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Molina V, Hadid M, Miró J, Dahdah N. Left Pulmonary Artery Stenting for Left Pulmonary Artery Stenosis Following Patent Ductus Arteriosus Device Closure: Case Series and Review of the Literature. Case Rep Cardiol 2024; 2024:6690515. [PMID: 38957211 PMCID: PMC11217573 DOI: 10.1155/2024/6690515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/23/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
Percutaneous device occlusion is currently the standard of care for most cases of patent ductus arteriosus (PDA). Albeit infrequent, device-related left pulmonary artery (LPA) stenosis is a known complication of this procedure, occasionally requiring stent placement to relieve the obstruction. We present a series of four patients who required left pulmonary stenting after ductus arteriosus device closure. A review of the current evidence is presented.
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Affiliation(s)
- Víctor Molina
- Division of Pediatric CardiologyCentre Hospitalier Universitaire Sainte-JustineUniversity of Montreal, Montreal, Canada
- Cardiology DepartmentDr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Mehdi Hadid
- Division of Pediatric CardiologyCentre Hospitalier Universitaire Sainte-JustineUniversity of Montreal, Montreal, Canada
| | - Joaquim Miró
- Division of Pediatric CardiologyCentre Hospitalier Universitaire Sainte-JustineUniversity of Montreal, Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric CardiologyCentre Hospitalier Universitaire Sainte-JustineUniversity of Montreal, Montreal, Canada
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Pabst von Ohain J, Tonino E, Kaemmerer H, Cleuziou J, Ewert P, Lange R, Hörer J. German Heart Centre Munich-45 years of surgery in adults with congenital heart defects: from primary corrections of septal defects and coarctation to complex reoperations. Cardiovasc Diagn Ther 2021; 11:492-502. [PMID: 33968628 DOI: 10.21037/cdt-20-831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Our historical overview in the form of a cohort study aimed to describe the changes in the cardiac operations in adults with congenital heart disease (ACHD), over 45 years in the German Heart Centre in Munich. Methods The study population comprised all consecutive patients aged 18 or more, who underwent surgery for congenital heart disease (CHD) at the German Heart Centre Munich, between 1974 and 2018. Operations were coded according to the Adult Congenital Heart Surgery (ACHS) score. Two-tailed chi-square test was used for testing on differences in the frequency of procedural groups between the decades. Results During the examined 45-year period, 2,882 operations were performed on ACHD. The number of operations per year increased with a correlation coefficient r=0.533, P<0.001. Overall operative mortality was 3.2%. There was no significant difference in mortality over the decades. The percentage of primary CHD diagnosis being the indication for the operation was 99% in the 1970s and decreased significantly to 56% in the 2010s, P<0.001. There was a significant decrease in the relative frequency of atrial septal defect closures from 45% in the 1970s and 1980s to 9% in 2010s (P<0.001). Coarctation repair made up 15% of all operations in the 1970s, then dropped significantly to 1% in the 2010s (P<0.001). The percentage of reoperations increased significantly from 7% in the 1970s to 50% in 2010s (P<0.001). Conclusions The spectrum of cardiac surgery in ACHD changed significantly over the last 45 years, from primary repair of septal defects and coarctation of the aorta in the 1970s to complex reoperations in the 2010s.
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Affiliation(s)
- Jelena Pabst von Ohain
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
| | - Eleonora Tonino
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Julie Cleuziou
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
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Anna Venugopalan VB, Wilson N, Archer N, Adwani S. Clinical Outcome at One Year of Age Following Device Closure of Patent Ductus Arteriosus (PDA) in Small Babies. Indian J Pediatr 2018; 85:584. [PMID: 29417457 DOI: 10.1007/s12098-018-2634-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Vikranth Bapu Anna Venugopalan
- Department of Neonatology, Birmingham City Hospital, Sandwell & West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
| | - Neil Wilson
- Department of Pediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Nick Archer
- Department of Pediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Satish Adwani
- Department of Pediatric Cardiology, John Radcliffe Hospital, Oxford, UK
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Dajer-Fadel W, Pliego-Sánchez M, Mejía-Melgar E, Yépez-Ramos D, Latorre-Davila C, Tortolero-Sánchez C, Flores-Calderón O, Ramírez-Castañeda S, López-Noria O, Argüero-Sánchez R. First published case of thoracoscopic patent ductus arteriosus closure in the general hospital of Mexico Dr. Eduardo Liceaga. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Feng J, Kong X, Sheng Y, Yang R. Patent ductus arteriosus with persistent pulmonary artery hypertension after transcatheter closure. Ther Clin Risk Manag 2016; 12:1609-1613. [PMID: 27843323 PMCID: PMC5098547 DOI: 10.2147/tcrm.s112400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To observe the change in pulmonary artery systolic pressure (PASP) of patients with persistent pulmonary arterial hypertension (PAH) after patent ductus arteriosus (PDA) occlusion. Background After occlusion of PDA in patients with PAH, some patients still tend to suffer from persistent PAH. Methods A chest X-ray, an electrocardiogram, and an echocardiogram were performed on nine patients at 24 hours, 1 and 6 months, and 1 year serially. Results There was a significant fall (P<0.05) in mean PASP after occlusion (to 59.3±12.7 mmHg). However, the aortic pressure and systemic arterial oxygen saturation changed slightly (P>0.05). During the follow up, there was a further fall in the PASP in five patients (No 1, 5, 6, 7, and 8). Four patients (No 2, 3, 4, and 8) showed the evidence of worsening PAH and were treated with sildenafil. Patient 2 died from acute right heart failure after a period of 11 months from the time of transcatheter closure, triggered by pulmonary infection. Conclusion Some patients with borderline hemodynamic data with PDA and PAH can deteriorate or keep sustained PAH after PDA closure. The treatment of permanent closure to these patients must be cautious.
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Affiliation(s)
- Jianqi Feng
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu; Department of Cardiology, the Second Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, People's Republic of China
| | - Xiangqing Kong
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Yanhui Sheng
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Rong Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
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Nezafati MH, Hashemian SH, Mahmoodi E, Hamedanchi A. Video-Assisted Thoracoscopic Surgical Closure of Patent Ductus Arteriosus: 300 Cases. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849230100900406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From June 1997 to October 2000, 300 consecutive patients (mean age, 6 years) with patent ductus arteriosus recognized by echocardiography and/or cardiac catheterization underwent video-assisted thoracoscopic surgery. Under general anesthesia, three 5-mm holes were made in the left thoracic wall. A video camera and specialized surgical devices were introduced. The ductus was dissected and 2 titanium clips were applied for complete closure of the ductus. Exclusion criteria were: diameter of the ductus > 9 mm; complicated patent ductus arteriosus (aneurysm formation, endocarditis, or calcification); and pleural adhesion or a previous left-sided thoracic operation. All cases were reassessed immediately after the procedure, and followed up by echocardiography. No residual shunt was recorded. The procedure was changed to a thoracotomy in 3 adults due to inappropriately dilated canal (> 9 mm); 2 others developed transient recurrent laryngeal nerve dysfunction. Mean procedure time was 20 ± 2 minutes. All patients were discharged shortly after the procedure (at approximately 20 hours). The results indicate that video-assisted thoracoscopic surgery was superior to other techniques of ductal closure.
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Affiliation(s)
| | - Seyed Hassan Hashemian
- Department of Cardiology Imam Reza Hospital Medical Center Mashhad University of Medical Sciences Mashhad, Iran
| | - Eftekhar Mahmoodi
- Department of Pediatric Cardiology Ghaem Hospital Medical Center Mashhad University of Medical Sciences Mashhad, Iran
| | - Ali Hamedanchi
- Department of Cardiology Imam Reza Hospital Medical Center Mashhad University of Medical Sciences Mashhad, Iran
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Slater BJ, Rothenberg SS. Thoracoscopic Management of Patent Ductus Arteriosus and Vascular Rings in Infants and Children. J Laparoendosc Adv Surg Tech A 2015; 26:66-9. [PMID: 26312644 DOI: 10.1089/lap.2015.0126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Both patent ductus arteriosus (PDA) and vascular rings often require surgical treatment to prevent complications and alleviate symptoms, respectively. Management in infants and children has traditionally required an open thoracotomy. However, given the known advantages of the thoracoscopic approach, increased technical experience, and improved instrumentation, the minimally invasive technique to repair these thoracic vascular anomalies has grown in popularity. SUBJECTS AND METHODS We report our experience with thoracoscopic PDA ligation and vascular ring division at a single institution. From October 1993 to March 2014, 78 patients underwent thoracoscopic PDA ligation, and 13 patients presented with vascular rings. Ages ranged from 2 days to 17 years (mean, 18 months), and weights ranged from 2 to 60 kg (mean, 8.5 kg) for the thoracoscopic PDA group, whereas ages ranged from 6 weeks to 13 years (mean, 19 months), and weights ranged from 3.6 to 38 kg (mean, 10 kg) for the thoracoscopic vascular ring division group. In the thoracoscopic PDA group, the mean operative time was 36 minutes. Complications consisted of one death not related to the procedure, one conversion to open for a torn ductus, one recurrence requiring re-operative thoracoscopic repair, and one residual PDA requiring cardiac catheterization with occlusion. In the vascular ring group, one procedure was unable to be completed thoracoscopically and was converted to open. In 2 cases, thoracoscopic exploration revealed no significant compression from the vascular ring, and dissection was stopped. CONCLUSIONS Thoracoscopic closure of PDA and division of vascular rings are safe and effective techniques that minimize physiologic and cosmetic adverse effects.
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Affiliation(s)
- Bethany J Slater
- Department of Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado
| | - Steven S Rothenberg
- Department of Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado
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Baruteau AE, Hascoët S, Baruteau J, Boudjemline Y, Lambert V, Angel CY, Belli E, Petit J, Pass R. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis 2014; 107:122-32. [PMID: 24560920 DOI: 10.1016/j.acvd.2014.01.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
Abstract
This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques.
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Affiliation(s)
- Alban-Elouen Baruteau
- M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Paris, France; Inserm UMR 1087, CNRS UMR 6291, l'Institut du Thorax, Nantes University, Nantes, France.
| | - Sébastien Hascoët
- M3C CHU Toulouse, Children's Hospital, Paediatric Cardiology, Paul-Sabatier University, Toulouse, France
| | - Julien Baruteau
- Great Ormond Street Hospital for Children, Metabolic Medicine Department, University College London, Institute for Women's Health, Gene Therapy Transfer Group, London, UK
| | - Younes Boudjemline
- M3C Necker Hospital for Sick Children, Paediatric Cardiology, Paris Descartes University, Paris, France; M3C Georges-Pompidou European Hospital, Adult Congenital Cardiology, Paris, France
| | - Virginie Lambert
- M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Paris, France; Inserm UMR 999, Marie-Lannelongue Hospital, Paris, France
| | - Claude-Yves Angel
- M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Paris, France
| | - Emre Belli
- M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Paris, France
| | - Jérôme Petit
- M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Paris, France
| | - Robert Pass
- Children's Hospital at Montefiore, Pediatric Cardiology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
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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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Gross AAR, Donnelly JP. Closure of tubular patent ductus arteriosus in infants with the amplatzer vascular plug II. Catheter Cardiovasc Interv 2013; 81:1188-93. [DOI: 10.1002/ccd.24754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 11/01/2012] [Accepted: 11/07/2012] [Indexed: 11/11/2022]
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Hong Z, Kutty S, Toth PT, Marsboom G, Hammel JM, Chamberlain C, Ryan JJ, Zhang HJ, Sharp WW, Morrow E, Trivedi K, Weir EK, Archer SL. Role of dynamin-related protein 1 (Drp1)-mediated mitochondrial fission in oxygen sensing and constriction of the ductus arteriosus. Circ Res 2013; 112:802-15. [PMID: 23334860 DOI: 10.1161/circresaha.111.300285] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
RATIONALE Closure of the ductus arteriosus (DA) is essential for the transition from fetal to neonatal patterns of circulation. Initial PO2-dependent vasoconstriction causes functional DA closure within minutes. Within days a fibrogenic, proliferative mechanism causes anatomic closure. Though modulated by endothelial-derived vasodilators and constrictors, O2 sensing is intrinsic to ductal smooth muscle cells and oxygen-induced DA constriction persists in the absence of endothelium, endothelin, and cyclooxygenase mediators. O2 increases mitochondrial-derived H2O2, which constricts ductal smooth muscle cells by raising intracellular calcium and activating rho kinase. However, the mechanism by which oxygen changes mitochondrial function is unknown. OBJECTIVE The purpose of this study was to determine whether mitochondrial fission is crucial for O2-induced DA constriction and closure. METHODS AND RESULTS Using DA harvested from 30 term infants during correction of congenital heart disease, as well as DA from term rabbits, we demonstrate that mitochondrial fission is crucial for O2-induced constriction and closure. O2 rapidly (<5 minutes) causes mitochondrial fission by a cyclin-dependent kinase- mediated phosphorylation of dynamin-related protein 1 (Drp1) at serine 616. Fission triggers a metabolic shift in the ductal smooth muscle cells that activates pyruvate dehydrogenase and increases mitochondrial H2O2 production. Subsequently, fission increases complex I activity. Mitochondrial-targeted catalase overexpression eliminates PO2-induced increases in mitochondrial-derived H2O2 and cytosolic calcium. The small molecule Drp1 inhibitor, Mdivi-1, and siDRP1 yield concordant results, inhibiting O2-induced constriction (without altering the response to phenylephrine or KCl) and preventing O2-induced increases in oxidative metabolism, cytosolic calcium, and ductal smooth muscle cells proliferation. Prolonged Drp1 inhibition reduces DA closure in a tissue culture model. CONCLUSIONS Mitochondrial fission is an obligatory, early step in mammalian O2 sensing and offers a promising target for modulating DA patency.
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Affiliation(s)
- Zhigang Hong
- Department of Medicine, Queen's University, 94 Stuart St, Kingston, Ontario, Canada
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Sridhar A, Subramanyan R, Rajasekar P. Transcatheter interruption of large residual flow after device closure of "Type A" patent ductus arteriosus. Ann Pediatr Cardiol 2012; 5:210-2. [PMID: 23129919 PMCID: PMC3487218 DOI: 10.4103/0974-2069.99632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of 3-year-old girl who had persistence of large residual flow following transcatheter closure of a 6 mm ‘Type A’ patent ductus arteriosus using a 12 × 10 mm duct occluder. Angiography revealed a large left-to-right shunt coursing through and exiting around the implanted device. Near total abolition of the residual shunt was achieved by initial implantation of an embolization coil within the duct occluder and subsequently an Amplatzer duct occluder (ADO II) adjacent to the duct occluder. This challenging case describes an additional technique of abolishing a large residual flow in and around a Nitinol duct occluder device.
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Affiliation(s)
- Anuradha Sridhar
- Department of Paediatric Cardiology, Frontier Lifeline Hospital and Dr. K.M. Cherian Heart Foundation, Chennai, India
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VIJAYALAKSHMI IB, CHITRA NARASIMHAN, PRAVEEN JAYAN, PRASANNA SIMHARAO. Challenges in Device Closure of a Large Patent Ductus Arteriosus in Infants Weighing Less Than 6 Kg. J Interv Cardiol 2012; 26:69-76. [DOI: 10.1111/j.1540-8183.2012.00762.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- I. B. VIJAYALAKSHMI
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
| | - NARASIMHAN CHITRA
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
| | - JAYAN PRAVEEN
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
| | - SIMHA RAO PRASANNA
- From the Sri Jayadeva Institute of Cardiovascular Sciences and Research; Karnataka; India
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Amanullah MM, Siddiqui MT, Khan MZ, Atiq MA. Surgical Rescue of Embolized Amplatzer Devices. J Card Surg 2011; 26:254-8. [DOI: 10.1111/j.1540-8191.2011.01249.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Choi DY, Kim NY, Jung MJ, Kim SH. The results of transcatheter occlusion of patent ductus arteriosus: success rate and complications over 12 years in a single center. Korean Circ J 2010; 40:230-4. [PMID: 20514333 PMCID: PMC2877787 DOI: 10.4070/kcj.2010.40.5.230] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 10/10/2009] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives Percutaneous occlusion of patent ductus arteriosus (PDA) has become increasingly attractive with the evolution of devices and techniques. We reviewed results for percutaneous occlusion of PDA using various devices in a single center. Subjects and Methods A retrospective review was done for 118 consecutive procedures performed in 111 patients with PDA between January 1996 and December 2007. Results The median age of the patients was 4.5 years (0.9 to 60.3 years); body weight was 16.9 kg (6.8 to 74.7 kg). The median PDA diameter at the pulmonic end was 3.8 mm (0.7 to 10 mm); mean pulmonary artery pressure was 21.0 mmHg (7 to 60 mmHg). Complete occlusion occurred in 76/111 (68.4%) immediately after implantation and in 100/111 (90.0%) at one year of follow-up. Second procedures for residual shunts were done in 7 patients. After the year 2001, the complete closure rate was 95.2% compared to 71.4% before 2001. Complications associated with the procedure were left pulmonary artery narrowing (all <20 mmHg) in 14, arrhythmia in 2, and death in 1. Conclusion Evolution of devices, cumulative experience, and health insurance covering the cost of devices have contributed to good outcomes in our center for percutaneous occlusion of PDA. Our results have improved over the years, particularly with the use of the Amplatzer duct occluder.
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Affiliation(s)
- Deok Young Choi
- Department of Pediatric Cardiology, Gachon University of Medicine and Science, Incheon, Korea
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Percutaneous retrieval of a migrated coil in the left atrium. Radiol Case Rep 2010; 5:335. [PMID: 27307876 PMCID: PMC4901020 DOI: 10.2484/rcr.v5i4.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Foreign bodies in the left atrium are rare events with potential major complications. We describe the percutaneous retrieval of a coil from the left atrium that migrated there during an embolization procedure for a pulmonary arteriovenous malformation.
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Yu ML, Huang XM, Wang JF, Qin YW, Zhao XX, Zheng X. Safety and efficacy of transcatheter closure of large patent ductus arteriosus in adults with a self-expandable occluder. Heart Vessels 2009; 24:440-5. [PMID: 20108077 DOI: 10.1007/s00380-009-1150-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 01/23/2009] [Indexed: 11/25/2022]
Abstract
Most occurrences of large patent ductus arteriosus (PDAs) of > or =10 mm have been surgically closed, and transcatheter closure of these large PDAs was only reported in a few case reports. The present study reviewed our experience in transcatheter closure of such large PDAs with a Chinese self-expandable occluder, which is similar to but much cheaper than the Amplatzer occluder. From July 2000 to January 2008, 23 patients underwent transcatheter closure of large PDA > or =10 mm with this kind of occluder. The mean (SD) age of the patients was 38.0 (15.6) years (range 18-75 years). Radiographs of the chest, electrocardiograms, and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month, 6 months, and then every year after successful closure. The mean (SD) angiographic PDA diameter was 12.8 (2.6) mm (range 10-18 mm) and the mean occluder diameter was 18.0 (2.9) mm (range 16-22 mm). The occluders were delivered successfully and closed the PDA completely in 19 out of the 23 patients. Pulmonary arterial pressures decreased significantly after occlusion in patients with successful treatment: 67.3 (24.7) mmHg (range 29-122 mmHg) before occlusion and 42.3 (22.0) mmHg (range 19-98 mmHg) immediately after the procedure. Radiographs of the chest and echocardiograms showed that the diameters of the left atrium, left ventricle, and the main pulmonary artery decreased, and the ejection fraction (EF) increased at a mean (SD) follow-up of 36.3 (18.7) months (range 6-72 months). No severe complication occurred. The immediate and long-term outcomes suggested that transcatheter closure of PDAs with the native PDA occluder is a safe and effective treatment for adults with large PDA > or =10 mm.
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Affiliation(s)
- Man-Li Yu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, PR China
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Abadir S, Boudjemline Y, Rey C, Petit J, Sassolas F, Acar P, Fraisse A, Dauphin C, Piechaud JF, Chantepie A, Lusson JR. Significant persistent ductus arteriosus in infants less or equal to 6kg: Percutaneous closure or surgery? Arch Cardiovasc Dis 2009; 102:533-40. [DOI: 10.1016/j.acvd.2009.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/03/2009] [Accepted: 04/07/2009] [Indexed: 11/30/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kusa J, Szkutnik M, Czerpak B, Bialkowski J. Percutaneous closure of previously surgical treated arterial ducts. EUROINTERVENTION 2008; 3:584-7. [PMID: 19608485 DOI: 10.4244/eijv3i5a105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To report our experience and strategies with transcatheter closure of residual patent ductus arteriousus (RPDA) in patients with previous surgical ligation. METHODS AND RESULTS Transcatheter closure of residual patent ductus arteriousus after surgical ligation was attempted in 19 patients. In 13 patients the residual patent ductus arteriosus was closed with detachable coils, in four with Rashkind umbrella and in two with Amplatzer occluder. In order to cross the recanalised duct with the delivery system a vascular loop was required in six patients. Complete closure of residual ducts were achieved in all but one patient. CONCLUSION Transcatheter closure appears to be a safe and effective treatment for residual persistent duct. Coil implantation seems to be the best option in the case of smaller ducts, and in larger ones the Amplatzer Duct Occluder appears to be superior. Taking a meticulous approach to choosing the correct device should prevent ineffective treatment.
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Affiliation(s)
- Jacek Kusa
- Congenital Heart Defects & Pediatric Cardiology dept., Silesian Centre for Heart Diseases, Zabrze, Poland
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Nezafati MH, Soltani G, Vedadian A. Video-assisted ductal closure with new modifications: minimally invasive, maximally effective, 1,300 cases. Ann Thorac Surg 2007; 84:1343-8. [PMID: 17888995 DOI: 10.1016/j.athoracsur.2007.04.077] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 04/15/2007] [Accepted: 04/23/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been shown to be a safe and effective method of closing patent ductus arteriosus (PDA). We retrospectively studied our series of patients with PDA who underwent VATS closure with new modifications. METHODS From June 1997 to December 2004, 1,300 consecutive patients diagnosed with PDA (mean age, 6 years) were referred to us, and all of them met our inclusion criteria for the VATS procedure. Recently, we made some minor alterations to our routine methodology. After complete closure of PDA by two titanium clips, the extubated patient leaves the operating room without a chest tube. RESULTS There were 3 cases of chylothorax, which were successfully treated by thoracotomy and ligation of the small lymphatic ducts after 1 week of close observation. The procedure was changed to thoracotomy in 7 patients. Meanwhile, 5 additional patients had transient recurrent laryngeal nerve dysfunction. All cases were reassessed immediately after the procedure, and followed for more than 7 years by control echocardiography. No significant complication or residual shunt was recorded during the follow-up period. Mean procedure time was about 10 +/- 2 minutes. All patients were discharged shortly after the procedure (about 20 hours). CONCLUSIONS Based on this experience, VATS appears to be safer and more effective as well as having other advantages such as being simple to perform, quick, and comfortable for the patients. Furthermore, the cosmetic benefits also make it appropriate as an outpatient procedure.
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Affiliation(s)
- Mohammad Hassan Nezafati
- Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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Abstract
See article on page 514
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Smith PJ, Martin MWS. Transcatheter embolisation of patent ductus arteriosus using an Amplatzer vascular plug in six dogs. J Small Anim Pract 2007; 48:80-6. [PMID: 17286660 DOI: 10.1111/j.1748-5827.2006.00255.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to assess the feasibility of transcatheter embolisation of a patent ductus arteriosus using an Amplatzer vascular plug (Amplatzer Medical UK) in six dogs. METHODS The Amplatzer vascular plug is a self-expandable, cylindrical device attached to a delivery cable. In all the dogs, the device was delivered transvenously. Successful device implantation was defined as firm anchorage of the device squarely within the distal part of the ductus arteriosus with no intra- or postoperative dislodgement. Successful occlusion of the ductus arteriosus occurred if a disappearance of the continuous murmur was achieved 24 hours after placement of the Amplatzer vascular plug. RESULTS The age of the dogs ranged from 16 weeks to 7.5 years. Their weights ranged from 2.9 to 27.6 kg (median 6 kg). Two dogs had congestive heart failure before embolisation. Successful device implantation was achieved in all dogs. Successful occlusion of the ductus arteriosus was achieved in four of the six dogs. Complications included mild lameness, residual shunting, and bruising and pruritus around the surgical wound site. At follow-up, two dogs had a continuous murmur and one required treatment for congestive heart failure. CLINICAL SIGNIFICANCE This technique may represent a clinically effective and less expensive alternative to the use of an Amplatzer duct occluder (Amplatzer Medical UK) in dogs with medium-sized patent ductus arteriosus. Further investigations are required to fully evaluate its efficacy and safety in various sizes and types of patent ductus arteriosus, and to determine the optimal device size in relation to the size of the ductus.
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Affiliation(s)
- P J Smith
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk CB8 0UH, UK
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Yan C, Zhao S, Jiang S, Xu Z, Huang L, Zheng H, Ling J, Wang C, Wu W, Hu H, Zhang G, Ye Z, Wang H. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Heart 2006; 93:514-8. [PMID: 16954130 PMCID: PMC1861497 DOI: 10.1136/hrt.2006.091215] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgical closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension in adults carries higher risk than in children. OBJECTIVES To investigate the application of self-expandable occluders for transcatheter closure of PDA associated with severe pulmonary arterial hypertension in adults, and the assessment of immediate and short-term results. METHODS 29 adult patients (6 men, 23 women) underwent attempted transcatheter closure of PDA at a mean (standard deviation (SD)) age of 31.1 (11.4) years (range 18-58 years) and a mean (SD) weight of 54.1 (7.1) kg (range 42-71 kg). On the basis of haemodynamic and clinical data obtained before and after trial occlusion, the final duct occlusion was determined and carried out. Radiographs of the chest, electrocardiograms and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month and 3-6 months after successful closure. RESULTS 20 of the 29 patients had successful occlusion (group 1), and 9 patients failed (named group 2). In group 1, in which occlusion was successful, mean (SD) pulmonary arterial pressures decreased markedly after trial occlusion: 78 (19.3) mm Hg (range 50-125 mm Hg) before occlusion and 41 (13.8) mm Hg (range 23-77 mm Hg) after occlusion. Systemic arterial oxygen saturation was found to be >90% in 19 patients and <90% in the remaining patient before inhalation of oxygen, and >95% during inhalation of oxygen or after occlusion in all 20 patients. In group 2, the occlusion was not successful, because in two patients the device was not available; another two patients showed worsening of symptoms. The other five patients showed increased pulmonary arterial pressures after trial closure; their mean (SD) pulmonary arterial pressures increased by 10.3 (6) mm Hg (4-16 mm Hg) after trial occlusion, and systemic arterial oxygen saturation was 85.5% (2.6%) (range 82.6-88%) before inhalation of oxygen and 94.7% (1.7%) (range 90.7-99.1%) during inhalation of oxygen. In group 1, the dimensions of the left atrium, left ventricle and pulmonary artery increased considerably in 3-6-months of follow-up compared with those of preocclusion. CONCLUSIONS Transcatheter closure is an effective treatment for adults with PDA associated with reversible severe pulmonary arterial hypertension. Further research is needed for the evaluation of long-term results.
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Affiliation(s)
- C Yan
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Weng KP, Lin CC, Huang SM, Huang TC, Lee CL, Hsieh KS. Guidewire and catheter manipulation without coil placement to close minimal patent ductus arteriosus. Int J Cardiol 2006; 106:250-4. [PMID: 16000227 DOI: 10.1016/j.ijcard.2005.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 05/25/2005] [Accepted: 06/04/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transcatheter coil closure (TCC) is safe and effective for most patients with PDA, but coil associated complications may occasionally be encountered. For occlusion of minimal PDA (<1 mm), we employed a closure protocol with guidewire and catheter manipulation. METHODS Between April 2000 and September 2004, 38 patients with a minimal PDA were classified into two groups according to the occlusion method at our institution. Group A consisted of 11 patients (age range 0.7 to 3.5 years; mean age 1.6 years) who underwent guidewire and catheter manipulation. Group B consisted of 27 patients (age range 0.5 to 2.7 years; mean age 1.3 years) who underwent TCC of PDA. RESULTS In group A (a PDA 0.4-0.9 mm), 9 (82%) patients had successful closure, and two (18%) patients failed the manipulation. No patient had complications during the procedure or follow-up. In group B (a PDA 0.5-0.9 mm), 26 (96%) patients had successful closure and 1 (4%) patient failed the attempt at TCC. No adverse events of coil closure was found during follow-up. Compared to the patients in group B, those in group A differed significantly in terms of procedure time. There were no significant differences in age, sex, body weight, PDA size, fluoroscopy time, success rate, and complication rate. CONCLUSIONS Our results indicate that the manipulation is safe and effective for patients with minimal PDA. The manipulation technique can be tried before TCC in patients with minimal PDA.
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Affiliation(s)
- Ken-Pen Weng
- Department of Pediatrics, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan
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Cay S, Ozturk S, Korkmaz S, Turkvatan A. Asymptomatic patent ductus arteriosus in a 41-year-old woman. Int J Cardiovasc Imaging 2005; 22:283-5. [PMID: 16049621 DOI: 10.1007/s10554-005-9009-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 06/13/2005] [Indexed: 11/24/2022]
Abstract
Patent ductus arteriosus is a rare adult congenital heart disease, especially asymptomatic cases are uncommon in older ages. We report here the case of a 41-year-old woman, who was incidentally found to have a patent ductus arteriosus. The patient also was asymptomatic. For anatomical demonstration, computerized tomography angiography was performed and then surgical intervention was applied.
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Affiliation(s)
- Serkan Cay
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey.
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27
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Butera G, De Rosa G, Chessa M, Piazza L, Delogu A, Frigiola A, Carminati M. Transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder in very young symptomatic children. Heart 2005; 90:1467-70. [PMID: 15547030 PMCID: PMC1768608 DOI: 10.1136/hrt.2003.025122] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse safety, efficacy, and follow up results of percutaneous closure of persistent ductus arteriosus (PDA) in very young symptomatic children. PATIENTS AND DESIGN Between March 2000 and March 2003, of 197 patients treated at the authors' institution 18 were symptomatic children aged < or = 3 years old. Seven of these children were < or = 1 year old. Indications for closure were failure to thrive (12 patients) and frequent respiratory infections (six patients). The procedure was carried out under heavy sedation with fluoroscopic control. The Amplatzer duct occluder device was used. Basal physical examinations and echocardiograms were performed before the procedure and at follow up (three, six, and 12 months and yearly thereafter). RESULTS Mean (SD) age was 18.3 (10) months and mean (SD) weight at closure was 9.1 (2.2) kg. Neither death nor any major complications occurred. Complications occurred in three patients aged < or = 1 year. Two patients had a mild inguinal haematoma. One patient had femoral artery thrombosis that was successfully treated by intravenous urokinase. The mean (SD) follow up was 12.8 (8.5) months. No problems occurred. Patients with recurrent respiratory infections had no significant recurrences and children who had failed to thrive had significantly increased growth. CONCLUSIONS In experienced hands, percutaneous closure of moderate to large PDA in very young symptomatic children is safe, effectively closes the PDA, and solves clinical problems.
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Affiliation(s)
- G Butera
- Paediatric Cardiology, Istituto Policlinico San Donato, Via Morandi, 30, 20097 San Donato Milanese, Milan, Italy.
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Vida VL, Rubino M, Bottio T, Padalino MA, Milanesi O, Pittarello D, Stellin G. Thoracoscopic closure of the patent arterial duct. Cardiol Young 2004; 14:164-7. [PMID: 15691405 DOI: 10.1017/s1047951104002082] [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: 11/07/2022]
Abstract
Video assisted thoracoscopic surgery for closure of the persistently patent arterial duct is an effective answer to the modern effort of seeking repair of congenital cardiac malformations with minimally invasive techniques. Between June, 1994, and December, 2002, 150 consecutive patients with an echocardiographic diagnosis of isolated patency of the arterial duct were referred to our Institution for video assisted thoracoscopic closure. The median age at the time of operation was 45 months, with a range from 3 to 161 months, and mean weight was 18 kg, with a range from 4.2 to 73 kg. Video assisted closure was possible in 139 patients (93%). The mean operative time was 37 min, with a range from 14 to 89 min. In the remaining 11 patients (7%), seen early in our experience, we converted to a mini-thoracotomy to achieve closure. In no instance did we encounter major haemorrhage requiring blood transfusion, and there were no hospital deaths. The mean period of stay in hospital was less than 24 h in 61 patients, less than 48 h in 88 patients seen earlier in our experience, and 21 days in 1 patient because of a persistent chylothorax. Other complications included palsy of the left recurrent laryngeal nerve in 1 patient, with partial regression at 6 months follow-up. We conclude that closure of the arterial duct by video-assisted thoroscopy combines the advantages of safe and complete extraluminal occlusion with an excellent clinical and aesthetic result, minimal postoperative pain, and short stay in hospital at low cost.
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Affiliation(s)
- Vladimiro L Vida
- Department of Cardiovascular Surgery, Paediatric Cardiac Surgery Unit, University of Padua-Medical School, Padova, Italy.
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Affiliation(s)
- Ronald G Grifka
- Cardiac Catheterization Laboratories, Cardiology Division, Texas Children's Hospital, Houston, Texas 77030, USA.
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30
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Lozier JS, Cowley CG. Reactivity of the ductus arteriosus: Implications for transcatheter therapy. Catheter Cardiovasc Interv 2004; 61:268-70. [PMID: 14755826 DOI: 10.1002/ccd.10760] [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] [Indexed: 11/06/2022]
Abstract
We report our experience in a 13-month-old boy undergoing transcatheter coil occlusion of a patent ductus arteriosus. Constriction of the ductus arteriosus with subsequent relaxation resulted in inadvertent coil embolization. This case report and review of the literature have implications for transcatheter treatment of persistent ductus arteriosus.
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Affiliation(s)
- John S Lozier
- Division of Pediatric Cardiology, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah, USA
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Beck A, Birk E, Blieden LC, Bruckheimer E. Stent implantation for coarctation of aorta caused by a Rashkind patent ductus arteriosus umbrella. Catheter Cardiovasc Interv 2004; 63:80-2. [PMID: 15343573 DOI: 10.1002/ccd.20128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This case demonstrates a novel use of stent implantation for relief of coarctation of the aorta caused by protrusion of a Rashkind patent ductus arteriosus umbrella. Follow-up 3 years after stent implantation shows complete relief of obstruction.
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Affiliation(s)
- Avi Beck
- Department of Pediatric Cardiology, Schneider Children's Medical Center-Israel, Beilinson Campus, Tel Aviv University, Petach Tikva, Israel
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Dugal JS, Jetley V, Singh C, Datta SK, Sabharwal JS, Sofat S. Amplatzer Device closure of Atrial Septal Defects and Patent Ductus Arteriosus: Initial Experience. Med J Armed Forces India 2003; 59:218-22. [PMID: 27407520 DOI: 10.1016/s0377-1237(03)80011-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Surgical closure of Atrial Septal Defects (ASD) and Patent Ductus Arteriosus (PDA) can be performed successfully with low mortality. However, the morbidity associated with general anaesthesia, thoracotomy, cardiopulmonary bypass, postoperative monitoring in the intensive care unit, several days of hospital stay and the requirement of blood products is considerable. The expense associated with this morbidity, operative scar and the psychologic trauma to the patient and parents are additional disadvantages of surgery. Hence, the closure of these defects by transcatheter methods with various devices has been evaluated worldwide. We report the initial experience at our centre with closure of secundum ASDs and large PDAs with the Amplatzer Septal Occluder and Amplatzer Duct Occluder.
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Affiliation(s)
- J S Dugal
- Classified Specialist (Medicine and Cardiology), Military Hospital (Cardiothoracic Centre), CTC, Pune - 411 040
| | - V Jetley
- Classified Specialist (Medicine and Cardiology), Military Hospital (Cardiothoracic Centre), CTC, Pune - 411 040
| | - Charanjit Singh
- Senior Advisor (Medicine and Cardiology), Military Hospital (Cardiothoracic Centre), CTC, Pune - 411 040
| | - S K Datta
- Classified Specialist (Medicine & Cardiology), Base Hospital, Delhi Cantt - 110 010
| | - J S Sabharwal
- Classified Specialist (Medicine and Cardiology), Military Hospital (Cardiothoracic Centre), CTC, Pune - 411 040
| | - Sunil Sofat
- Classified Specialist (Medicine) and Senior Resident (Cardiology), Military Hospital (Cardiothoracic Centre), CTC, Pune - 411 040
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Kouris NT, Sifaki MD, Kontogianni DD, Zaharos I, Kalkandi EM, Grassos HE, Babalis DK. Patent ductus arteriosus endarteritis in a 40-year old woman, diagnosed with transesophageal echocardiography. A case report and a brief review of the literature. Cardiovasc Ultrasound 2003; 1:2. [PMID: 12709262 PMCID: PMC153664 DOI: 10.1186/1476-7120-1-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 03/24/2003] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nikos T Kouris
- Cardiology Dept, Western Attica General Hospital, Athens 12351, Greece
| | - Maria D Sifaki
- Cardiology Dept, Western Attica General Hospital, Athens 12351, Greece
| | | | - Ioannis Zaharos
- Cardiology Dept, Western Attica General Hospital, Athens 12351, Greece
| | - Eleni M Kalkandi
- Cardiology Dept, Western Attica General Hospital, Athens 12351, Greece
| | - Haris E Grassos
- Cardiology Dept, Western Attica General Hospital, Athens 12351, Greece
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Forbes TJ, Harahsheh A, Rodriguez-Cruz E, Morrow WR, Thomas R, Turner D, Vincent JA. Angiographic and hemodynamic predictors for successful outcome of transcatheter occlusion of patent ductus arteriosus in infants less than 8 kilograms. Catheter Cardiovasc Interv 2003; 61:117-22. [PMID: 14696170 DOI: 10.1002/ccd.10751] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transcatheter occlusion of patent ductus arteriosus (PDA) using Gianturco coils (GCs) has been performed for the past decade. However, little has been written regarding anatomical and hemodynamic predictors for successful occlusion of the PDA in infants. This report is to evaluate the outcome of transcatheter occlusion of PDA in symptomatic infants less than 8 kg and to assess predictors of successful occlusion. Retrospective review of catheterization charts and cineangiograms of 42 symptomatic infants who underwent cardiac catheterization for attempted transcatheter occlusion of their PDA was conducted. The hemodynamic and angiographic data evaluated included the length/diameter (L/D) ratio, defined as the length divided by the narrowest diameter of the ductus arteriosus, and preocclusion pulmonary artery pressures. Thirty-one out of 42 patients (74%) had successful occlusion. Twenty-nine out of 42 infants had an L/D ratio > 3. Of these, 26 (90%) had successful occlusion of their PDA. Thirteen out of 42 patients had an L/D ratio < or = 3. Of these, 8 (62%) had unsuccessful occlusion. Complications encountered were transient loss of femoral arterial pulse (n = 6), coil embolization (n = 5), hemolysis (n = 2), and mild left pulmonary artery obstruction (n = 2). No permanent loss of femoral arterial pulse was noted. These complications resulted in no mortality and minimal morbidity. The L/D ratio was the strongest predictor of successful outcome, with an L/D ratio greater than 3.0 being more amenable to transcatheter occlusion (odds ratio of 4.6). Other predictors for success included lower preocclusion systolic, diastolic, and mean pulmonary artery pressure and smaller ductal diameter. Our conclusion was that infants less than 8 kg with an L/D ratio > 3.0 can safely and successfully undergo transcatheter occlusion of their PDA using transcatheter coils.
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Affiliation(s)
- Thomas J Forbes
- Department of Cardiology at Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
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Fernández Ruiz A, del Cerro Marín MJ, Rubio Vidal D, Castro Gussoni MC, Moreno Granados F. [Transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder: initial results and mid-term follow-up]. Rev Esp Cardiol 2002; 55:1057-62. [PMID: 12383391 DOI: 10.1016/s0300-8932(02)76756-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter closure of patent ductus arteriosus is a well-established procedure. The aim of this study was to assess the initial and mid-term results of the treatment of PDA with the Amplatzer duct occluder. PATIENTS AND METHODS From October 1999 to December 2001, 30 children underwent transcatheter closure of persistent ductus arteriosus at a mean SD age of 5 4.02 years (range: 3 months to 14 years) and weight of 20.3 10.3 kg (range: 4.5-45 kg). Infants under 10 kg weight made up 46% of total patients. A lateral view aortogram was made to determine the morphology of the ductus and select the size of the device. Occlusion was achieved using the anterograde venous approach. Follow-up evaluations were made with chest X-ray and echocardiogram at 24 hours and 1, 4 and 12 months after implantation. RESULTS Twenty-eight patients (93.3%) immediately achieved complete occlusion, and on color Doppler examination the closure rate was 100% within 24 hours of implantation. There was no device embolization. In the follow-up, a 19-month-old patient developed a 20 mmHg gradient across the aortic arch. CONCLUSIONS Patent ductus arteriosus can be easily occluded with the Amplatz Duct Occluder, which is effective and particularly useful in infants and children with relatively large PDA. Further experience and long-term follow-up are still needed to assess the safety of this device in smaller children.
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El Mallah MK, Sands AJ, Casey FA, Craig BG, Mulholland HC. Transcatheter occlusion of the patent ductus arteriosus: a comparison of two devices. Ir J Med Sci 2002; 171:151-4. [PMID: 15736355 DOI: 10.1007/bf03170504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transcatheter occlusion of the arterial duct is a safe and effective alternative to surgical closure. The Rashkind umbrella occluder and the Cook coil are two established devices, although the former is no longer manufactured. AIMS To assess any difference in outcomes between the use of the Cook detachable coil and the Rashkind double umbrella in patent ductus arteriosus (PDA) occlusion. METHODS A retrospective study of 77 patients in whom PDA occlusion was attempted using the Cook detachable PDA coil from March 1996 to March 2000. A comparison was carried out with patients in whom occlusion was attempted using the Rashkind double umbrella between 1989 and 1996. RESULTS The rate of immediate complete occlusion was 24% compared with 29.9% for the Rashkind device. The figure for complete occlusion after 24 hours with the PDA coil was 63% compared with 61.5% in the Rashkind group (p > 0.1). The overall closure rate in the coil group was 72% versus 74.6% for umbrellas. CONCLUSION The outcome in terms of complete duct closure using the Cook coil is comparable with figures obtained using the Rashkind umbrella. Both devices have a good safety profile in the short and medium-terms.
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Affiliation(s)
- M K El Mallah
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Northern Ireland
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37
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Thanopoulos BD, Tsaousis GS, Djukic M, Al Hakim F, Eleftherakis NG, Simeunovic SD. Transcatheter closure of high pulmonary artery pressure persistent ductus arteriosus with the Amplatzer muscular ventricular septal defect occluder. Heart 2002; 87:260-3. [PMID: 11847167 PMCID: PMC1767051 DOI: 10.1136/heart.87.3.260] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The design of devices currently used for closure of persistent ductus arteriosus (PDA) with high pulmonary artery pressure is not ideal and there is a risk of embolisation into the aorta. OBJECTIVE To investigate the use of the Amplatzer muscular ventricular septal defect occluder (AMVSDO) for treatment of PDA with high pulmonary artery pressure. PATIENTS AND DESIGN Seven patients, aged 5-12 years, with large PDAs and systemic or near systemic pulmonary artery pressure underwent attempted transcatheter closure using the AMVSDO. The device consists of two low profile disks made of a nitinol wire mesh with a 7 mm connecting waist. Balloon occlusion of the duct was performed before closure from the venous side, and prosthesis size was chosen according to the measured diameter of the occluding balloon. A 7 French sheath was used to deliver the device. All patients underwent a complete haemodynamic and angiographic study one year after occlusion. RESULTS The mean (SD) angiographic PDA diameter was 9.8 (1.7) mm (range 7-13 mm) and the mean AMVSDO diameter was 11.4 (1.8) mm (range 9-16 mm). Q(p)/Q(s) ranged from 1.9-2.2 (mean 2.0 (0.1)). Successful device delivery and complete closure occurred in all patients (100% occlusion rate, 95% confidence interval 59.04% to 100.00%). Mean systolic pulmonary artery pressures were as follows: before balloon occlusion, 106 (13) mm Hg; during occlusion, 61 (6) mm Hg; immediately after the procedure, 57 (5) mm Hg; and at the one year follow up catheterisation, 37 (10) mm Hg. Fluoroscopy time was 10.4 (4.3) min (range 7-18 min). No complications occurred. CONCLUSIONS AMVSDO is an important adjunct for closure of large PDAs associated with high pulmonary artery pressure. Further studies are required to document its efficacy, safety, and long term results in a larger number of patients.
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Affiliation(s)
- B D Thanopoulos
- Department of Cardiology, Aghia Sophia Children's Hospital, Athens, Greece.
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38
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O'Donnell C, Neutze JM, Skinner JR, Wilson NJ. Transcatheter patent ductus arteriosus occlusion: evolution of techniques and results from the 1990s. J Paediatr Child Health 2001; 37:451-5. [PMID: 11885708 DOI: 10.1046/j.1440-1754.2001.00689.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the evolution of transcatheter patent ductus arteriosus (PDA) occlusion techniques and results. METHODS A single institution, retrospective review including all patients with intention to close a PDA from 1991 to 1998, with no exclusions. RESULTS Rashkind occluder (n = 65), sideris double-button (n = 6), Cook detachable coil (n = 28) and Amplatzer ductal occluder (n = 4) were used. Successful implantation occurred in 99 of 103 patients. There was a need for a second transcatheter procedure to close residual ductal shunting in 12% of patients: Rashkind umbrellas (n = 8), double-button (n = 1), coils (n = 3). Eight patients (8%) required surgery, including 4 of 6 patients with the double-button occluder. CONCLUSIONS The Rashkind occluder and the Sideris double-button device both had an unacceptably high rate of residual shunts requiring a second transcatheter procedure or surgical closure. Detachable coils and the Amplatzer ductal occluder have become the current technology of choice for transcatheter PDA closure with high success rates.
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Affiliation(s)
- C O'Donnell
- Department of Paediatric Cardiology, Green Lane Hospital, Auckland, New Zealand
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39
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Formigari R, Toscano A, Herraiz I, Bialkowski J, Donti A, Picchio FM, Bermudez-Cañete R, Ballerini L. Late follow-up of occlusion of the patent ductus arteriosus with the Rashkind device with emphasis on long-term efficacy and risk for infections. Am J Cardiol 2001; 88:586-8. [PMID: 11524079 DOI: 10.1016/s0002-9149(01)01749-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Formigari
- Pediatric Cardiology, University of Bologna, Policlinico S. Orsola, Bologna, Italy.
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40
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Kong H, Gu X, Bass JL, Titus J, Urness M, Kim TH, Hunter DW. Experimental evaluation of a modified Amplatzer duct occluder. Catheter Cardiovasc Interv 2001; 53:571-6. [PMID: 11515016 DOI: 10.1002/ccd.1225] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to evaluate a new device specifically designed for patent ductus arteriosus (PDA) occlusion based on PDA anatomy. Percutaneous closure of aortopulmonary shunts was attempted in 10 dogs. Shunts were surgically created in the location and orientation of PDA. The occlusion prosthesis consisted of a cylindrical frame filled with polyester and a 32 degree angled retention disk. The delivery system of the device included a 6 Fr thin-walled Teflon introducing sheath, an antirotating delivery catheter, and cable. Complete occlusion of the shunt was obtained in nine animals. One animal died before device placement. Temporary hemolysis occurred in one dog after device placement. The disk of device was completely covered by smooth glistening neoendothelium at 1-3 months postmortem examination. None of the devices protruded into the lumen of the aorta. The device is an improvement over the standard Amplatzer duct occluder. The angled retention disk lies flatly against the aortic wall, avoiding turbulence or an aortic pressure gradient.
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Affiliation(s)
- H Kong
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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41
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Lee CH, Leung YL, Chow WH. Transcatheter closure of the patent ductus arteriosus using an Amplatzer duct occluder in adults. JAPANESE HEART JOURNAL 2001; 42:533-7. [PMID: 11693289 DOI: 10.1536/jhj.42.533] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patent ductus arteriosus (PDA) is a congenital heart disease that frequently escapes detection until the patient reaches adulthood. Percutaneous closure of the PDA has been established as a safe alternative to surgery, the Amplatzer duct occluder (ADO) is a new device that has been recently reported in paediatric patients. Our initial experience with an of ADO in an adult population appears to be encouraging and as good as in paediatric patients.
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Affiliation(s)
- C H Lee
- Cardiac Medical Unit, Grantham Hospital, Hong Kong
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42
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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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43
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Thanopoulos BD, Hakim FA, Hiari A, Tsaousis GS, Paphitis C, Hijazi ZM. Patent ductus arteriosus equipment and technique. Amplatzer duct occluder: intermediate-term follow-up and technical considerations. J Interv Cardiol 2001; 14:247-54. [PMID: 12053313 DOI: 10.1111/j.1540-8183.2001.tb00743.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Between May 1997 and June 2000, 69 patients, ages 0.1 to 34 years, underwent attempted anterograde transcatheter closure of a patent ductus arteriosus (PDA) using the Amplatzer Duct Occluder (ADO). The ADO is a cone-shaped, self-centering, and repositionable occluder made of nitinol wire mesh. A 5Fr to 7Fr sheath was used for the delivery of the device. The mean PDA diameter (at the pulmonary end) was 4.6 +/- 1.9 mm (range 1 mm-8.5 mm). Sixty-seven of the 69 patients had successful device placement. The mean ADO smallest diameter was 6.9 +/- 1.8 mm (range 4 mm-12 mm). Complete angiographic closure occurred in 62 (92.5%) of 67 patients (95% confidence interval, 88.22%-98.77%). In five patients, there was a trivial residual shunt immediately after the procedure. At 24 hours, color Doppler flow imaging revealed complete closure in all 67 (100%) patients. The unsuccessful attempts occurred in two patients with a small, 1-mm diameter native PDA and residual PDA after surgical occlusion. Fluoroscopy time was 7.6 +/- 1.8 minutes (4 min-18 min). No complications were observed. At a median follow-up of 1.5 years (range 0.25 to 3.2 years), all patients had complete closure without complications. We conclude that transcatheter closure using the ADO is a highly effective and safe treatment for most patients with PDA.
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Affiliation(s)
- B D Thanopoulos
- Department of Pediatric Cardiology, Aghia Sophia Children's Hospital, Thivon & Levadias Street, 115 27 Athens, Greece.
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Moore JW, DiMeglio D, Javois AP, Takahashi M, Berdjis F, Cheatham JP. Results of the phase I food and drug administration clinical trial of duct-occlud device occlusion of patent ductus arteriosus. Catheter Cardiovasc Interv 2001; 52:74-8. [PMID: 11146528 DOI: 10.1002/1522-726x(200101)52:1<74::aid-ccd1018>3.0.co;2-f] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to evaluate the safety and the efficacy of transcatheter patent ductus arteriosus (PDA) occlusion with the Duct-Occlud device. Six centers participated in this phase I U.S. Food and Drug Administration-approved clinical trial with investigational device exemption. Patients with restrictive PDA (less than 4-mm minimum diameter) were eligible for the study. Sixty-two patients were enrolled. Forty-eight patients had successful implantation of Duct-Occlud devices. Patient follow-up evaluations were conducted at hospital discharge and after 2 and 12 months. At discharge and after 1 year, all patients had clinical PDA closure. Closure assessed by color flow Doppler was 55% at discharge, 88% at 2 months, and 94% at 1 year. There were no complications related to implantation or noted in follow-up evaluations. The Duct-Occlud device is safe and efficacious for the closure of small- to moderate-size patent ductus arteriosus.
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Affiliation(s)
- J W Moore
- Heart Center for Children, St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
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45
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Justino H, Justo RN, Ovaert C, Magee A, Lee KJ, Hashmi A, Nykanen DG, McCrindle BW, Freedom RM, Benson LN. Comparison of two transcatheter closure methods of persistently patent arterial duct. Am J Cardiol 2001; 87:76-81. [PMID: 11137838 DOI: 10.1016/s0002-9149(00)01276-5] [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: 11/18/2022]
Abstract
A randomized trial of arterial duct occlusion with a double umbrella (DU) or wire coil (WC) was undertaken for patients <18 years of age, weighing >10 kg with isolated ducts < or = 3 mm in diameter. Baseline, procedural, and outcome characteristics were compared in an intention-to-treat analysis according to randomization group. From 40 consecutively screened patients, 2 were not enrolled due to a ductal diameter of >3 mm on initial aortography, 38 patients were randomized to either the DU (n = 20) or WC (n = 18) groups. The groups did not differ significantly with respect to age, weight, gender, duct size, type, or branch pulmonary artery diameters. Crossover occurred only in the DU group, where 4 patients (20%) had a ductal diameter of < or = 1 mm and could not be entered for umbrella placement. All remaining DU group patients had ductal diameters of > or = 1.3 mm (p <0.0001). There were no embolizations or secondary implants in the DU group, but in the WC group there was 1 early and 1 late embolization, with 6 patients (33%) with > or = 2 coils. Mean times for the procedure (DU 68+/-19 minutes; WC 65+/-27 minutes; p = 0.70) and fluoroscopy (DU 14+/-4 minutes; WC 11+/-6 minutes; p = 0.22) did not differ significantly. Angiographic duct closure was documented in 4 of 13 patients (31%) of the DU group and 4 of 18 patients (22%) of the WC group (p = 0.69). Combined with an echocardiogram, closure in 11 of 17 patients with DU (65%) and 13 of 18 patients with WC (72%) (p = 0.64) was documented before hospital discharge. One WC group patient received thrombolytic therapy for a femoral artery thrombus. Follow-up at a median of 6.5 months (range 3.2 to 37) showed closure by Doppler echocardiography in 15 of 19 patients with DU (79%) versus 14 of 18 patients with WC (78%) (p = 1.0). Thus, with a tendency toward similar procedural characteristics and outcomes, the higher cost of the DU system compared with coil implants favors the use of coils for closure of the small arterial duct.
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Affiliation(s)
- H Justino
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada
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46
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Bilkis AA, Alwi M, Hasri S, Haifa AL, Geetha K, Rehman MA, Hasanah I. The Amplatzer duct occluder: experience in 209 patients. J Am Coll Cardiol 2001; 37:258-61. [PMID: 11153748 DOI: 10.1016/s0735-1097(00)01094-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to assess the safety and efficacy of the Amplatzer ductal occluder (ADO) in transcatheter occlusion of patent ductus arteriosus (PDA). BACKGROUND Transcatheter closure of small to moderate sized PDAs is an established procedure. The ADO is a self-expandable device with a number of salutary features, notably its retrievability, ease of delivery via small 5F to 7F catheters and a range of sizes suitable even for the larger PDAs. METHODS Between November 1997 and August 1999, the ADO was successfully implanted in 205 of 209 patients with PDA. The inclusion criteria for this device occlusion method were patients with clinical and echocardiographic features of moderate to large PDA, weighing > or =3.5 kg as well as asymptomatic adolescents and adults with PDA measuring > or =5.0 mm on two-dimensional (2D) echocardiogram. Occlusion was achieved via the antegrade venous approach. Follow-up evaluations were performed with 2D echocardiogram, color-flow mapping and Doppler measurement of the descending aorta and left pulmonary artery velocity at 24 h and 1, 3, 6 and 12 months after implantation. RESULTS Two hundred and five patients had successful PDA occlusion using this device. The patients were between two months and 50 years (median 1.9) and weighed between 3.4 kg and 63.2 (median 8.4). Infants made up 26% of the total patients. The PDA measured from 1.8 to 12.5 mm (mean 4.9) at the narrowest diameter. Forty-four percent of patients achieved immediate complete occlusion. On color Doppler the closure rates at 24 h and 1 month after implant were 66% and 97%, respectively. At 6 and 12 months all except one patient attained complete occlusion. Device embolization occurred in three patients; in two this was spontaneous, and in the other it was due to catheter manipulation during postimplant hemodynamic measurement. Mild aortic narrowing was seen in an infant. CONCLUSIONS Patent ductus arteriosus occlusion using ADO is safe and efficacious. It is particularly useful in symptomatic infants and small children with relatively large PDA. Embolization can be minimized by selection of appropriate sized devices, and caution should be exercised in infants <5 kg.
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Affiliation(s)
- A A Bilkis
- Department of Pediatric Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
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Qureshi SA, Redington AN, Wren C, Ostman-Smith I, Patel R, Gibbs JL, de Giovanni J. Recommendations of the British Paediatric Cardiac Association for therapeutic cardiac catheterisation in congenital cardiac disease. Cardiol Young 2000; 10:649-67. [PMID: 11117403 DOI: 10.1017/s1047951100008982] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of these recommendations are to improve the outcome for patients after, and to provide acceptable standards of practice of therapeutic cardiac catheterisation performed to treat congenital cardiac disease. The scope of the recommendations includes all interventional procedures, recognising that for some congenital malformations, surgical treatment is equally as effective as, or occasionally preferable to, interventional treatment. The limitations of the recommendations are that, at present, no data are available which compare the results of interventional treatment with surgery, and certainly none which evaluate the numbers and types of procedures that need to be performed for the maintenance of skills. Thus, there is a recognised need to collect comprehensive data with which these recommendations could be reviewed in the future, and re-written as evidence-based guidelines. Such a review will have to take into account the methods of collection of data, their effectiveness, and the latest developments in technology. The present recommendations should, therefore, be considered as consensus statements, and as describing accepted practice, which could be used as a basis for ensuring and improving the quality of future care.
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Befeler B, Justiniano A, Zahn E. Transcatheter closure of a patent ductus arteriosus in an elderly patient with the Gianturco-Grifka vascular occlusion device. Clin Cardiol 2000; 23:790-1. [PMID: 11061061 PMCID: PMC6654991 DOI: 10.1002/clc.4960231020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/1999] [Accepted: 10/01/1999] [Indexed: 11/06/2022] Open
Abstract
This paper reports the unusual case of a 76-year-old woman who was discovered to have a hemodynamically significant patent ductus arteriosus following uneventful mitral valve replacement, utilizing cardiopulmonary bypass. The shunt was successfully eliminated using a new transcatheter device, thereby obviating the need for further surgery. The patient did not have calcification within the ductus, making diagnosis prior to surgery more difficult.
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Affiliation(s)
- B Befeler
- Miami Children's Hospital, Division of Pediatric Cardiology, Florida, USA
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49
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Faella HJ, Hijazi ZM. Closure of the patent ductus arteriosus with the amplatzer PDA device: immediate results of the international clinical trial. Catheter Cardiovasc Interv 2000; 51:50-4. [PMID: 10973018 DOI: 10.1002/1522-726x(200009)51:1<50::aid-ccd11>3.0.co;2-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this article is to present the immediate and short-term results of the international registry of transcatheter closure of patent ductus arteriosus (PDA) using the Amplatzer duct occluder (ADO). Three hundred sixteen patients (221 females) in various centers with clinical and/or echocardiographic evidence of PDA underwent an attempt of catheter closure at a median age of 2.1 years and median weight of 10.7 kg. The median Qp/Qs ratio was 2.3, the median length of the PDA was 6.7 mm and the median diameter of the PDA at its narrowest point (usually the pulmonic end) was 3.8 mm. Immediately after closure and by angiography, the PDA was completely closed in 177/311 patients (56%) and within 24 hr the complete closure rate increased to 76% (235/308). Complications were encountered in 15 patients, including 1 major complication due to device embolization and subsequent death, 6 moderate complications, and 8 minor complications. The median fluoroscopy time was 12 min and the median total procedure time was 70 min. One hundred fourteen patients reached the 6-month follow-up. Color Doppler echocardiography demonstrated complete closure in 109 patients (94.6%). Thirty-eight patients reached the 1-year follow-up mark. There was complete closure in 100% of the patients as documented by color Doppler echocardiography. So far there has been no episodes of delayed device migration, endocarditis, thromboembolism, and wire fracture or device disruption. We conclude that the ADO is safe and effective in most patients with PDA up to a diameter of 10.6 mm. Further clinical trials are underway to assess its long-term safety and efficacy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Child
- Child, Preschool
- Cineangiography
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/therapy
- Echocardiography, Doppler, Color
- Embolization, Therapeutic/adverse effects
- Embolization, Therapeutic/instrumentation
- Embolization, Therapeutic/methods
- Equipment Design
- Female
- Humans
- Infant
- Infant, Newborn
- International Cooperation
- Male
- Middle Aged
- Radiography, Thoracic
- Treatment Outcome
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Affiliation(s)
- H J Faella
- Cardiology Institute Spanish Hospital and Garrahan Hospital, Buenos Aires, Argentina
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Abstract
Interventional catheterization and minimally invasive surgical techniques offer the real possibility of a reduction in cost and morbidity when compared with the traditional surgical approach to patent ductus arteriosus. Video-assisted thoracoscopic surgery may prove to be a superior technique because of its application to a wider range of patients needing ductal closure, a lower incidence of residual shunting, no evidence for recurrent shunting, and the absence of intravascular foreign bodies.
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Affiliation(s)
- A S Bensky
- Department of Pediatrics, Winston-Salem, North Carolina 27157, USA
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