventricle patients, pulmonary atresia with intact ventricular septum, branch pulmonary artery stenosis, and muscular ventricular septal defect closure have important benefits and limitations compared with traditional approaches. CONCLUSION A growing body of evidence supports the use of hybrid interventions in congenital heart disease. But important questions remain regarding improved survival and other long-term outcomes, such as neurocognition, that might impact widespread adoption as a primary treatment strategy.
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Affiliation(s)
- Jeffrey D Zampi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
| | - C Todd Sower
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Timothy S Lancaster
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Vikram Sood
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer C Romano
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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2
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Gao B. Pulmonary Artery Stenosis in Tetralogy of Fallot. Cardiol Rev 2023:00045415-990000000-00172. [PMID: 37966279 DOI: 10.1097/crd.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital cardiac defect. The survival rate after primary complete repair is high (98-100%); however, pulmonary artery stenosis (PAS) is not uncommon after TOF repair, and severe PAS aggravates pulmonary regurgitation, resulting in right ventricle dilation, ventricular arrhythmia, and possibly death. PAS in TOF can be congenital due to hypoplasia or coarctation or can be acquired secondary to a surgical procedure. The latter may be caused by an exogenous conduit implant, compression from the adjacent enlarged ascending aorta, or outflow tract dilation after transannular patch repair. PAS can also be caused by the pulmonary artery plasty strategy itself. Here, the intrinsic mechanisms underlying PAS and pulmonary artery plasty techniques and strategies are reviewed to provide guidance for surgeons.
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Affiliation(s)
- Botao Gao
- From the Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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3
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Hybrid intra-operative pulmonary artery stenting in congenital heart disease. Indian J Thorac Cardiovasc Surg 2011. [DOI: 10.1007/s12055-011-0127-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Guo QK, Lu ZQ, Cheng SF, Cao Y, Zhao YH, Zhang C, Zhang YL. Off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on simple congenital heart diseases (ASD, VSD and PDA) attached consecutive 210 cases report: a single institute experience. J Cardiothorac Surg 2011; 6:48. [PMID: 21486486 PMCID: PMC3090330 DOI: 10.1186/1749-8090-6-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/13/2011] [Indexed: 11/21/2022] Open
Abstract
Objective This paper intends to report our experiences by using an operation of off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on the treatment of consecutive 210 patients with simple congenital heart diseases (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods The retrospective clinical data of OPOTTMIS in our institute were collected and compared to other therapeutic measures adopted in the relevant literatures. After operation, all the patients received electrocardiography (ECG) and echocardiography (echo) once a month within the initial 3 months, and no less than once every 3 ~ 6 months later. Results The successful rate of the performed OPOTTMIS operation was 99.5%, the mortality and complication incidence within 72 hours were 0.5% and 4.8%, respectively. There were no major complications during peri-operation such as cardiac rupture, infective endocarditis, strokes, haemolysis and thrombosis. The post-operation follow-up outcomes by ECG and echo checks of 3 months to 5 years showed that there were no III° AVB, no obvious Occluder migration and device broken and no moderate cardiac valve regurgitation, except 1 VSD and 1 PDA with mild residual shunts, and 2 PDA with heart expansion after operation. However, all the patients' heart functions were in class I~II according to NYH standard. Conclusion The OPOTTMIS is a safe, less complex, feasible and effective choice to selected simple CHD patients with some good advantages and favorable short term efficacies.
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Affiliation(s)
- Qing-Kui Guo
- Department of Cardio-thoracic Surgery, Shanghai NO,6 People Hospital Affiliated Shanghai Jiao Tong University, NO, 600 Yishan Road, Shanghai, 86: 200233, China
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Asoh K, Hickey E, Dorostkar PC, Chaturvedi R, van Arsdell G, Humpl T, Benson LN. Outcomes of emergent cardiac catheterization following pediatric cardiac surgery. Catheter Cardiovasc Interv 2009; 73:933-40. [DOI: 10.1002/ccd.21919] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Menon SC, Cetta F, Dearani JA, Burkhart HA, Cabalka AK, Hagler DJ. Hybrid intraoperative pulmonary artery stent placement for congenital heart disease. Am J Cardiol 2008; 102:1737-41. [PMID: 19064034 DOI: 10.1016/j.amjcard.2008.07.061] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/30/2008] [Accepted: 07/30/2008] [Indexed: 11/24/2022]
Abstract
Percutaneous branch pulmonary artery (PA) stenting can be challenging, especially in patients with stenosis of the right ventricular (RV) outflow tract or tortuous PA branches. In these cases, a hybrid procedure deploying PA stent(s) during cardiac surgery provides an alternative to relieve branch PA stenosis. The Mayo Clinic Congenital Cardiac surgical database was used to identify all patients having hybrid PA stent procedures. Retrospective analysis of clinical data, procedural details, and outcomes was performed. Between January 1997 and November 2006, 24 patients (15 females), median age 15 years (range 3 to 67 years), had hybrid PA stent procedures. A total of 27 stents were deployed. A left PA stent was placed in 13, right PA stent in 8; 3 patients had bilateral PA stents. Primary cardiac diagnoses were pulmonary atresia (9), tetralogy of Fallot (7), tricuspid atresia (2), and others (6). Maximum balloon diameters ranged from 8 to 16 mm (median = 12 mm). Concomitant surgical procedures performed were RV to PA conduit replacement or RV outflow tract reconstruction (14), pulmonary valve replacement (7), and others (3). Two procedures were performed following complications of percutaneous procedure. There were no deaths or PA damage. There were 2 cases of distal stent migration. Repeat stent dilations within 6 months were performed in 3 patients. In conclusion, hybrid PA stenting can play an important role in the management of congenital heart disease with complex branch PA anatomy. It also can be used as an emergency rescue procedure following complications of percutaneous transcatheter procedures, such as stent embolization. Hybrid procedures were safe and effective in most patients, although stent positioning remains critical. Intraoperative fluoroscopy and active suture fixation of the proximal stent may reduce the need for late reintervention.
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Kozlik-Feldmann R, Lang N, Aumann R, Lehner A, Rassoulian D, Sodian R, Schmitz C, Hinterseer M, Hinkel R, Thein E, Freudenthal F, Vasilyev NV, Vasylev NV, del Nido PJ, Netz H. Patch closure of muscular ventricular septal defects with a new hybrid therapy in a pig model. J Am Coll Cardiol 2008; 51:1597-603. [PMID: 18420104 DOI: 10.1016/j.jacc.2007.10.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 10/10/2007] [Accepted: 10/23/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We evaluated a novel technique for hybrid patch closure of muscular ventricular septal defects (mVSDs) without cardiopulmonary bypass (CPB) in a pig model. BACKGROUND So far, surgical and interventional therapies for mVSDs have been associated with significant morbidity, especially in newborns and infants. Thus, it is essential to develop new techniques. Hybrid therapy is an innovative approach for mVSDs that combines the advantages of surgical and interventional techniques. METHODS Six pigs underwent left anterolateral thoracotomy to expose the left ventricle (LV). The mVSDs were created under echocardiographic guidance with a 7.5-mm sharp punch instrument that was forwarded via an LV incision. A special designed patch system composed of a patch with a Nitinol frame was passed across the carotid artery into the LV and positioned in front of the mVSD. An instrument resembling a stapler was introduced across the LV wall on the beating heart without use of CPB. The patch was fixed with Nitinol anchors on the septum under echocardiographic and fluoroscopic guidance. Finally, the Nitinol frame was detached from the patch. RESULTS The locations of the defects were apical (n = 1), midmuscular (n = 3), and anterior muscular (n = 2). Closure of the mVSD was successful in 5 of 6 animals confirmed by echocardiography, hemodynamic measurements, and explantation of the heart. Animals were hemodynamically stable throughout the experiment. CONCLUSIONS Here, we present a novel technique for hybrid closure of mVSDs without use of CPB. Further development of the patch system is necessary to assess applicability in humans, especially for the target group of newborns and infants.
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Tekin Y, Ozer S, Murat B, Hulusi UM, Timucin ON. Closure of adult patent ductus arteriosus under cardiopulmonary bypass by using foley balloon catheter. J Card Surg 2007; 22:219-20. [PMID: 17488419 DOI: 10.1111/j.1540-8191.2007.00390.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The wall of patent ductus arteriosus (PDA) in adults is usually fragile and may be associated with calcification. METHOD We present a 43-year-old female patient who underwent successful ductal closure operation under cardiopulmonary bypass (CPB) via a transpulmonary route. RESULTS The operation was uneventful and the patient was discharged from the hospital on the 4th postoperative day. CONCLUSION Transpulmonary route for the closure of the PDA by using CPB is a safe and acceptable approach in adult patients.
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Affiliation(s)
- Yildirim Tekin
- Cardiovascular Surgery Service, Goztepe Safak Hospital, Istanbul, Turkey
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Bacha EA, Hijazi ZM, Cao QL, Abdulla R, Starr JP, Quinones J, Koenig P, Agarwala B. Hybrid pediatric cardiac surgery. Pediatr Cardiol 2005; 26:315-22. [PMID: 16374678 DOI: 10.1007/s00246-005-8648-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Minimally invasive strategies can be expanded by combining standard surgical and interventional techniques. We performed a longitudinal prospective study of all pediatric patients who have undergone hybrid cardiac surgery at the University of Chicago Children's Hospital. Hybrid cardiac surgery was defined as combined catheter-based and surgical interventions in either one setting or in a planned sequential fashion within 24 hours. Between June 2000 and June 2003, 25 patients were treated with hybrid approaches. Seventeen patients with muscular ventricular septal defects (mVSDs) (mean age, 4 months; range, 2 weeks-4 years) underwent either sequential Amplatzer device closure in the catheterization laboratory followed by surgical completion (group 1A, n = 9) or one-stage intraoperative off-pump device closure (group IB, n = 8) with subsequent repair of any concomitant heart lesions. Eight patients with branch pulmonary artery (PA) stenoses (group 2) underwent intraoperative PA stenting or stent balloon dilatation along with concomitant surgical procedures. All patients survived hospitalization. Complications from the hybrid approach were mostly confined to groups 1A and 2. At a mean follow-up of 18 months, 2 group 1A patients died suddenly several months after discharge. All other patients are doing well. Hybrid pediatric cardiac surgery performed in tandem by surgeons and cardiologists is safe and effective in reducing or eliminating cardiopulmonary bypass. Patients with mVSDs who are small, have poor vascular access, or have concomitant cardiac lesions are currently treated in one setting with the perventricular approach.
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Affiliation(s)
- E A Bacha
- Congenital Heart Center, University of Chicago Hospitals, 5841 S. Maryland Avenue, MC 5040, IL 60637, USA.
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Arbatli H, Ozbek U, Demirsoy E, Unal M, Yağan N, Sönmez B. Repair of recurrent patent ductus arteriosus in an adult with cardiopulmonary bypass. J Card Surg 2003; 18:17-9. [PMID: 12696761 DOI: 10.1046/j.1540-8191.2003.01904.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recurrence of ductal patency is a rarely encountered complication in surgical repair of patent ductus arteriosus (PDA). An adult patient with ductal recurrency underwent closure of ductus by using cardiopulmonary bypass via transpulmonary approach. She had significant improvement of symptoms and no residual shunt or pseudoneurysm seven months after surgery.
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Affiliation(s)
- Harun Arbatli
- Department of Cardiovascular Surgery, Memorial Hospital, Istanbul, Türkiye.
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11
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Optimal treatment for adult patent ductus arteriosus: Reply. Ann Thorac Surg 2001. [DOI: 10.1016/s0003-4975(01)03139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Invited commentary. Ann Thorac Surg 2000. [DOI: 10.1016/s0003-4975(00)02194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Toda R, Moriyama Y, Yamashita M, Iguro Y, Matsumoto H, Yotsumoto G. Operation for adult patent ductus arteriosus using cardiopulmonary bypass. Ann Thorac Surg 2000; 70:1935-7; discussion 1937-8. [PMID: 11156098 DOI: 10.1016/s0003-4975(00)01702-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical repair of adult patent ductus arteriosus is more hazardous than when performed on young patients. METHODS Nine adult patent ductus arteriosus patients underwent surgical repair between January 1986 and December 1998. There were 3 male and 6 female patients (mean age 55.0 years). The ratio of pulmonary blood flow to systemic flow was 2.40 +/- 0.95, and pulmonary arterial pressure was 56.0 +/- 26.4 mm Hg. The operation was performed using transpulmonary approach under total cardiopulmonary bypass. Balloon occlusion method was also utilized. RESULTS Direct closure was made in 5 and patch closure in 4 patients. Cardiopulmonary bypass and balloon occlusion were safely established. Cardioplegic arrest was not required in the 2 most recent patients. No operative death has occurred. Pulmonary arterial systolic pressure decreased to 35.3 +/- 6.6 mm Hg at 6 months after operation. The mean follow-up period for all patients is 55 months. To date, neither recannalization of the ductus nor pseudoaneurysm has been recognized. CONCLUSIONS Cardiopulmonary bypass with balloon occlusion provides a safe operation for adult patients with complicated patent ductus arteriosus.
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Affiliation(s)
- R Toda
- Second Department of Surgery, Faculty of Medicine, Kagoshima University, and National Minami Kyushu Chuoh Hospital, Japan.
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Omari BO, Shapiro S, Ginzton L, Milliken JC, Baumgartner FJ. Closure of short, wide patent ductus arteriosus with cardiopulmonary bypass and balloon occlusion. Ann Thorac Surg 1998; 66:277-8. [PMID: 9692490 DOI: 10.1016/s0003-4975(98)00362-2] [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: 11/17/2022]
Abstract
The wide, short patent ductus arteriosus in adults and older adolescents poses an extreme hazard with standard closed ligation techniques. The method of transpulmonary balloon catheter occlusion and repair of pediatric ductus arteriosus is herein reported in older patients using a Foley catheter and normothermic bypass. Transesophageal echocardiography is crucial in assessing the size of the ductus and confirming adequacy of repair. The technique is simple and safe even in the presence of a wide, short ductus.
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Affiliation(s)
- B O Omari
- Division of Cardiothoracic Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
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Metras D. A new clamp for division and suture of patent ductus arteriosus. J Thorac Cardiovasc Surg 1994. [DOI: 10.1016/s0022-5223(94)70024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Whitlark JD, Lajos TZ, Visco JP. Combined aortic valve replacement and closure of patent ductus arteriosus in the elderly. J Card Surg 1994; 9:85-8. [PMID: 8012105 DOI: 10.1111/j.1540-8191.1994.tb00830.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- J D Whitlark
- Department of Surgery, State University of New York at Buffalo 14203
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Surgery for hypertensive aneurysmal ductus. Indian J Thorac Cardiovasc Surg 1993. [DOI: 10.1007/bf02666039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Concurrent aortic stenosis and patent ductus arteriosus are not infrequent in children but are rare in adults. An adult case is described with diagnosis by cardiac catheterization and magnetic resonance imaging and with management by combined aortic valve replacement and patent ductus ligation. Review of the English-language literature produced only 8 such cases in adults, 2 of which were managed by a single-stage operation. Successful diagnosis in the adult requires careful observation at cardiac catheterization, and simultaneous valve replacement and ductus ligation may be a useful option in patient management.
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Affiliation(s)
- D D Glower
- Department of Surgery, Duke University Medical Center, Durham, NC 27710
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John S, Korula R, Jairaj PS, Muralidharan S, Ravikumar E, Babuthaman C, Sathyamoorthy I, Krishnaswamy S, Cherian G, Sukumar IP. Results of surgical treatment of ventricular septal defects with pulmonary hypertension. Thorax 1983; 38:279-83. [PMID: 6867981 PMCID: PMC459536 DOI: 10.1136/thx.38.4.279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Two hundred and twenty-five consecutive patients with interventricular septal defect and associated pulmonary hypertension have undergone corrective surgery at the Christian Medical College Hospital. The mean preoperative systolic pulmonary artery pressure was 70.5 (range 31-136) mm Hg and the calculated pulmonary vascular resistance ranged from 300 to 1680 dyn/s cm-5. A paracoronary right ventriculotomy was the approach of choice. Profound hypothermia and circulatory arrest were not used, even in 12 patients weighing under 10 kg. Among the older children and young adolescents there were 27 who had a calculated pulmonary vascular resistance of over 800 dyn/s cm-1 and their mortality was 22%, which is good when compared with that of other series. It is evident that both the early and the late death rate after surgery increase with the age of the patient, especially in those with associated pulmonary hypertension. In 69 patients studied after repair recatheterisation showed no residual defect by oximetry. The fall in the pulmonary artery pressures after surgery has been striking in most patients. The late death rate was 2.5%. The surviving patients are leading normal, active lives.
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Abstract
A relatively simple and safe method for closure of the patient ductus arteriosus in the elderly patient is described. It has been done successfully in 4 patients.
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Abstract
A technique for closure of the complicated ductus arteriosus is described which has proved both simple and safe. The technique embodies the use of profound hypothermia, low flow, and direct suture of the pulmonary end of the ductus arteriosus through a pulmonary arteriotomy. No operative deaths have occurred among 4 patients so treated, and no complications from air embolism or hemorrhage have been encountered.
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Abstract
An improved surgical procedure for patch closure of the ductus arteriosus under cardiopulmonary bypass is presented. A patch with a Fogarty catheter inserted through its center is used. The catheter is insinuated into the aorta through a pulmonary arteriotomy under normothermic cardiopulmonary bypass. An inflated intraaortic balloon is made to plug the orifice of the ductus using gentle traction on the catheter. The catheter may be slanted in any direction that is convenient to provide satisfactory visualization of the operative field.
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Mehl SJ, Kronzon I, Glassman E. Patent ductus arteriosus in adult patients with aortic valvular disease: the importance of routine screening for a left-to-right shunt at cardiac catheterization. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1976; 2:403-8. [PMID: 1000629 DOI: 10.1002/ccd.1810020415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Two patients, catheterized primarily for the preoperative assessment of clinically apparent aortic stenosis and insufficiency, were found to have a patent ductus arteriosus as well at cardiac catheterization. The association of aortic valve disease and patent ductus arteriosus is reviewed, and the importance of making the diagnosis prior to aortic valve replacement is stressed, emphasizing the routine use of the hydrogenplatinum electrode system.
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Gonçalves-Estella A, Pérez-Villoria J, González-Reoyo F, Giménez-Méndez J, Castro-Cels A, Castro-Llorens M. Closure of a complicated ductus arteriosus through the transpulmonary route using hypothermia. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)41502-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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