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Mariager AF, Hammeken A, Malham M, Raja AA, Sellmer A, Skjellerup SL, Raja RA, Navne J, Sillesen AS, Vejlstrup N, Bundgaard H, Iversen KK, Garne E, Jeppesen DL. Age-Related Prevalence of Open Ductus Arteriosus in Full-Term Newborns. Neonatology 2023; 120:527-531. [PMID: 37285834 DOI: 10.1159/000529842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The ductus arteriosus is part of the fetal circulation. Normally, the vessel closes during the cardiac transition. Delayed closure is associated with complications. The aim of this study was to evaluate the age-related prevalence of open ductus arteriosus in full-term neonates. METHODS Echocardiograms were collected in the population study, the Copenhagen Baby Heart Study. The present study included full-term neonates with an echocardiogram performed within 28 days after birth. All echocardiograms were reviewed to assess ductus arteriosus patency. RESULTS A total of 21,649 neonates were included. In neonates examined at day zero and day seven, an open ductus arteriosus was found in 36% and 0.6%, respectively. Beyond day seven, the prevalence remained stable at 0.6%. CONCLUSION More than one-third of full-term neonates had an open ductus arteriosus on the first day of life, declining rapidly within the first week and stabilizing below 1% after day seven.
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Affiliation(s)
- Anton Friis Mariager
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alberte Hammeken
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Malham
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sellmer
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine Aarhus University Hospital, Aarhus, Denmark
| | - Signe Levring Skjellerup
- Department of Internal Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Raheel Altaf Raja
- Department of Pediatrics and Adolescents, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Johan Navne
- Department of Intensive Care Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Capital Region's Unit of Inherited Cardiac Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Dorthe Lisbeth Jeppesen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bhat YA, Almesned A, Alqwaee A, Al Akhfash A. Catheter Closure of Clinically Silent Patent Ductus Arteriosus Using the Amplatzer Duct Occluder II-Additional Size: A Single-Center Experience. Cureus 2021; 13:e17481. [PMID: 34589368 PMCID: PMC8465329 DOI: 10.7759/cureus.17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Transcatheter closure is the treatment of choice for most patent ductus arteriosus (PDA) in infants, children, and adults. However, there is a controversy regarding transcatheter closure of clinically silent PDAs. Some authors favor device closure to eliminate the lifelong risk of infective endarteritis while others recommend avoiding PDA closure in such patients. The study describes our experience of closing the silent PDAs using the Amplatzer duct occluder II-additional size (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN). Materials and methods From April 2018 through March 2021, 52 consecutive pediatric patients aged 18 years and less with clinically silent PDA who had transcatheter closure at our center were enrolled. Patients were excluded if they had clinically detected PDAs; had surgical ligation of PDA with no residual shunt; had left heart dilatation on echocardiography; or moderate-sized PDAs closed with ADO II-AS. In addition, patients with an innocent murmur or murmur due to an associated lesion were included. This study was retrospective, and all of the 52 patients underwent PDA device closure using ADO II-AS. Results Fifty-two consecutive patients were enrolled with a median age of 17 months, range (97-2.5) 94.5 months. Mean weight was 11.29 kilogram, range (24.8-3.5) 21.3 kilogram, and mean follow-up was 13.5 months, range (29-0) 29 months. Thirty-one (59.6%) were females, and 21 (40.4%) were males. The mean procedure time was 30.6 min, range (60-10) 50 min, and mean fluoroscopic time was 5.5 min, range (28-1.7) 26.3 min. The mean volume of contrast given was 9.1 milliliter, range (30-4) 26 milliliter. Forty-five (45; 88.2%) patients had immediate closure of PDA. No patients had anesthetic or vascular complications; however, two patients had procedural complications. Device placement was unsuccessful in one patient with Downs syndrome. The mean follow-up for our patients was 13.5 months, range (29-0) 29 months; the patients were asymptomatic at the follow-up, and none of the patients had any residual leak. None of the patients showed coarctation or left pulmonary artery stenosis at the latest follow-up. Conclusion The usefulness of catheter-based therapy for silent PDA is less well-established by current evidence. Further studies are needed to justify the intervention solely based on the premise that the silent duct is a substrate for infective endarteritis; however, our reason to close silent PDA was to do so primarily because of social reasons. This study found that device closure of silent PDA is safe and effective using an ADO II-AS device with minimal risk of embolization and a low residual shunt rate. Coils have been used to close small PDAs, however, with higher rates of embolization and device malpositioning. We believe ADO-II AS offers an advantage of safety and efficacy over coils. In addition, the study highlights the advantage of using an ADO II-AS device, which can be delivered via a four French delivery system with no arterial complications.
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Affiliation(s)
- Yasser A Bhat
- Department of Pediatric Cardiology, Prince Sultan Cardiac Centre, Buraidah, SAU
| | | | - Abdullah Alqwaee
- Department of Pediatric Cardiology, Prince Sultan Cardiac Centre, Buraidah, SAU
| | - Ali Al Akhfash
- Department of Pediatric Cardiology, Prince Sultan Cardiac Centre, Buraidah, SAU
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Hakim K, Tagorti M, Msaad H, Ben Othmen R, Ouaghlani K, Ouarda F. Transcatheter closure of silent patent ductus arteriosus for prevention of endocarditis is justified. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2021.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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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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5
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Bae JY, Park HS, Cho YJ, Kim TK, Jeon Y, Hong DM. Newly detected patent ductus arteriosus by transesophageal echocardiography in patient who underwent cardiopulmonary bypass -A case report-. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jun-yeol Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han-seul Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Deok Man Hong
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Vijayalakshmi IB. Evaluation of Left to Right Shunts by the Pediatrician: How to Follow, When to Refer for Intervention? Indian J Pediatr 2015; 82:1027-32. [PMID: 26452492 DOI: 10.1007/s12098-015-1861-9] [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: 04/27/2015] [Accepted: 07/22/2015] [Indexed: 02/01/2023]
Abstract
Left to right shunts are the most common congenital heart defects which may cause increased pulmonary blood flow leading to dilatation of cardiac chambers, congestive heart failure, pulmonary artery hypertension and eventually Eisenmenger's syndrome. Many children are, however, referred late for correction making them either high risk for intervention or inoperable. The device closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus can literally cure the patient for life, without a scar on the chest. Hence, it is important for every pediatrician to know how to follow and when to refer the patients with left to right shunts for either device closure or surgical intervention, so that the patient can lead a near normal life.
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Affiliation(s)
- I B Vijayalakshmi
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, 560 069, India.
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7
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Chugh R, Salem MM. Echocardiography for Patent Ductus Arteriosus Including Closure in Adults. Echocardiography 2014; 32 Suppl 2:S125-39. [DOI: 10.1111/echo.12457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Reema Chugh
- Cardiology Division; CMOB 308; Kaiser Permanente Medical Center; Panorama City California
| | - Morris M. Salem
- Pediatric Cardiology; Kaiser Permanente-Los Angeles Medical Center; Los Angeles California
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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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9
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Consensus on timing of intervention for common congenital heart diseases: part I - acyanotic heart defects. Indian J Pediatr 2013; 80:32-8. [PMID: 22752706 DOI: 10.1007/s12098-012-0833-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 06/14/2012] [Indexed: 12/15/2022]
Abstract
The purpose of this review/editorial is to discuss how and when to treat the most common acyanotic congenital heart defects (CHD); the discussion of cyanotic heart defects will be presented in a subsequent editorial. By and large, the indications and timing of intervention are decided by the severity of the lesion. Balloon pulmonary valvuloplasty is the treatment of choice for valvar pulmonary stenosis and the indication for intervention is peak-to-peak systolic pressure gradient >50 mmHg across the pulmonary valve. For aortic valve stenosis, balloon aortic valvuloplasty appears to be the first therapeutic procedure of choice; the indications for balloon dilatation of aortic valve are peak-to-peak systolic pressure gradient across the aortic valve in excess of 70 mmHg irrespective of the symptoms or a gradient ≥ 50 mmHg with either symptoms or electrocardiographic ST-T wave changes indicative of myocardial perfusion abnormality. The indications for intervention in coarctation of the aorta are significant hypertension and/or congestive heart failure along with a pressure gradient in excess of 20 mmHg across the coarctation; the type of intervention varies with age at presentation and the anatomy of coarctation: surgical intervention for neonates and young infants, balloon angioplasty for discrete native coarctation in children, and stents in adolescents and adults. Long segment coarctations or those associated with hypoplasia of the isthmus or transverse aortic arch require surgical treatment in younger children and stents in adolescents and adults. For post-surgical aortic recoarctation, balloon angioplasty in young children and stents in adolescents and adults are treatment options. Transcatheter closure methods are currently preferred for ostium secundum atrial septal defects (ASDs); the indications for occlusion are right ventricular volume overload by echocardiogram. Ostium primum, sinus venosus and coronary sinus ASDs require surgical closure. For all ASDs elective closure around age 4 to 5 y is recommended or as and when detected beyond that age. For the more common perimembraneous ventricular septal defects (VSDs) of large size, surgical closure should be performed prior to 6 to 12 mo of age. Muscular VSDs may be closed with devices. Patent ductus arteriosus (PDA) may be closed with Amplatzer Duct Occluder if they are moderate to large and Gianturco coils if they are small. Surgical and video-thoracoscopic closure are the available options at some centers. In the presence of pulmonary hypertension appropriate testing to determine suitability for closure should be undertaken. The treatment of acyanotic CHD with currently available medical, transcatheter and surgical methods is feasible, safe and effective and should be performed at an appropriate age in order to prevent damage to cardiovascular structures.
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Souaga KA, Kramoh KE, Katche KE, Kirioua Kamenan YA, Amani KA, N'goran YK, Kangah MK, Kakou MG. [Infective endocarditis complicating patent ductus arteriosus: emergency surgical treatment of two cases]. Ann Cardiol Angeiol (Paris) 2011; 61:125-7. [PMID: 21272857 DOI: 10.1016/j.ancard.2010.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 12/20/2010] [Indexed: 11/17/2022]
Abstract
Infective endocarditis is a rare complication of patent ductus arteriosus nowadays. About two patients, aged 7 and 5 years old, we diagnosed and treated a patent ductus arteriosus complicated with an infective vegetative endocarditis with a risk of pulmonary embolism. We report in this observation this clinical and surgical experience.
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Affiliation(s)
- K A Souaga
- Service de chirurgie cardiovasculaire, institut de cardiologie, Abidjan, Cote d'Ivoire.
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11
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Gologorsky E, Giquel J, Gologorsky A. A silent patent ductus arteriosus: a culprit or an innocent bystander? World J Pediatr Congenit Heart Surg 2011; 2:129-32. [PMID: 23804944 DOI: 10.1177/2150135110386250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 4-mm patent ductus arteriosus (PDA) was serendipitously diagnosed during intraoperative transesophageal echocardiography for a noncardiac procedure in an obese adult patient with a history of decreased exercise tolerance and dyspnea, despite a negative preoperative transthoracic examination. This uncommon event poses questions regarding the relevance of this finding to the differential diagnosis of dyspnea in an obese adult with a negative transthoracic echocardiography study, given the unknown prevalence of this pathology and the absence of consensus regarding the clinical management.
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Affiliation(s)
- Edward Gologorsky
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
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12
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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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13
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Abstract
Persistent patency of the arterial duct represents one of the most common lesions in the field of congenital cardiac disease. The strategies for management continue to evolve. In this review, we focus on management beyond the neonatal period. We review the temporal evolution of strategies for management, illustrate the currently available the techniques for permanent closure of the patent arterial duct, review the expected outcomes after closure, discuss the current controversy over the appropriate treatment of the so-called "silent" duct, and provide recommendations for the current state of management of patients with persistent patency of the arterial duct outside of the neonatal period.At the Congenital Heart Institute of Florida, we now recommend closure of all patent arterial ducts, regardless of their size. Before selecting and performing the type of procedure, we explain the natural history of the persistently patent arterial duct to the parents or legal guardian of the child. Particular emphasis is placed on the risks of endocarditis, including the recognition that many cases of endocarditis may not be preventable. The devastating effects of endocarditis, coupled with the perception of more anecdotal reports of endocarditis with the silent duct, as well as the low risk of interventions, has led us to recommend closure of the patent arterial duct in these situations. We now recommend intervention, after informed consent, for all patients with a patent arterial duct regardless of size, including those in which the patent duct is "silent". We recognize, however, that this remains a controversial topic, especially given the new recommendations for endocarditis prophylaxis from American Heart Association. Since 2003, our strategy for closure of the patent arterial duct has changed subsequent to the availability of the Amplatzer occluder. This new device has allowed significantly larger patent arterial ducts to be closed with interventional catheterization procedures that in the past would have been closed at surgery. During the interval between 2002 and 2006 inclusive, the overall surgical volume at our Institute has been stable. Over this period, the number of patients undergoing surgical ligation of the patent arterial duct has decreased, with this decline in volume most notable for the subgroup of patients weighing more than five kilograms. This decrease has been especially notable in thoracoscopic procedures and is attributable to the increased ability to close larger ducts using the Amplatzer occluder. For infants with symptomatic pulmonary overcirculation weighing less than 5 kilograms, our preference is for the surgical approach. For patients who have ductal calcification, significant pleural scarring, or "window-like" arterial ducts, video-assisted ligation is not an option and open surgical techniques are used. When video-assisted ligation is possible, the approach is based on family and surgeon preference. When open thoracotomy is selected, we usually use a muscle-sparing left posterolateral thoracotomy. For patients weighing more than 5 kilograms, we currently recommend percutaneous closure for all patent arterial ducts as the first intervention, reserving surgical treatment for those cases that are not amenable to the percutaneous approach. For symptomatic infants weighing greater than 5 kilogram with large ducts, we prefer to use the Amplatzer occluder. In rare instances, the size of the required ductal occluder is so large that either encroachment into the aorta or pulmonary arteries is noted, and the device is removed. The child is then referred for surgical closure. We can now often predict via echocardiography that a duct is too large for transcatheter closure, even with the Amplatzer occluder, and refer these patients directly to surgery. For patients with an asymptomatic patent arterial duct, we prefer to wait until the weight is from 10 to 12 kilograms, or they are closer to 2 years of age. If the patent arterial duct is greater than 2.0 to 2.5 millimetres in diameter, our preference is to use the Amplatzer occluder. For smaller ducts, we typically use stainless steel coils. Using this strategy, we close all patent arterial ducts, regardless of their size.
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Onji K, Matsuura W. Pulmonary endarteritis and subsequent pulmonary embolism associated with clinically silent patent ductus arteriosus. Intern Med 2007; 46:1663-7. [PMID: 17917330 DOI: 10.2169/internalmedicine.46.0215] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 49-year-old man without heart murmur was admitted with fever because of bacteremia following a tooth extraction. Antibiotics rapidly alleviated the fever; however, a small nodule in the pulmonary artery was identified on computed tomography (CT). When the patient experienced chest discomfort with fever, CT demonstrated the absence of the nodule and the appearance of an abnormal lung opacity, and echocardiography showed turbulent retrograde flow in the pulmonary artery. We had the rare opportunity to follow a case of pulmonary bacterial endarteritis and subsequent pulmonary embolism with clinically silent patent ductus arteriosus (PDA) that was confirmed by 3-dimensional CT.
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Affiliation(s)
- Keiichi Onji
- Department of Internal Medicine, National Hospital Organization, Higashihiroshima Medical Center, Hiroshima
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15
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Stein JI. Silenter persistierender Ductus arteriosus Botalli. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gillor A, Perrey SE, Schnegg C. Soll ein silenter persistierender Ductus arteriosus Botalli verschlossen werden? Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1330-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Today most patients with congenital heart disease survive childhood to be cared for by adult cardiologists. The number of physicians that should be trained to manage these lesions is unknown because we do not know the number of patients. METHODS To answer this question, the expected numbers of infants with each major type of congenital heart defect born in each 5-year period since 1940 were estimated from birth rates and incidence. The numbers expected to survive with or without treatment were estimated from data on natural history and the results of treatment. Finally, lesions were categorized as simple, moderate, or complex, based on the amount of expertise in management needed for optimal patient care. RESULTS From 1940 to 2002, about 1 million patients with simple lesions, and half that number each with moderate and complex lesions, were born in the United States. If all were treated, there would be 750,000 survivors with simple lesions, 400,000 with moderate lesions, and 180,000 with complex lesions; in addition, there would be 3,000,000 subjects alive with bicuspid aortic valves. Without treatment, the survival in each group would be 400,000, 220,000, and 30,000, respectively. The actual numbers surviving will be between these 2 sets of estimates. CONCLUSIONS Survival of patients with congenital heart disease, treated or untreated, is expected to produce large numbers of adults with congenital disease, and it is likely that many more adult cardiologists will need to be trained to manage moderate and complex congenital lesions.
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Affiliation(s)
- Julien I E Hoffman
- Department of Pediatrics, University of California, San Francisco, Calif 94143, USA.
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Stanley BJ, Luis-Fuentes V, Darke PGG. Comparison of the incidence of residual shunting between two surgical techniques used for ligation of patent ductus arteriosus in the dog. Vet Surg 2003; 32:231-7. [PMID: 12784199 DOI: 10.1053/jvet.2003.50025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the incidence of residual patent ductus arteriosus (PDA) flow after ligation using 2 different dissection techniques: a standard dissection and a method described by Jackson and Henderson. STUDY DESIGN A randomized, prospective study. ANIMALS Thirty-five dogs admitted for surgical correction of a left to right shunting PDA. METHODS Dogs were randomly assigned: 19 to a standard dissection technique (group S) and 16 to the Jackson and Henderson dissection group (group JH). RESULTS Gender ratio, age at surgery, and diameter of the ductus were not statistically different between groups. Breed distribution was also similar. Because 1 dog had fatal intraoperative hemorrhage, only 34 dogs were available for residual flow comparisons. Twenty-one percent of group S dogs had residual flow compared with 53% in group JH. Whereas no intraoperative complications occurred in group S, 3 were encountered in group JH. CONCLUSIONS The incidence of residual flow was higher when the Jackson and Henderson dissection was used for PDA ligation compared with a standard method of dissection. This was probably because of entrapment of loose connective tissue within the medial aspect of the ligature, impeding complete closure of the ductus. CLINICAL RELEVANCE Ideal PDA closure should result in no residual ductal flow to prevent possible adverse long-term sequelae, such as recanalization and infective endocarditis.
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Affiliation(s)
- Bryden J Stanley
- Department of Clinical Veterinary Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Edinburgh, Scotland
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Chang ST, Hung KC, Hsieh IC, Chang HJ, Chern MS, Lin FC, Wu D. Evaluation of shunt flow by multiplane transesophageal echocardiography in adult patients with isolated patent ductus arteriosus. J Am Soc Echocardiogr 2002; 15:1367-73. [PMID: 12415230 DOI: 10.1067/mje.2002.125918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The role of multiplane (M) transesophageal echocardiography (TEE) in the diagnosis of isolated patent ductus arteriosus (PDA) in adults and its effectiveness in the assessment of the pulmonary to systemic flow ratio were evaluated and compared with those obtained from cardiac catheterization examination. Eleven consecutive patients, ranging from 17 to 56 years old (mean of 29.5 +/- 12.0), with clinically suspected PDA were subjects of this study. A complete transthoracic echocardiographic study was performed in each patient before MTEE. MTEE with Doppler color flow mapping showed clear visualization of a ductal structure between the descending aorta and pulmonary artery with a continuous turbulent mosaic flow suggestive of PDA in all 11 patients. The pulmonary/systemic flow and vascular resistance ratios obtained by echocardiography and cardiac catheterization correlated well (r = 0.8732, P =.0004; r = 0.623, P =.04, respectively). This study demonstrated that MTEE combined with transthoracic echocardiography examination is an accurate noninvasive means in the diagnosis of PDA and assessment of the pulmonary to systemic flow and vascular resistance ratios in adult patients.
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Affiliation(s)
- Shih-Tai Chang
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Jaeggi ET, Fasnacht M, Arbenz U, Beghetti M, Bauersfeld U, Friedli B. Transcatheter occlusion of the patent ductus arteriosus with a single device technique: comparison between the Cook detachable coil and the Rashkind umbrella device. Int J Cardiol 2001; 79:71-6. [PMID: 11399343 DOI: 10.1016/s0167-5273(01)00406-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED Transcatheter coil occlusion of the patent ductus arteriosus (PDA) has become the interventional treatment option of choice. Immediate occlusion of any residual shunting results in excellent closure rates, but frequently requires multiple coil deployment. AIMS To assess the efficacy and limitations of single Cook detachable coil PDA closure compared to a preceding series of Rashkind umbrella procedures. METHODS AND RESULTS Between 1990 and 1999, transcatheter occlusion of a small (<2 mm; n=45) or moderate-sized (2-4 mm; n=47) PDA was successfully attempted in 90/92 consecutive patients (mean age 6+/-4.8 years) with a coil (39/41) or Rashkind device (51/51). Immediate angiographic closure rates for both devices were low, although better for small (54-68%) than moderate ducts (7-22%, P<0.01). A 2-year echocardiographic closure rate of small ducts increased to 92% for the coil group versus 95% for the Rashkind group. By that time, moderate-sized ducts were only occluded in 64% with the coil and 54% with the Rashkind device. A visible residual shunt at post-implant angiography in moderate ducts was associated with a high incidence (59%) of long-term echocardiographic shunt patency and a need for repeat interventions for audible residual shunts (32%). CONCLUSIONS Single coil transcatheter occlusion is the treatment of choice for the small duct as most residual shunts will resolve spontaneously. However, long-term shunt persistence after single coil deployment in moderate sized ducts is as frequent as with the Rashkind device. A primary multiple coil approach is advocated if the postcoil aortogram shows residual ductal shunting and if there is persistence of a ductal murmur on auscultation.
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Affiliation(s)
- E T Jaeggi
- Paediatric Cardiology, University Children's Hospital of Geneva, 6 Rue Willy-Donzé, 1211, Geneva, Switzerland.
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Affiliation(s)
- R Arora
- Department of Cardiology, GB Pant Hospital, New Delhi 110001, India
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Rao PS, Balfour IC, Jureidini SB, Singh GK, Chen SC. Five-loop coil occlusion of patent ductus arteriosus prevents recurrence of shunt at follow-up. Catheter Cardiovasc Interv 2000; 50:202-6. [PMID: 10842391 DOI: 10.1002/(sici)1522-726x(200006)50:2<202::aid-ccd13>3.0.co;2-1] [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: 11/06/2022]
Abstract
Recent reports suggest reopening of the patent ductus arteriosus (PDA) after complete occlusion with three-loop Gianturco coils. We hypothesize that five-loop coils may produce a larger thrombus than three-loop coils, which will result in no or less probability of recanalization of PDA during follow-up. This study is designed to test this hypothesis. Follow-up echocardiographic and Doppler data of 30 patients who underwent five-loop coil occlusion of small to medium-sized PDA during a 33-month period ending December 1998 were examined. Thirty patients had no residual shunt on echo Doppler study on the day following the procedure and were followed for 6 to 30 months (median, 12) after coil implantation. At the last follow-up study, none of the patients had a residual shunt and left atrial size decreased. Careful pulsed, continuous wave, and color Doppler interrogation of left/main pulmonary artery junction and proximal descending aorta did not reveal any evidence for obstruction. The follow-up data suggest that complete occlusion of small- to medium-sized PDAs is feasible with five-loop coils without evidence for recanalization at a mean follow-up of 12 months. Much longer (2 to 5 years) follow-up data may be necessary to confirm these observations. We speculate that a greater degree of thrombosis is produced within the ductus by the five-loop coils, which in turn may be responsible for lack of shunt recurrence. We recommend use of five-loop instead of three-loop coils for transcatheter occlusion of small- to medium-sized PDAs.
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Affiliation(s)
- P S Rao
- Division of Pediatric Cardiology, Saint Louis University School of Medicine/SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri 63104, USA.
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Tomita H, Fuse S, Hatakeyama K, Chiba S. Endothelialization of the coils used to occlude a persistent ductus arteriosus: an angiographic study. JAPANESE CIRCULATION JOURNAL 2000; 64:262-6. [PMID: 10783048 DOI: 10.1253/jcj.64.262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To assess the endothelialization of the coils used to close a persistent ductus arteriosus (PDA), the present study comprised a review of the follow-up aortograms and pulmonary angiograms in 25 patients who underwent coil occlusion. The minimal diameter and the length of the PDA were measured prior to the procedure, and the shortest distance between the aortic end of the deployed coil and the aortic end of the PDA was measured after coil deployment. Evidence of endothelial coverage of the coil was sought on follow-up angiograms performed 6-24 (15+/-5) months later and the factors that determined the thickness of the endothelial coverage on the aortic end were investigated. Separation of the coil and the contrast column were detected at the aortic end in all cases and at the pulmonary end in 18 of 25 cases. The thickness of the separation ranged from 0.4 to 1.3 (0.7+/-0.2) mm at the aortic end and 0.3 to 0.8 (0.6+/-0.2) mm at the pulmonary end. The length of the ductus and of the ampulla had a significant positive correlation with the thickness of the aortic end separation. Apparent endothelial coverage of the coil was completed by 6 months after coil occlusion. Infective endocarditis or thromboembolism is an unlikely complication once endothelium covers the implanted coil.
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Affiliation(s)
- H Tomita
- Department of Pediatrics, Sapporo Medical University School of Medicine, Japan.
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Yanýk A, Yetkin E, Lleri M, Yetkin G, Penen K, Göskel S. Vegetation due to Streptococcus viridans in the pulmonary artery in a child with patent ductus arteriosus. Int J Cardiol 2000; 72:189-91. [PMID: 10646961 DOI: 10.1016/s0167-5273(99)00169-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
In the absence of irreversible pulmonary hypertension, closure of clinically detectable patent ductus arteriosus (PDA) is usually recommended in adults. Device closure obviates the need for general anesthesia and a surgical incision and eliminates postoperative pain, long convalescence, and lifelong scarring. Over the past 20 years, the efficacy and safety of transcatheter device closure of PDA in adults has been established. Even though the immediate success rate is lower with transcatheter device closure than with surgical closure, transcatheter reintervention for residual clinical shunts is very effective at abolishing residual leaks. The late complete closure rate, as determined by echocardiography, is very similar with surgical closure and with device closure. The clinical significance of silent residual shunts is unknown. In patients with silent residual shunts, the use of prophylactic antibiotics is as of yet recommended. Occlusion devices should be used whenever possible in adults, and surgical closure of patent ducts should be reserved for patients with larger ducts. The method of ductal closure should be selected on the basis of the quality of and experience with available interventional and surgical resources. Emerging minimally invasive surgical treatments seem promising, but further experience and follow-up are needed before widespread application of these techniques can be recommended.
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Raaijmaakers B, Nijveld A, van Oort A, Tanke R, Daniëls O. Difficulties generated by the small, persistently patent, arterial duct. Cardiol Young 1999; 9:392-5. [PMID: 10476829 DOI: 10.1017/s1047951100005199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over recent years, echo-Doppler cardiography has shown that a small, sometimes silent, arterial duct exists in more patients than previously recognized. To know the incidence of an arterial duct subsequent to therapy, we studied retrospectively our patients undergoing open-heart surgery and surgical or catheter closure. Three groups of patients were studied: those with patency of the duct subsequent to open heart surgery without any sign of patency before or during surgery, those with persistent duct after surgical ligation and those with persistent patency after attempted catheter occlusion with the Rashkind device. In the first group (of 431 children) four (0.9%) had persistence of this duct, of which three were silent. In the second group, patency persisted in four of 100 patients (4%), three being silent. In the last group there were five persisting shunts, three producing no murmur, in 30 patients (17%). We compared our results with those reported in the literature and conclude that echo-Doppler cardiography is needed to detect persistent shunting across a duct after therapy, since most of the residual ducts in this study were silent. This means that clinical findings alone cannot be relied upon, and careful echo-Doppler cardiography is essential. Also, the process of closure of a persistent duct by surgical ligation or transcatheter intervention is no guarantee of success. The risk of infective endocarditis is important in such persistent ducts and, at present, it is unknown either for a small, silent duct or in a persistent duct that remains open after attempted transcatheter closure, but now is in association with a foreign body.
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Affiliation(s)
- B Raaijmaakers
- Children's Heart Centre, University Hospital Nijmegen, The Netherlands.
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Rao PS, Kim SH, Choi JY, Rey C, Haddad J, Marcon F, Walsh K, Sideris EB. Follow-up results of transvenous occlusion of patent ductus arteriosus with the buttoned device. J Am Coll Cardiol 1999; 33:820-6. [PMID: 10080487 DOI: 10.1016/s0735-1097(98)00610-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this presentation is to document results of buttoned device (BD) occlusion of patent ductus arteriosus (PDA) in a large number of patients with particular emphasis on long-term follow-up in an attempt to provide evidence for feasibility, safety and effectiveness of this method of PDA closure. BACKGROUND Immediate and short-term results of BD occlusion of PDA have been documented in a limited number of children. METHODS During a six-year period ending August 1996, transcatheter BD closure of PDA was attempted in 284 patients, ages 0.3 to 92 years (median 7) under a protocol approved by the local institutional review boards and FDA with an investigational device exemption in U.S. cases. RESULTS The PDAs measured 1 to 15 mm (median 4) at the narrowest diameter; 20 were larger than 8 mm and 10 larger than 10 mm. They were occluded with devices measuring from 15 to 35 mm delivered via 7F (N = 140) or 8F (N = 144) sheaths. Successful implantation of the device was accomplished in 278 (98%) of 284 patients. The Qp:Qs decreased from 1.8+/-0.6 (mean+/-SD) to 1.09+/-0.19 (p < 0.001). Effective occlusion defined as no (N = 167 [60%]) or trivial (N = 79 [28%]) residual shunt was achieved in 246 (88%) patients. All types of PDAs, irrespective of the shape (conical, tubular or short), size (small or large) or length (short or long) of the PDA and previously implanted Rashkind devices, could be occluded. Follow-up data, 1 to 60 months (median 24) after device implantation, were available in 234 (84%) patients. Seven (3%) patients required reintervention to treat residual shunt with (N = 2) or without (N = 5) hemolysis. Actuarial reintervention-free rates were 95% at 1 and 5 years. There was gradual reduction of actuarial residual shunts and were 40%, 28%, 21%, 14%, 11%, 10%, 6% and 0% respectively at 1 day, 1, 6, 12, 24, 36, 48 and 60 months after device implantation. Incorporation of folding plug over the button loop in 10 additional patients produced immediate and complete occlusion of PDA. CONCLUSIONS This large multiinstitutional experience confirms the feasibility, safety and effectiveness of buttoned device closure of PDAs. All types of PDAs irrespective of the shape, length and diameter can be effectively occluded. Incorporation of folding plug over the button loop produces complete PDA occlusion at the time of device implantation.
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Affiliation(s)
- P S Rao
- Division of Pediatric Cardiology, University of Wisconsin Medical School, Madison, USA.
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Novo García E, Bermúdez R, Herraiz I, Salgado A, Balaguer J, Moya JL, Pinto J. [Ductus closure in adults with the Rashkind device: comparative results]. Rev Esp Cardiol 1999; 52:172-80. [PMID: 10193170 DOI: 10.1016/s0300-8932(99)74891-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Catheter occlusion of the persistent ductus arteriosus with Rashkind device is an alternative to the surgical closure demonstrated in children, however a few results have been reported of occlusion in adults. METHOD From 1990 to 1996 in 127 patients with persistent ductus arteriosus undergoing occlusion by Raskind device. Two groups according age: 105 children (< 14 years) and 22 adults (> 14 years), were studied retrospectively. The results were analysed by immediate aortogram and follow-up at 24 hours, 6 and 12 months by color-Doppler echocardiograms. RESULTS The adults were frequently asymptomatic (86%) and with high incidence (59%) of silent ductus. Similar QP/QS (1.61 +/- 0.47 in adults vs 1.49 +/- 0.51) was calculated although pulmonary pressure was superior in children (12.50 +/- 2.97 vs 16.84 +/- 5.88 mmHg; p = 0.003). In group > 14 years the ductal anatomy favorable (Krichenko type A or B) was more frequent (91% vs 73%; p = 0.06) and ductal diameter significantly higher (3.03 +/- 1.50 vs 2.41 +/- 0.96 mm; p = 0.009). In adults 17 mm umbrella were used more frequently (91 vs 61%; p = 0.02). Absence complications (embolization, bacteremia, haemolysis, proximal stenosis of the left pulmonary artery) were found in adults against 4.72% in children. The occlusion were more effective in adults specially in early controls: 55% vs 34% (p = 0.09), 82% vs 69%, 91% vs 77% and 95% vs 83% (p > 0.10). Multivariate analysis identified age as an independent predictor of complete occlusion. CONCLUSION Our experience in transcatheter occlusion of persistent ductus arteriosus with Rashkind device in adults support the efficacy, safety and excellent early results despite higher incidence of silent asymptomatic ductus.
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Affiliation(s)
- E Novo García
- Servicio de Cardiología, Hospital General Universitario, Guadalajara
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Prieto LR, DeCamillo DM, Konrad DJ, Scalet-Longworth L, Latson LA. Comparison of cost and clinical outcome between transcatheter coil occlusion and surgical closure of isolated patent ductus arteriosus. Pediatrics 1998; 101:1020-4. [PMID: 9606229 DOI: 10.1542/peds.101.6.1020] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the cost (measured as resource utilization by the institution) and clinical effectiveness of transcatheter coil occlusion and surgical patent ductus arteriosus (PDA) closure. Similar comparisons have been made previously with other devices no longer in use in the United States. No such comparison has been made for coil occlusion, which has been performed increasingly since 1992. METHODS All patients who underwent either coil or surgical closure of uncomplicated PDA at our institution between August 1993 and June 1996 were retrospectively identified. Patients were included in the study if they were eligible for either closure technique. Thus, they had a restrictive PDA (not associated with pulmonary hypertension) and no overt evidence of congestive heart failure. Patients were excluded if they had other significant cardiac or noncardiac problems. Total procedural and recovery costs (including labor, material, equipment, and overhead) incurred by the provider were determined using a cost accounting system called Transition Systems, Inc. To define further how costs differed for the two techniques, total costs were subdivided into the categories of professional, technical, inpatient hospital stay, postprocedure testing, and supplies and other miscellaneous costs. PDA closure rates and associated complications also were compared. Follow-up information was sought from outpatient visits to our institution or by contacting the referring physicians. RESULTS A total of 39 patients were identified, 3 of whom were excluded because of coexisting medical problems. The study group consisted of 36 patients; 24 underwent PDA coil occlusion and 12 surgical closure. Mean age and weight were 8.8 years and 28.5 kg for the coil patients, and 7.3 years and 32.8 kg for the surgical patients. Median procedural duration was 150 minutes for the coil group and 165 minutes for the surgical group. The total cost to the institution of coil occlusion was significantly lower than that of surgical closure ($5273 vs $8509). The largest difference lay in the cost of hospital stay ($398 vs $2566) and in the professional costs ($1506 vs $2782). Technical costs were similar ($2156 for coil, $2151 for surgery), although use of the catheterization laboratory per unit of time was more expensive than use of the operating room ($800 vs $400 per hour). Additional technical costs of the surgical procedure related to general anesthesia and postoperative care made up the difference. No patient in either group had a residual PDA murmur at hospital discharge or thereafter. Follow-up echocardiography was performed in all coil occlusion patients, and tiny residual leaks were detected in 17%. Only 42% of the surgical patients had postoperative echocardiography; none had residual leaks. There were no deaths or major complications in either group. CONCLUSIONS Transcatheter coil occlusion is as effective and less costly than surgical closure if silent residual leaks are not considered clinically significant. This information may be used increasingly in patient care decisions in the current era of managed medical care.
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Affiliation(s)
- L R Prieto
- Division of Pediatrics, Cleveland Clinic Foundation, OH 44195, USA
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Affiliation(s)
- I D Sullivan
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London.
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Daniels CJ, Cassidy SC, Teske DW, Wheller JJ, Allen HD. Reopening after successful coil occlusion for patent ductus arteriosus. J Am Coll Cardiol 1998; 31:444-50. [PMID: 9462591 DOI: 10.1016/s0735-1097(97)00491-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study was performed to determine the frequency of patent ductus arteriosus (PDA) reopening and the factors that may predict reopening after successful coil occlusion. BACKGROUND Transcatheter coil occlusion is a widely used and accepted method to close a PDA. After documented successful coil occlusion, we found PDAs that reopened. We hypothesized that specific factors are involved in those that reopened. METHODS All patients who underwent percutaneous transarterial PDA coil occlusion were studied. Successful coil occlusion was documented. PDA reopening was determined when Doppler-echocardiography (DE) performed after the procedure was negative for PDA flow but at follow-up demonstrated PDA shunting. Patients with a reopened PDA were compared with all other patients in evaluating independent variables. RESULTS Coil occlusion for PDA was attempted in 22 patients. Clinical success was achieved in 20 patients (91%), and DE was negative for PDA shunting in 19 patients (90%). At follow-up, five patients demonstrated reopening. The PDA minimal diameter was 1.4 +/- 0.5 mm (mean +/- SD) for the reopened group and 1.2 +/- 0.7 mm for the other patients. The PDA length was 2.9 +/- 1.9 mm for the reopened group and 7.1 +/- 3.2 mm for all other patients. All those with type B PDA were in the reopened group. When independent variables were compared between groups, only PDA length and type B PDA predicted reopening (p < 0.05). CONCLUSIONS PDA reopening may occur after successful coil occlusion. Short PDA length and type B PDA are associated with reopening. The data suggest that in such anatomy, alternative strategies to the current coil occlusion technique should be considered.
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Affiliation(s)
- C J Daniels
- Division/Section of Pediatric Cardiology, Columbus Children's Hospital and Ohio State University College of Medicine, 43205, USA
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Abstract
Coil occlusion of patent ductus arteriosus with 5-loop coils was undertaken in 10 patients without coil embolizations, and with 90% immediate occlusion and 100% occlusion at follow-up. We conclude that 5-loop coil occlusion of patent ductus arteriosus is safe and effective.
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Affiliation(s)
- P S Rao
- Department of Pediatrics, St. Louis University School of Medicine/Cardinal Glennon Children's Hospital, Missouri 63104, USA
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Su BH, Watanabe T, Shimizu M, Yanagisawa M. Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants. Arch Dis Child Fetal Neonatal Ed 1997; 77:F36-40. [PMID: 9279181 PMCID: PMC1720677 DOI: 10.1136/fn.77.1.f36] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS To identify the patent ductus arteriosus (PDA) shunt flow pattern using Doppler echocardiography; and to assess whether it could be used to predict the development of clinically significant PDA. METHODS Premature infants weighing under 1500 g, who required mechanical ventilation, and in whom daily echocardiography could be performed from day 1 until the ductus closed, and on day 7 to confirm closure, were studied. The PDA shunt flow was identified from four Doppler patterns, and the closed pattern of a closed duct was also presented. Clinically significant PDA was diagnosed when there was colour Doppler echocardiographic evidence of left to right ductal shunt associated with at least two of the following clinical signs: heart murmur (systolic or continuous); persistent tachycardia (heart rate > 160/min); hyperactive precordial pulsation; bounding pulses; and radiographic evidence of cardiomegaly or pulmonary congestion. RESULTS Of 68 infants enrolled into this study, clinically significant PDA developed in 31. The most recordable sequence of transition change of shunt flow pattern for clinically significant PDA was: pulmonary hypertension pattern, to growing pattern, to pulsatile pattern, to closing pattern, to closed pattern. And that for non-clinically significant PDA was: pulmonary hypertension pattern, to closing pattern, to closed pattern. The growing and the pulsatile patterns were mostly documented in infants with clinically significant PDA. The first documented growing pattern to predict clinically significant PDA gave a sensitivity of 64.5% and a specificity of 81.1%; the first documented pulsatile pattern gave a sensitivity of 93.5% and a specificity of 100%. CONCLUSION Doppler echocardiographic assessment of PDA shunt flow pattern during the first 4 days of life is useful for predicting the development of clinically significant PDA in premature infants. At that stage, the closing or closed Doppler pattern indicates that infants are not at risk of developing clinically significant PDA; the growing or pulsatile Doppler pattern indicates a continuing risk of developing clinically significant PDA.
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Affiliation(s)
- B H Su
- Department of Neonatology, Tokyo Metropolitan Tsukiji Maternity Hospital, Japan
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GRAY DARRYLT. The Application of Epidemiologic Methods to the Assessment of Cardiology Outcomes. J Interv Cardiol 1997. [DOI: 10.1111/j.1540-8183.1997.tb00004.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bulbul ZR, Fahey JT, Doyle TP, Hijazi ZM, Hellenbrand WE. Transcatheter closure of the patent ductus arteriosus: a comparative study between occluding coils and the Rashkind umbrella device. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 39:355-63; discussion 364. [PMID: 8958423 DOI: 10.1002/(sici)1097-0304(199612)39:4<355::aid-ccd6>3.0.co;2-c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was performed to evaluate the efficacy of transcatheter coil closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Transcatheter coil closure of the patent ductus arteriosus has been reported with encouraging results. We present our experience with ducti up to 5.0 mm in diameter and report the short-term follow-up. We compare the results with our previous experience with the Rashkind umbrella device. Seventy-one patients underwent transcatheter coil closure. Median age was 3.1 years, and median weight was 13.6 kg. Mean ductus diameter was 2.0 +/- 1.1 mm. These were compared with 105 patients who underwent transcatheter closure using a single Rashkind umbrella device. The median age was 3.2 years and the median weight was 14.0 kg. The mean ductus diameter for this group was 2.1 +/- 0.6 mm. The ductus murmur in the coil group disappeared in all patients. Immediate (< or = 24h), complete closure was achieved in 89% of the coil group as compared to 71% for the Rashkind umbrella device group (P < 0.005). Closure rate for the coil group was 97% at the 6-month follow-up, vs. 82% for the Rashkind umbrella device group at the 6-12 month follow-up (P < 0.05). In almost all patients requiring more than one coil, the ductus was crossed serially from the aortic end. All patients with ductus diameter > or = 3.0 mm required two or more coils. Eleven coils in six patients embolized to the pulmonary arteries. All coils except one were retrieved with subsequent successful foil placement. Sixty-seven patients (94%) in the coil group were discharged in < or = 24 h. Transcatheter closure of the patent ductus arteriosus using multiple coils is a more effective technique than the Rashkind umbrella closure and has excellent short-term results. This can be performed safely as an outpatient procedure.
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Affiliation(s)
- Z R Bulbul
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA
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Abstract
Many devices have been developed for transcatheter occlusion of PDA. Bulkiness of the device, complexity of the procedure, and significant residual complications make the majority of the devices unsuitable for routine clinical use. Although no randomized comparative clinical trials exist, on the basis of published literature and my personal experience, coil occlusion may be best suited to close small ducts (< or = 3.5 mm) and the adjustable buttoned device may be most appropriate for large PDAs (> 3.5 mm). Clinical trials on larger patient populations than are currently available and long-term follow-up are necessary to further support these recommendations. Indications for transcatheter closure should be exactly as those used for surgical closure: PDA with audible continuous murmur with echo Doppler confirmation. The so-called silent ducts need not be closed.
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Rao PS. Which method to use for transcatheter occlusion of patent ductus arteriosus? CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 39:49-51. [PMID: 8874946 DOI: 10.1002/(sici)1097-0304(199609)39:1<49::aid-ccd10>3.0.co;2-j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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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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Weber HS, Cyran SE, Gleason MM, White MG, Baylen BG. Transcatheter vascular occlusion of the small patent ductus arteriosus: an alternative method. Pediatr Cardiol 1996; 17:181-3. [PMID: 8662032 DOI: 10.1007/bf02505209] [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: 02/01/2023]
Abstract
The current strategies concerning a small (</=2 mm) patent ductus arteriosus (PDA) include surgical ligation, transcatheter implantation of the Rashkind occluder device, or no intervention requiring indefinite endocarditis precautions. Five patients have undergone successful transcatheter closure of a small-caliber PDA utilizing a single 3 mm Gianturco occluder coil as an alternative to surgical ligation. The coil was delivered to traverse the narrowest dimension of the PDA, leaving loops of coil in both the pulmonary and aortic ends of the ductus. All PDAs were successfully occluded, and the duration of hospitalization for all patients was 1 day. At latest follow-up (11 +/- 2 months), echocardiography demonstrates complete ductus occlusion in all patients, with no obstruction to left pulmonary arterial or descending aortic flow. Transcatheter coil occlusion of the small ductus is an easily accomplished, safe, effective alternative to surgical ligation, thereby avoiding a lateral thoracotomy incision, shortening hospitalization, and reducing costs.
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Affiliation(s)
- H S Weber
- Department of Pediatrics (Cardiology), The Pennsylvania State University Childrens Hospital, Milton S. Hershey Medical Center, P.O. Box 850, Hershey, PA 17033, USA
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Abstract
This article reviews the current status of transcatheter technology, which has been applied to close the patent ductus arteriosus (PDA). Pioneering work in this field was performed by Porstmann in the 1960s and Rashkind in the 1970s. Devices which have been implanted in the PDA have basic designs as plugs, umbrellas, or coils. The experience reported with each type of device is detailed. Issues and controversies are examined. It appears that coils should be the preferred method for closing smaller PDAs (3-mm diameter or smaller), and Rashkind or similar devices, if available, should be reserved for larger PDAs (> 3-mm diameter). Surgery is necessary for neonatal and for rare large PDAs. Transcatheter technology is still evolving and may become more effective and cheaper.
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Affiliation(s)
- J W Moore
- Department of Cardiology, Children's Heart Institute, Children's Hospital, San Diego, California 92123, USA
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Magee AG, Stumper O, Burns JE, Godman MJ. Medium-term follow up of residual shunting and potential complications after transcatheter occlusion of the ductus arteriosus. Heart 1994; 71:63-9. [PMID: 8297698 PMCID: PMC483613 DOI: 10.1136/hrt.71.1.63] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To determine the causes and outcome of residual shunting after transcatheter occlusion of persistent ductus arteriosus with the Rashkind double umbrella occluder, and to determine the potential of the device to produce obstruction to flow in the aorta and left pulmonary artery. DESIGN Angiographic examination of morphology of ductus followed by prospective clinical and ultrasound evaluation (including cross sectional imaging, colour flow mapping, and pulse wave Doppler) of all patients undergoing occlusion of persistent ductus arteriosus between October 1987 and July 1992. PATIENTS 140 patients with ages between 0.5 and 78 (median 3.8) years and weights between 6.8 and 74 (median 13.8) kg. INTERVENTIONS Attempted implantation of the Rashkind double umbrella ductus occluder under angiographic control through a transvenous (n = 136) or transarterial (n = 4) approach. MAIN OUTCOME MEASURES Successful occlusion of ductus; frequency, pattern, and prognosis of residual shunts; Doppler velocities in left pulmonary artery and aorta; volume loading of the left heart. RESULTS Including reocclusions the overall rate of successful occlusion was 96%. A total of six devices embolised at the time of operation (4.3%) with no sequelae. There were no anatomical factors that predicted a poor outcome, but suboptimal positioning of the device led to a significantly higher incidence of residual shunts (p < 0.001). Colour flow mapping correctly identified shunts that were unlikely to close spontaneously (n = 9) and to date seven have undergone successful closure with a second device. Encroachment of device legs produced statistically (p < 0.001) but not clinically significant increases in left pulmonary artery Doppler velocities that diminished with time. CONCLUSIONS Transcatheter occlusion provides a safe and effective means of closing a persistent ductus arteriosus. Doppler colour flow mapping is necessary for follow up and shows those ducts requiring reocclusion. The device did not produce significant disturbance to flow in the pulmonary arteries or aorta.
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Affiliation(s)
- A G Magee
- Department of Paediatric Cardiology, Royal Hospital for Sick Children, Edinburgh
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Lloyd TR, Fedderly R, Mendelsohn AM, Sandhu SK, Beekman RH. Transcatheter occlusion of patent ductus arteriosus with Gianturco coils. Circulation 1993; 88:1412-20. [PMID: 8403287 DOI: 10.1161/01.cir.88.4.1412] [Citation(s) in RCA: 200] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Transcatheter occlusion with Gianturco coils has been attempted in a small number of patients with tiny (< or = 1.5-mm diameter) patent ductus arteriosus, and preliminary results have been encouraging. The present study extends this method to larger ductus sizes and makes recommendations for proper coil size selection. METHODS AND RESULTS Coil occlusion was attempted in 24 consecutive patients with patent ductus arteriosus who did not require other cardiac surgery. Median patient age was 4.2 years (8 months to 30 years), and mean ductus diameter was 1.7 +/- 0.8 mm. Two instances of coil embolization occurred in the first 4 patients, with successful coil retrieval. Based on this experience, we proposed that the coil helical diameter should be twice or more the minimum ductus diameter, with coil length sufficient for three or more loops. With these recommendations, coils were successfully implanted in the subsequent 20 consecutive patients. Of the 22 patients with successful coil implantation, 15 (68%) had no residual shunting, and 7 had trace residual shunting by angiography. The continuous murmur was abolished in all 22 patients. No significant complications occurred, and all patients were discharged within 24 hours of successful coil implantation. No change in the systolic pressure gradient between main and left pulmonary artery or ascending and descending aorta was observed. CONCLUSIONS Transcatheter occlusion of patent ductus arteriosus can be safely and effectively achieved in patients with ductus diameters up to 3.3 mm. Coil occlusion does not cause obstruction to flow in the left pulmonary artery or descending aorta. Coils should be selected to provide a helical diameter twice or more the minimum ductus diameter and a length sufficient for three or more loops.
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Affiliation(s)
- T R Lloyd
- Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, Mich
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Ge ZM, Zhang Y, Fan DS, Fan JX, Ji XP, Zhao YX, Hatle L. Reliability and accuracy of measurement of transductal gradient by Doppler ultrasound. Int J Cardiol 1993; 40:35-43. [PMID: 8349364 DOI: 10.1016/0167-5273(93)90228-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Simultaneous continuous wave Doppler echocardiography, aortic and pulmonary artery pressure measurements were performed during cardiac catheterization in 46 patients with patent ductus arteriosus. Doppler-derived systolic, mean and diastolic transductal gradients correlated well with those measured by catheterization, respectively (r = 0.972, SEE = 6.8 mmHg; r = 0.965, SEE = 5.4 mmHg; r = 0.939, SEE = 6.2 mmHg), and there were clinically acceptable agreements between the two technical measurements. It is concluded that Doppler echocardiography is a reliable and accurate technique for noninvasive estimation of transductal gradients.
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Affiliation(s)
- Z M Ge
- Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Danford DA, Rayburn WF, Miller AM, Felix GL, Bussey ME. Effect of low intravaginal doses of prostaglandin E2 on the closure time of the ductus arteriosus in term newborn infants. J Pediatr 1993; 122:632-4. [PMID: 8463916 DOI: 10.1016/s0022-3476(05)83552-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Seventeen term newborn infants (control subjects) and 17 whose mothers had been given intravaginal doses of prostaglandin E2 (PGE2) were examined serially by color Doppler echocardiography to determine whether maternal PGE2 prolonged ductal patency. No clinically relevant differences in closure times were found. Low-dose intravaginal PGE2 therapy was not associated with prolonged ductal patency in term infants.
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Affiliation(s)
- D A Danford
- Department of Pediatrics, University of Nebraska College of Medicine, Omaha
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Balzer DT, Spray TL, McMullin D, Cottingham W, Canter CE. Endarteritis associated with a clinically silent patent ductus arteriosus. Am Heart J 1993; 125:1192-3. [PMID: 8465758 DOI: 10.1016/0002-8703(93)90144-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- D T Balzer
- Washington University School of Medicine, St. Louis, MO
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Latson LA. Residual shunts after transcatheter closure of patent ductus arteriosus. A major concern or benign "techno-malady"? Circulation 1991; 84:2591-3. [PMID: 1959208 DOI: 10.1161/01.cir.84.6.2591] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hosking MC, Benson LN, Musewe N, Dyck JD, Freedom RM. Transcatheter occlusion of the persistently patent ductus arteriosus. Forty-month follow-up and prevalence of residual shunting. Circulation 1991; 84:2313-7. [PMID: 1959187 DOI: 10.1161/01.cir.84.6.2313] [Citation(s) in RCA: 174] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Percutaneous closure of the persistently patent ductus arteriosus with the Rashkind prosthesis is an established effective therapeutic modality, although some patients are left with residual shunting. To evaluate this, a retrospective study of the prevalence of persistent shunting over a 40-month period in the first 190 patients was undertaken. METHODS AND RESULTS All patients (male 45, female 145; mean age, 3.9 +/- 3.6 years; range, 5 months to 20 years) had serial clinical and color-flow echocardiographic follow-up at 6-12-month intervals (range, 6-40 months). Four patients required surgical removal of an embolized device, leaving a cohort of 186 patients in whom 196 procedures were performed, resulting in successful placement of 195 devices (43 17-mm [22%] and 152 12-mm [78%]). Complications occurred in seven of 195 procedures (3.6%). Nine of 10 attempted reocclusions (all with 12-mm devices) were successful. The prevalence of residual shunting was 38% at 1 year, 18% at 2 years, and 8% at 40 months. Patients with ductus measuring less than 4 mm had a higher success of initial occlusion. Thirty-four patients were left with residual shunting determined by color-flow Doppler study, but no anatomic or echocardiographic features were found predictive for residual shunting. All remain asymptomatic with 26 (76%) having no detectable murmur, two (6%) a continuous murmur, and six (18%) a systolic murmur. CONCLUSIONS Catheter occlusion will obviate the need for surgery in the majority of patients presenting with persistently patent ductus arteriosus. Reocclusion has been found feasible in those with continuous murmurs (nine of nine) and should be offered early because it is unlikely for spontaneous closure to occur in this group. It appears prudent to follow those with small residual shunting because further spontaneous closure can occur.
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Affiliation(s)
- M C Hosking
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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