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Yasuhara J, Kuno T, Kumamoto T, Kojima T, Shimizu H, Yoshiba S, Kobayashi T, Sumitomo N. Comparison of transcatheter patent ductus arteriosus closure between children and adults. Heart Vessels 2020; 35:1605-1613. [PMID: 32494943 DOI: 10.1007/s00380-020-01639-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
The data comparing the characteristics and effect of transcatheter patent ductus arteriosus (PDA) closure between children and adults is scarce. We analyzed 54 consecutive patients who underwent transcatheter PDA closures. We divided the patients into 2 groups of < 18 years and ≥ 18 years and compared the hemodynamic changes before and after the PDA closure. Adults had a higher incidence of heart failure on admission, diagnoses by heart failure and incidental echocardiography, PDA calcifications, and procedural complications than children (all P < 0.05). The left ventricular end-diastolic volume index (LVEDVI), left atrial diameter index (LADI), and LV mass index (LVMI) decreased after the PDA closure in children but not in adults. The LV ejection fraction (LVEF) significantly decreased 1 day after the PDA closure in both groups but remained low at 6 months after the procedure in only adults. The percent change in the LVEDVI, LADI, LVMI, and LVEF from baseline to 6 months after the procedure was significantly lesser in adults than children (LVEDVI: - 5.2 ± 29.1% vs. - 34.9 ± 18.9%, LADI: - 7.0 ± 13.2% vs. - 22.1 ± 18.9%, LVMI: - 11.0 ± 16.5% vs. - 34.1 ± 15.7%, LVEF: - 5.9 ± 7.6% vs. 6.1 ± 9.1%, all P < 0.05). Transcatheter PDA closure was not associated with a reduction in the LV and LA volume as well as an improvement in the LV hypertrophy and LV function in adults as compared to children. We suggested that an early diagnosis and transcatheter PDA closure during childhood might provide clinical benefit before progressive LV remodeling and heart failure.
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Affiliation(s)
- Jun Yasuhara
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Center for Cardiovascular Research and Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Takashi Kumamoto
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Department of Pediatrics, Saga University Hospital, Saga, Japan
| | - Takuro Kojima
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Hiroyuki Shimizu
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.,Department of Intensive Care, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Shigeki Yoshiba
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.
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Tobler D, Greutmann M. Simple cardiac shunts in adults: atrial septal defects, ventricular septal defects, patent ductus arteriosus. Heart 2020; 106:307-314. [DOI: 10.1136/heartjnl-2019-314700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Zanjani KS, Sobhy R, El-Kaffas R, El-Sisi A. Multicenter Off-Label Use of Nit-Occlud Coil in Retrograde Closure of Small Patent Ductus Arteriosus. Pediatr Cardiol 2017; 38:828-832. [PMID: 28224170 DOI: 10.1007/s00246-017-1589-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Abstract
We studied the safety and efficacy of closing patent ductus arteriosus by Nit-Occlud coils via retrograde approach. This is a retrospective study of 46 attempts to close ducts by this method in two hospitals in Egypt and Iran. Ductus arteriosus was crossed by left or right Judkins or endhole catheters. The coil was delivered via the same catheter or the provided endhole catheter after exchange. The procedure was successful in 42 out of 46 attempts. Fluoroscopy and procedural times were significantly shorter when the catheter was not exchanged. This method is effective and safe for the closure of small ducts. Crossing the duct and delivering the coil by a left Judkins catheter is the easiest and fastest way to perform this method.
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Affiliation(s)
- Keyhan Sayadpour Zanjani
- Pediatric Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rodina Sobhy
- Pediatric Cardiology Department, Cairo University Children's Hospital, Cairo University, 2 Aly Basha Ibrahim Street, Mounira, PO Box: 11111, Cairo, Egypt
| | - Rania El-Kaffas
- Pediatric Cardiology Department, Cairo University Children's Hospital, Cairo University, 2 Aly Basha Ibrahim Street, Mounira, PO Box: 11111, Cairo, Egypt
| | - Amal El-Sisi
- Pediatric Cardiology Department, Cairo University Children's Hospital, Cairo University, 2 Aly Basha Ibrahim Street, Mounira, PO Box: 11111, Cairo, Egypt.
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Abstract
As closing a patent arterial duct is relatively simple, safe, and successful, most children with a patent arterial duct have it closed soon after diagnosis. The larger ducts are closed to prevent congestive heart failure, pulmonary vascular disease, or aneurysmal dilatation of the ductus, and smaller ducts are closed to prevent infective endocarditis. Consequently, there is no opportunity to determine whether spontaneous closure or diminution in size of the patent arterial duct is common. If the duct does become smaller, flow through it may be so low that no murmur is produced - the silent ductus. The frequency and best management of the silent patent arterial duct are unknown, and we do not know whether these tiny ducts are the last stage before spontaneous closure.
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Abstract
Down syndrome is the most common chromosomal abnormality, with an incidence of one case in every 650 live births. It is strongly associated with heart disease, which constitutes the main cause of mortality during the first 2 years of life in this population. Most of the cardiac abnormalities in patients with Down syndrome can be suspected by analysing the surface 12-lead ECG. The purpose of this systematic review was to analyse all available published material on surface ECG and cardiac rhythm and conduction abnormalities in patients with Down syndrome to facilitate the search to the clinical cardiologist and paediatrician.
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Mak MS, Ong CC, Tay ELW, Teo LLS. Clinics in diagnostic imaging (155). Incidental PDA with secondary pulmonary arterial hypertension. Singapore Med J 2014; 55:462-6; quiz 467. [PMID: 25273929 DOI: 10.11622/smedj.2014113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report the case of a 70-year-old man with an asymptomatic large patent ductus arteriosus (PDA) incidentally detected on triple-rule-out computed tomography (CT). CT clearly demonstrated a vascular structure connecting the descending thoracic aorta to the roof of the proximal left pulmonary artery, consistent with a PDA. Secondary pulmonary arterial hypertension was also evident on CT. The patient was eventually diagnosed with acute coronary syndrome and was successfully treated with coronary artery bypass graft surgery and concomitant patch closure of the PDA. This article aims to outline the imaging features of PDA and highlight the information provided by CT, which is crucial to treatment planning. The pathophysiology, clinical manifestations and closure options of PDA are also briefly discussed.
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Affiliation(s)
| | | | | | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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Porras D, Bergersen L. Standardizing care in congenital heart disease: approaches in the catheterization laboratory. Interv Cardiol 2014. [DOI: 10.2217/ica.13.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
More than three decades have passed since the introduction of transcatheter devices for closure of patent ductus arteriosus, and many occluders have been made available since then. The ideal requirements of any procedure are a user-friendly technique, optimum success rate, no residual anomaly, minimal morbidity/mortality, and comparability or superiority to the existing conventional modality of treatment. With various advancements in device design, delivery and assisted systems, the tremendous procedural safety and effectiveness, along with low cost and widespread availability of these devices makes transcatheter closure of patent ductus arteriosus a preferred therapeutic modality in all age groups, with decreasing demographic trends of surgical management.
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Affiliation(s)
- R Arora
- Metro Hospital and Heart Institute, G.B. Pant Hospital, New Delhi 110002, India.
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Abstract
During fetal life, the ductus arteriosus is a normal and essential structure that connects the pulmonary artery to the distal aortic arch, permitting right ventricular ejection into the aorta. After birth, with commencement of pulmonary blood flow and a 2-ventricle circulation, a variety of physiological and biochemical signals normally result in complete closure of the ductus. Persistent patency of the ductus arteriosus may impair systemic cardiac output and result in deleterious effects on the cardiovascular system and lungs. Although surgery is still the treatment of choice for most premature infants with patent ductus arteriosus (PDA), transcatheter techniques have largely supplanted surgery for closure of PDA in children and adults. This article is a review of the PDA in term infants, children, and adults, with focus on the clinical manifestations and management.
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Affiliation(s)
- Douglas J Schneider
- Division of Pediatric Cardiology, Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA.
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Navaratnarajah M, Mensah K, Balakrishnan M, Raja SG, Bahrami T. Large patent ductus arteriosus in an adult complicated by pulmonary endarteritis and embolic lung abscess. Heart Int 2011; 6:e16. [PMID: 22049313 PMCID: PMC3205782 DOI: 10.4081/hi.2011.e16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022] Open
Abstract
Patent ductus arteriosus in the adult is an extremely rare clinical phenomenon. We report the case of a 34-year old man who developed pulmonary endarteritis and subsequent embolic lung abscess secondary to a large patent ductus arteriosus. This brief report also provides an overview of the natural history, potential complications, optimal therapy, and diagnostic dilemmas associated with this persistent congenital cardiac defect in adults.
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Fortescue EB, Lock JE, Galvin T, McElhinney DB. To close or not to close: the very small patent ductus arteriosus. CONGENIT HEART DIS 2010; 5:354-65. [PMID: 20653702 DOI: 10.1111/j.1747-0803.2010.00435.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2-4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk:benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.
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Affiliation(s)
- Elizabeth B Fortescue
- Harvard Medical School and Department of Cardiology, Children's Hospital Boston, Boston, MA, USA
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Aoyagi S, Chihara S, Fukunaga S, Mori R, Suda K. Transcatheter coil embolization for patent ductus arteriosus in the elderly: report of a case and review of the published work. Geriatr Gerontol Int 2009; 9:329-32. [PMID: 19702946 DOI: 10.1111/j.1447-0594.2009.00541.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patent ductus arteriosus is the third most common congenital cardiovascular anomaly, however, it is rarely found in the elderly. We describe a case of patent ductus arteriosus in a 72-year-old woman in whom patent ductus arteriosus was successfully managed by transcatheter coil embolization. The patient had been diagnosed with a heart murmur for the first time 1 year earlier at the age of 71. She was asymptomatic but a continuous murmur was heard. Cardiac catheterization revealed migration of a catheter from the main pulmonary artery into the descending aorta through a patent ductus arteriosus and a significant step-up of oxygen saturation in the main pulmonary artery with a pulmonary-to-systemic flow ratio of 1.68. Aortograms demonstrated a communication between the aorta and the pulmonary artery through a patent ductus arteriosus with a minimal diameter of 3.7 mm. Transcatheter coil embolization of the patent ductus arteriosus was successfully carried out with two 0.052-inch-diameter Gianturco coils. Doppler echocardiographic study confirmed no residual shunt in the main pulmonary artery after the procedure. Non-surgical transcatheter occlusion using coil embolization appears to be an effective and minimally invasive technique for treatment of patent ductus arteriosus in the elderly.
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Affiliation(s)
- Shigeaki Aoyagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan.
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Abstract
This report describes a 92-year-old woman patient with patent ductus arteriosus (PDA). She seems to be the oldest patient with PDA hitherto reported in the medical history. She developed infective endocarditis (IE) and congestive heart failure, and died at the age of 92. At autopsy, the PDA was found to the left of the origin of the left subclavian artery. Both left and right ventricles were hypertrophied with markedly dilated pulmonary arteries. IE involving the aortic valve extended to the sinus of Valsalva and pericardium, inducing pericarditis and cardiac tamponade. IE also resulted in systemic septic embolization.
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Affiliation(s)
- Paul Khairy
- From the Adult Congenital Heart Center and Electrophysiology Service (P.K.), Montreal Heart Institute, University of Montreal, and the McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) (A.J.M.), Montreal, Canada
| | - Ariane J. Marelli
- From the Adult Congenital Heart Center and Electrophysiology Service (P.K.), Montreal Heart Institute, University of Montreal, and the McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) (A.J.M.), Montreal, Canada
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MESH Headings
- Abnormalities, Multiple
- Adult
- Aneurysm/etiology
- Child
- Diagnostic Techniques, Cardiovascular
- Dinoprostone/physiology
- Ductus Arteriosus/embryology
- Ductus Arteriosus/physiology
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/embryology
- Ductus Arteriosus, Patent/epidemiology
- Ductus Arteriosus, Patent/physiopathology
- Ductus Arteriosus, Patent/surgery
- Ductus Arteriosus, Patent/therapy
- Eisenmenger Complex/etiology
- Eisenmenger Complex/physiopathology
- Epoprostenol/physiology
- Heart Failure/etiology
- Humans
- Hypertension, Pulmonary/etiology
- Incidence
- Infant
- Infant, Newborn
- Oxygen/blood
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Affiliation(s)
- Douglas J Schneider
- University of Illinois College of Medicine at Peoria, and Cardiac Catheterization Laboratory, Children's Hospital of Illinois, 420 NE Glen Oak Ave, Suite 304, Peoria, IL 61603, USA.
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Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. ACTA ACUST UNITED AC 2006. [DOI: 10.1097/00149831-200606000-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Festic E, Steiner RM, Spatz E. Aortic dissection with extension to a patent ductus arteriosus. Int J Cardiovasc Imaging 2005; 21:459-62. [PMID: 16047130 DOI: 10.1007/s10554-004-7985-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Accepted: 12/21/2004] [Indexed: 11/25/2022]
Abstract
An 81-year-old woman presented with shortness of breath and fever of 3 days duration. An enhanced CT of the chest revealed a patent ductus arteriosus (PDA) communicating with the true lumen of an aortic arch dissection. Neither the aortic dissection nor the PDA was suspected. The patient had no history of a connective tissue abnormality or other condition which would predispose to dissection other than systemic hypertension. It is likely that propagation of the aortic dissection partially re-opened the ductus arteriosus.
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Affiliation(s)
- Emir Festic
- Department of Medicine, New York Methodist Hospital, New York, NY, USA
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Kobayashi T, Tomita H, Fuse S, Takamuro M, Hatakeyama K, Horita N, Tsutsumi H. Coil Occlusion for Patent Ductus Arteriosus Larger Than 3 mm. Circ J 2005; 69:1271-4. [PMID: 16195630 DOI: 10.1253/circj.69.1271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coil occlusion of patent ductus arteriosus (PDA) is now widely accepted as the first-line treatment, but there are few reports of age-dependent differences in the complications associated with this technique. METHODS AND RESULTS Sixteen patients (11 adults, 5 children) with a PDA larger than 3 mm, who underwent coil occlusion at Sapporo Medical University Hospital between September 1995 and August 2004, were enrolled. Immediate and intermediate outcomes and complications were analyzed. Procedural success rate was 72.7% (8/11) in the children and 100% (5/5) in the adults. Coil migration occurred in 4 children and 1 adult, and 3 adult patients had hemolysis. CONCLUSION Hemolysis was more frequent in adults than in children even though the residual shunt was trivial.
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Affiliation(s)
- Toshiyuki Kobayashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Japan
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Abstract
Postocclusion survival data from dogs with left-to-right shunting patent ductus arteriosus (PDA) was available from 80 dogs, diagnosed from 1990 to 2000. Of these, 37 had undergone a procedure to close the ductus and were re-evaluated at the time of this study; clinical data from the follow-up examination was compared with that from the original examination. Radiographically, the right ventricle remained apparently enlarged, and the aortic bulge associated with dilation of the descending aorta did not disappear after closure. On M-mode echocardiography, left ventricular chamber diameter in diastole and systole and left ventricular posterior wall in systole decreased significantly. Mitral endocardiosis was a common feature. Residual flow was evident in 46 per cent of the animals. Late closure occurred in 8 per cent of the dogs, and trivial recanalisation in 19 per cent. The maximum survival time postclosure was 168 months and, after non-occlusion, 114 months, suggesting that dogs with PDA follow an unpredictable course. However, there was a significant difference in survival times between the corrected and non-corrected group.
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Affiliation(s)
- N Van Israël
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, Edinburgh University, Roslin EH25 9RG
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Van Israël N, French AT, Dukes-McEwan J, Welsh EM. Patent Ductus Arteriosus in the older Dog. J Vet Cardiol 2003; 5:13-21. [DOI: 10.1016/s1760-2734(06)70040-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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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Affiliation(s)
- L M Fayad
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY 10003, USA
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Amir IM, Maranets I, Barash P. Transesophageal echocardiography of the distal aortic arch. J Cardiothorac Vasc Anesth 1998; 12:599-603. [PMID: 9801987 DOI: 10.1016/s1053-0770(98)90110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- I M Amir
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT
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Watanabe S, Saitou H, Hata M, Miura M, Zuguchi M, Tabayashi K. [Percutaneous transcatheter coil embolization of the patent ductus arteriosus for elderly patient with left ventricular disfunction]. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:643-6. [PMID: 9750449 DOI: 10.1007/bf03217795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We performed the coil embolization for 64-year-old male with patent ductus arteriosus and left ventricular dysfunction. We used "snare method" and "cross catheter technique" delivering one coil transvenously and one coil transarterially. Echocardiograms at 7 month after the procedure demonstrated complete occlusion of the ductus, though small shunt was detected at discharge.
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Affiliation(s)
- S Watanabe
- Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan
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Haviv YS, Safadi R, Gilon D. Patent ductus arteriosus in older people. J Am Geriatr Soc 1998; 46:541-2. [PMID: 9560089 DOI: 10.1111/j.1532-5415.1998.tb02488.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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29
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Abstract
A newly diagnosed atrial fibrillation warrants a full investigation of the etiopathogenesis of this common arrhythmia. In the adult population, the most frequently associated conditions are systemic hypertension, coronary artery disease, mitral valvulopathy, congestive heart failure, and hyperthyroidism. Nevertheless, more infrequent and even rare, yet correctable, etiologies should not be overlooked. We describe three patients who presented to our hospital with a first episode of atrial fibrillation and who subsequently were demonstrated to have very unusual cardiovascular pathologies subtending this common arrhythmia. In all three cases, trans-esophageal echocardiography was instrumental in reaching an accurate diagnosis that was later confirmed at surgery.
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Affiliation(s)
- P Raggi
- Long Island College Hospital, Brooklyn, New York, USA
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30
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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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31
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Shyu KG, Lai LP, Lin SC, Chang H, Chen JJ. Diagnostic accuracy of transesophageal echocardiography for detecting patent ductus arteriosus in adolescents and adults. Chest 1995; 108:1201-5. [PMID: 7587417 DOI: 10.1378/chest.108.5.1201] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To compare the accuracy of transesophageal echocardiography (TEE) with that of transthoracic echocardiography (TTE) in the detection of patent ductus arteriosus (PDA) in the adolescent and the adult, 40 patients with PDA and 50 patients with other congenital heart diseases were studied. All echocardiograms were recorded before cardiac catheterization and surgery. The echocardiographic diagnosis of PDA was made by direct visualization of a shunt flow in the duct. A mosaic flow in the pulmonary artery without direct visualization of the duct was considered possible but not definitely diagnostic of PDA. TEE showed greater sensitivity and negative predictive value than TTE (97% vs 42%, and 98% vs 68%, respectively; p < 0.001) in confirming the diagnosis of PDA. The specificity and positive predictive value in establishing the diagnosis of PDA were the same for both techniques. In the subgroup of patients with Eisenmenger's syndrome, the sensitivity of TEE and TTE in confirming diagnosis of PDA was 100% and 12% (p < 0.01), respectively. The sensitivity of monoplane and biplane TEE in the diagnosis of PDA was comparable (95% and 100%, respectively; p = NS). In conclusion, TEE was highly sensitive and specific in detecting PDA in adolescents and adults. It was also highly valuable for detecting the cause of pulmonary hypertension in patients with Eisenmenger's syndrome.
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Affiliation(s)
- K G Shyu
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China
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32
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Schräder R, Kadel C, Cieslinski G, Bussmann WD, Kaltenbach M. Non-thoracotomy closure of persistent ductus arteriosus beyond age 60 years. Am J Cardiol 1993; 72:1319-21. [PMID: 8256713 DOI: 10.1016/0002-9149(93)90306-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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33
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34
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Schenck MH, O'Laughlin MP, Rokey R, Ludomirsky A, Mullins CE. Transcatheter occlusion of patent ductus arteriosus in adults. Am J Cardiol 1993; 72:591-5. [PMID: 8362776 DOI: 10.1016/0002-9149(93)90357-i] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
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)
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Affiliation(s)
- M H Schenck
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston 77030
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35
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Abstract
Patent ductus arteriosus is an uncommon anomaly in adult patients. Surgical closure of patent ductus arteriosus in this age group presents difficult problems to the surgeon. We report our experience of 21 adult patients (19-62 years of age, mean 40 years) who underwent closure of the ductus by transfemoral implantation of a Rashkind double umbrella device. The patients came to light because of atrial fibrillation, congestive heart failure, residual flow after surgical ligation of the duct or because of incidental diagnosis made during physical examination or chest X-ray. In ten patients the pulmonary arterial pressure was normal (systolic pressure < 30 mmHg), in eleven it was elevated (systolic pressure from 30 to 100 mmHg, mean 50 mmHg). In seven patients the duct was clearly calcified and the size of the duct varied from 3 to 9 mm (mean 4.3 mm). In 16 patients the ductus resulted perfectly closed after implantation of the first double umbrella device, two patients had minimal residual aortopulmonary flow, whereas in three patients the residual shunt was significant; two of these also developed haemolysis and went to surgery, in the latter the shunt was completely abolished after implantation of a second 17-mm device 16 months later. In conclusion transcatheter closure of patent ductus arteriosus in adults is feasible, even in the presence of calcifications and/or pulmonary hypertension; taking into account the significant surgical risk, PDA umbrella closure should be considered the first choice procedure in this group of patients.
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Affiliation(s)
- P Bonhoeffer
- Department of Cardiology, Ospedali Riuniti di Bergamo, Italy
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36
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Bijl M, Bronzwaer JG, van Rossum AC, Verheugt FW. Angina pectoris due to left main coronary artery compression in Eisenmenger ductus arteriosus. Am Heart J 1993; 125:1767-71. [PMID: 8498323 DOI: 10.1016/0002-8703(93)90771-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Bijl
- Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands
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37
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Prasad K, Radhakrishnan S, Sinha N. Extensive calcification of pulmonary arteries with left-to-right shunting across the arterial duct. Int J Cardiol 1992; 35:419-21. [PMID: 1612808 DOI: 10.1016/0167-5273(92)90245-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Extensive calcification of the pulmonary trunk extending to the arterial duct is described in a young adult. The unusual feature was the presence of restriction of the duct with only left-to-right shunting. The rarity of this condition and its surgical importance is emphasized.
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Affiliation(s)
- K Prasad
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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38
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Celermajer DS, Hughes CF, Baird DK, Sholler GF. Persistent ductus arteriosus in adults A review of surgical experience with 25 patients. Med J Aust 1991. [DOI: 10.5694/j.1326-5377.1991.tb142228.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David S Celermajer
- The Cardiothoracic Surgical UnitRoyal Prince Alfred HospitalMissenden RoadCamperdown, Sydney2050
| | - Clifford F Hughes
- The Cardiothoracic Surgical UnitRoyal Prince Alfred HospitalMissenden RoadCamperdown, Sydney2050
| | - Douglas K Baird
- The Cardiothoracic Surgical UnitRoyal Prince Alfred HospitalMissenden RoadCamperdown, Sydney2050
| | - Gary F Sholler
- Adolph Basser Institute of Cardiology, The Children's HospitalBridge RoadCamperdown, Sydney2050
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39
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Yamaguchi T, Fukuoka H, Yamamoto K, Katsuta S, Ohta M. Transfemoral closure of patent ductus arteriosus: an alternative to surgery in older patients. Cardiovasc Intervent Radiol 1990; 13:291-3. [PMID: 2124166 DOI: 10.1007/bf02578628] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two patients with congestive heart failure underwent successful closure of patent ductus arteriosus (PDA) at ages 58 and 63, respectively, using the transfemoral technique of Porstmann and Sato. The long-term benefits obtained in these two patients suggests a potential role for this technique in the elderly patient with PDA.
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Affiliation(s)
- T Yamaguchi
- Department of Radiology, Hiroshima University School of Medicine, Japan
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40
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Morgan JM, Gray HH, Miller GA, Oldershaw PJ. The clinical features, management and outcome of persistence of the arterial duct presenting in adult life. Int J Cardiol 1990; 27:193-9; discussion 201-2. [PMID: 2365507 DOI: 10.1016/0167-5273(90)90159-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- J M Morgan
- Cardiac Department, Brompton Hospital, London, U.K
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41
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Vita JA, Bittl JA, Selwyn AP, Lock JE. Transcatheter closure of a calcified patent ductus arteriosus in an elderly man. J Am Coll Cardiol 1988; 12:1382-5. [PMID: 3170978 DOI: 10.1016/0735-1097(88)92624-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Successful transcatheter closure of a calcified patent ductus arteriosus was performed in a symptomatic 78 year old man. Cardiac catheterization revealed a left to right shunt across the patent ductus arteriosus with a pulmonary to systemic flow ratio of 2.8:1. Calcification of the ductus and severe lung disease increased the risk of surgical patent ductus arteriosus closure. A 17 mm Rashkind double umbrella was positioned in the ductus percutaneously by way of the femoral vein. After closure of the ductus there was marked hemodynamic improvement and the patient was discharged with improved exercise tolerance. Transcatheter closure of patent ductus arteriosus may be a viable option for the elderly patient too sick to withstand cardiovascular surgery.
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Affiliation(s)
- J A Vita
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115
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42
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Abstract
Patent ductus arteriosus presenting in an elderly patient is unusual. This report describes the oldest patient (72 years) to undergo successful surgical interruption of a patent ductus arteriosus with a unique clinical presentation of typical angina pectoris with normal coronary anatomy. A possible pathophysiologic mechanism for this previously unreported presenting symptom is proposed. The natural history of patent ductus arteriosus and the role of surgery in the elderly patient are discussed.
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Affiliation(s)
- S Zarich
- Department of Medicine, New England Deaconess Hospital, Boston
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43
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Marquis RM. Congenital heart disease: the ductus arteriosus as pathfinder. BRITISH HEART JOURNAL 1987; 58:429-36. [PMID: 3314953 PMCID: PMC1277335 DOI: 10.1136/hrt.58.5.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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44
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Peller OG, Gold JP, Isom OW. Patent ductus arteriosus associated with rheumatic mitral regurgitation in the adult. Am J Cardiol 1987; 60:924-6. [PMID: 3661414 DOI: 10.1016/0002-9149(87)91054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- O G Peller
- Department of Medicine, New York Hospital, New York
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45
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Fisher RG, Moodie DS, Sterba R, Gill CC. Patent ductus arteriosus in adults--long-term follow-up: nonsurgical versus surgical treatment. J Am Coll Cardiol 1986; 8:280-4. [PMID: 2942590 DOI: 10.1016/s0735-1097(86)80040-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The long-term prognosis of adult patients with patent ductus arteriosus treated medically or surgically has not been demonstrated. One hundred seventeen adult patients ranging in age from 18 to 81 years (mean 36) were followed up for 1 to 37 years (mean 18). Forty-five patients were treated nonsurgically and 72 had surgical closure. The nonsurgical group experienced significantly more cyanosis (p = 0.002) and had fewer diastolic murmurs (p greater than 0.001) than did the surgical group. In the nonsurgical group, patients with cardiomegaly before treatment were more likely to die (p greater than 0.001) than were patients who did not have cardiomegaly. In the surgical group, patients with cardiomegaly before treatment had a worse prognosis (p = 0.09) than that of patients with normal heart size. Seven patients, five in the nonsurgical and two in the surgical group, presented with a pulmonary artery systolic pressure greater than 100 mm Hg. Five of these patients are alive and well at a mean follow-up time of 18 years. The two nonsurvivors were in the nonsurgical group and died at 4 and 19 years of follow-up, respectively. Adult patients with patent ductus arteriosus should be treated surgically, especially if cardiomegaly is seen at initial presentation.
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46
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Abstract
At the Mayo Clinic, from 1945 through 1983, a definitive diagnosis of patent ductus arteriosus was first made in 38 patients when they were more than 50 years old. Of the 29 patients who had cardiac catheterization, 14 had a small left-to-right shunt, 7 had a moderate shunt, and 8 had a large shunt. Five patients, including 2 with right-to-left shunts through the ductus, had pulmonary systolic pressures greater than 75 mm Hg. Thirty procedures were done in 29 patients: ductal ligation in 7, division and suture in 13, transaortic patch closure in 3, and closure via median sternotomy with extracorporeal circulation in 7. There was one intraoperative death (operative mortality, 3.3%). Although technically more challenging, surgical repair is associated with low mortality and excellent follow-up survival. The patients who benefit most from surgical correction are those with Qp/Qs greater than 1.5 and pulmonary artery systolic pressure less than 75 mm Hg.
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48
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Pérez JE, Nordlicht SM, Geltman EM. Patent ductus arteriosus in adults: diagnosis by suprasternal and parasternal pulsed Doppler echocardiography. Am J Cardiol 1984; 53:1473-5. [PMID: 6720599 DOI: 10.1016/s0002-9149(84)91509-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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