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Peng Y, Cheng Z, Zhang Y, Yi Q. Long term follow-up of patients with patent ductus arteriosus after transcatheter closure. Pediatr Res 2024:10.1038/s41390-024-03317-x. [PMID: 38877281 DOI: 10.1038/s41390-024-03317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND To investigate the concurrent, long-term, and future adverse events and assess the trend of adverse events in pediatric patients with patent ductus arteriosus (PDA) after transcatheter closure. METHODS A total of 1590 patients underwent transcatheter PDA closure were enrolled, including 465 patients (median age = 22 months) in the training group and 1125 patients in the validation group. Logistic regression analysis was used to assess independent risk factors associated with concurrent adverse events after closure. The chi-square test was used to evaluate the 5-year follow-up trend. RESULTS Multivariable logistic regression analysis indicated that low age, female, and high pulmonary end diameter were independent risk factors for concurrent adverse events after closure. For patients without concurrent adverse events and for those who with concurrent adverse events but return to normal, the Chi-square test showed no abnormal results at the 5-year follow-up. Furthermore, the follow-up data of the validation group were not significantly different from those of the training group. CONCLUSION The value of long-term follow-up of children may be limited for those who did not have a concurrent adverse event after closure nor for those who had a concurrent adverse event after closure but returned to normal during the 5-year follow-up period. IMPACT Follow-up monitoring of adverse events tended to be recommended in pediatric patients with PDA after transcatheter closure. However, follow-up in these pediatric patients is expensive and there is a risk of sedation for echocardiography examination frequently. ·Patients who had no concurrent adverse events after closure did not show any abnormality at 5-year follow-up. ·Most of the patients who had concurrent adverse events after closure returned to normal at 5-year follow-up. The value of long-term follow-up may be limited for the above patients after transcatheter PDA closure.
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Affiliation(s)
- Yue Peng
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Zhenli Cheng
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Yan Zhang
- Department of Pediatric Heart center, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610000, China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Wu PW, Yeh SJ, Lee PC, Pan KT, Tien CW, Chao YC, Lin SM, Chen MR, Hung WL. Hemodynamic and Echocardiographic Characteristics and the Presence of Pulmonary Hypertension in Patent Ductus Arteriosus Patients who Underwent Transcatheter Closure. Pediatr Cardiol 2023:10.1007/s00246-023-03157-2. [PMID: 37029813 DOI: 10.1007/s00246-023-03157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
We investigated the hemodynamic parameters of pediatric PDA patients and focused on the influence of PDA size on pulmonary arterial pressure and the prevalence of pulmonary hypertension. A total of 52 patients aged between 2 months and 20 years who received transcatheter closure of a PDA from January 2018 to June 2022 in our institution were retrospectively recruited. Their hemodynamic parameters collected both by echocardiography and by cardiac catheterization were analyzed to delineate the influence of PDA size on the pulmonary vascular system. The echocardiographic-based ductal size and indexed PDA size were 1.93 mm (1.15-6 mm) and 4.05 mm/m2 (2.03-25.47 mm/m2), respectively. The pulmonary artery pressure measured was 20.83 mmHg (8-45 mmHg). We found a positive correlation between indexed PDA size and mean pulmonary arterial pressure (mPAP) (Pearson correlation coefficient = 0.47, p < 0.001). A subgroup analysis showed that 28 patients (53.8%) developed pulmonary hypertension (PH) (defined as mPAP > 20 mmHg). The median age of the PH group was 1.02 years [range: 0.19-8.64], which was significantly younger than the non-PH group's median age of 3.43 years [range: 0.42-19.96] (p = 0.001). The indexed PDA size for the PH group, 4.69 mm/m2, was significantly higher than that of the non-PH group, 3.2 mm/m2 (p = 0.004). The major risk factor for patients with PH was the PDA/BSA index, with an OR of 2.181 (95% CI, 1.224-3.887). Our demographic data showed younger patients with a higher PDA/BSA index are more likely to develop pulmonary hypertension.
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Affiliation(s)
- Po-Wei Wu
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan
- Division of Pediatric Cardiology, Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Jen Yeh
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan
| | - Pi-Chang Lee
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ke-Ting Pan
- Institute of Environmental Design and Engineering, Bartlett School, UCL, London, UK
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Tien
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan
| | - Yen-Chun Chao
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan
| | - Shan-Miao Lin
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan
- Department of Pediatric Cardiology, Mackay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
| | - Ming-Ren Chen
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan
| | - Wei-Li Hung
- Department of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan.
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Salam A, Bautista-Rodriguez C, Karsenty C, Bouvaist H, Piccinelli E, Fraisse A. Transcatheter closure of tubular patent ductus arteriosus using muscular ventricular septal defect devices in infants and small children with congestive heart failure. Arch Cardiovasc Dis 2022; 115:134-141. [DOI: 10.1016/j.acvd.2022.01.003] [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: 07/02/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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Arafuri N, Murni IK, Idris NS, Uiterwaal CSPM, Savitri AI, Nugroho S, Noormanto N. Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country. Glob Heart 2021; 16:25. [PMID: 34040938 PMCID: PMC8064284 DOI: 10.5334/gh.831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair. Methods All cases of PAH related to left-to-right shunt CHD repairs from 2015-2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019-2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth's correction and restricted mean survival time were used for survival analysis. Results Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m2). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had -476.1 days (95% confidence interval [CI]: -714.4, -237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups. Conclusion In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.
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Affiliation(s)
- Nadya Arafuri
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Indah K. Murni
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Nikmah S. Idris
- Pulmonary Hypertension Department, Great Ormond Street Hospital for Children, London, GB
| | - Cuno S. P. M. Uiterwaal
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NL
| | - Ary I. Savitri
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NL
| | - Sasmito Nugroho
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Noormanto Noormanto
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
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Xu J, Wang L, Shen Y, Geng L, Chen F. Transcatheter closure for patent ductus arteriosus in patients with Eisenmenger syndrome: to do or not? BMC Cardiovasc Disord 2020; 20:505. [PMID: 33261574 PMCID: PMC7709273 DOI: 10.1186/s12872-020-01795-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidences of benefit from targeted therapies, ES patients once thought to be inoperable may have increasing options for management. This study aims to explore whether PDA in patients with ES can be treated with transcatheter closure (TCC). METHODS Between August 2014 and July 2016, four of fifteen PDA-ES patients whose Qp/Qs improved significantly and Qp/Qs > 1.5 after acute vasodilator testing with 100% oxygen were selected to receive TCC and pulmonary vasodilator therapy. PAH-targeted drugs were prescribed before and after occlusion for all. Trial occlusion was performed before permanent closure. RESULTS The first TCC failed after initiation of PAH-targeted drugs for 6 months in four patients. After the medication was adjusted and extended to 12 months, TCC was performed for all without hemodynamic intolerances during perioperative period. Pulmonary artery systolic pressure (PASP) was significantly decreased (≥ 40%) immediately after TCC. During a mean follow-up of 48 ± 14.70 months, there were a further decrease of PASPs in two patients, the other two showed improved pulmonary vascular resistance, WHO functional class and six-minute walking distance despite deteriorated PASP. CONCLUSION Some selected PDA-ES patients might benefit from TCC and combined PAH-targeted drugs play a crucial role.
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Affiliation(s)
- Jing Xu
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Liang Wang
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Yunli Shen
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Liang Geng
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Fadong Chen
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China.
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Salavitabar A, Krishnan US, Turner ME, Vincent JA, Torres AJ, Crystal MA. Safety and Outcomes of Transcatheter Closure of Patent Ductus Arteriosus in Children With Pulmonary Artery Hypertension. Tex Heart Inst J 2020; 47:250-257. [PMID: 33472220 DOI: 10.14503/thij-19-6982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To investigate whether transcatheter device closure of patent ductus arteriosus (PDA) is safe in children with pulmonary artery hypertension, we retrospectively analyzed our experience with 33 patients who underwent the procedure from January 2000 through August 2015. Pulmonary artery hypertension was defined as a pulmonary vascular resistance index (PVRI) >3 WU · m2. All 33 children (median age, 14.5 mo; median weight, 8.1 kg) underwent successful closure device implantation and were followed up for a median of 17.2 months (interquartile range [IQR], 1.0-63.4 mo). During catheterization, the median PVRI was 4.1 WU · m2 (IQR, 3.6-5.3 WU · m2), and the median mean pulmonary artery pressure was 38.0 mmHg (IQR, 25.5-46.0 mmHg). Premature birth was associated with pulmonary vasodilator therapy at time of PDA closure ( P=0.001) but not with baseline PVRI (P=0.986). Three patients (9.1%) had device-related complications (one immediate embolization and 2 malpositions). Two of these complications involved embolization coils. Baseline pulmonary vasodilator therapy before closure was significantly associated with intensive care unit admission after closure (10/12 [83.3%] with baseline therapy vs 3/21 [14.3%] without; P <0.001). Of 11 patients receiving pulmonary vasodilators before closure and having a device in place long-term, 8 (72.7%) were weaned after closure (median, 24.0 mo [IQR, 11.0-25.0 mo]). We conclude that transcatheter PDA closure can be performed safely in many children with pulmonary artery hypertension and improve symptoms, particularly in patients born prematurely. Risk factors for adverse outcomes are multifactorial, including coil use and disease severity. Multicenter studies in larger patient populations are warranted.
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Affiliation(s)
- Arash Salavitabar
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, 10032
| | - Usha S Krishnan
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, 10032
| | - Mariel E Turner
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, 10032
| | - Julie A Vincent
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, 10032
| | - Alejandro J Torres
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, 10032
| | - Matthew A Crystal
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, 10032
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Kanabar K, Bootla D, Kaur N, Pruthvi CR, Krishnappa D, Santosh K, Guleria V, Rohit MK. Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm). Indian Heart J 2020; 72:107-112. [PMID: 32534682 PMCID: PMC7296248 DOI: 10.1016/j.ihj.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/23/2019] [Accepted: 03/28/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Transcatheter closure is the first-choice strategy for the management of appropriate patients with patent ductus arteriosus (PDA). The management of large PDAs is challenging due to the limited available sizes of approved devices and the inherent risks of surgical ligation, especially in adults with calcified PDAs. This study aimed to assess the outcomes of the off-label use of large occluders at a tertiary center. METHODS This retrospective review included patients who underwent transcatheter PDA closure with large occluders (≥16 mm) over 16 years. The baseline patient data, procedural details, angiograms, and immediate outcomes were recorded and patients were followed up at 3, 6, 12 months after the intervention and annually thereafter. RESULTS Of the 685 patients who underwent transcatheter PDA closure, 36 patients (mean age 16.6 ± 12.5 years) needed occluders ≥ 16 mm in size. Cocoon duct occluder, Cera duct occluder, Amplatzer atrial septal occluder (ASO), and Cera muscular ventricular septal defect occluders were used for PDA closure. There was no device embolization, one patient in whom ASO was used had residual shunt with intravascular hemolysis requiring surgery, and one patient had mild left pulmonary artery narrowing after the intervention, which was managed conservatively. No patient had residual shunt and one patient had persistent pulmonary hypertension at an intermediate duration of follow-up. CONCLUSION Transcatheter PDA closure with the use of large devices, which are available in Asia and Europe, is an effective and safe method, especially in adolescents and adults. However, a close follow-up of these patients is mandatory.
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Affiliation(s)
- Kewal Kanabar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Dinakar Bootla
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Navjyot Kaur
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - C R Pruthvi
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Darshan Krishnappa
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vivek Guleria
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Yang MC, Liu HK, Wu HY, Tey SL, Yang YN, Wu CY, Wu JR. Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern. Front Pediatr 2020; 8:591441. [PMID: 33194925 PMCID: PMC7649389 DOI: 10.3389/fped.2020.591441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA. Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups. Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05). Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsuan-Yin Wu
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, E-Da Hospital, Kaohsiung City, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
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Severe Pulmonary Arteriopathy in a Neonate with Congenital Rubella Syndrome and Patent Ductus Arteriosus. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1614-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Weisz DE, Giesinger RE. Surgical management of a patent ductus arteriosus: Is this still an option? Semin Fetal Neonatal Med 2018; 23:255-266. [PMID: 29636280 DOI: 10.1016/j.siny.2018.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The evolution of neonatal intensive care over the past decade has seen the role of surgical patent ductus arteriosus (PDA) ligation in preterm infants both decrease in scope and become laden with uncertainty. Associations of ligation with adverse neonatal and neurodevelopmental outcomes have rendered the ligation decision more challenging for clinicians and have been associated with a decline in surgical treatment, but these findings may be due to bias from confounding by indication in observational studies rather than a causal detrimental effect of ligation. Accordingly, ligation may still be indicated for infants with large ductal shunts and moderate-severe respiratory insufficiency in whom the prospect of timely spontaneous closure appears low. Ultimately a randomized trial of surgical ligation versus conservative management is necessary to assess the efficacy of this invasive intervention in a population of extremely preterm infants with large ductal shunts. Simultaneously, the transcatheter approach to ductal closure in the very immature infant represents an exciting therapeutic alternative but which is still in its infancy. Insights into the pathophysiology of postoperative cardiorespiratory deterioration, including the importance of left ventricular afterload, may help clinicians avoid instability and mitigate a potentially injurious aspect of surgical treatment. This review examines the evidence regarding the benefits and risks of PDA surgery in preterm neonates and provides a pathophysiology-based management paradigm to guide perioperative care in high-risk infants.
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Affiliation(s)
- Dany E Weisz
- Department of Paediatrics, University of Toronto, Toronto, Canada; Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Regan E Giesinger
- Department of Paediatrics, University of Toronto, Toronto, Canada; Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
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Use of covered stents in simultaneous management of coarctation of the aorta and patent ductus arteriosus. Anatol J Cardiol 2018; 19:332-336. [PMID: 29578201 PMCID: PMC5998845 DOI: 10.14744/anatoljcardiol.2018.61257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: To report clinical and procedural characteristics of twelve patients who received a covered stent for the treatment of aortic coarctation and concurrent patent ductus arteriosus (PDA). Methods: A single center database was retrospectively evaluated to obtain data of patients with combined aortic coarctation and PDA. We selected patients in whom a covered stent was used for the treatment of both pathologies. The stent length was chosen so as to cover the entire length of the lesion from healthy to healthy tissue and also cover the ampulla of PDA. Results: The median age of the patients was 15 (range, 6.5-35) years. The diameter of the coarctated segment increased from a median of 8.4 (range, 2.6-10.8) mm to 16 (range, 9-24) mm (p<0.005), whereas the pressure gradient decreased from a median of 43 (range, 10-71) mm Hg to 0 (range, 0-8) mm Hg (p<0.005). Fourteen covered stents were used for 12 patients. Following deployment, seven stents were flared with larger and low-pressure balloons because of the gap between the distal end of the stent and the poststenotic dilated segment of the aorta, which caused residual PDA shunts and/or instability of the stent. After the procedure, no residual PDA shunt was present in any patient. Conclusion: To the best of our knowledge, this study includes the largest series of patients reported in literature in whom covered CP stents were used for simultaneous percutaneous treatment of coarctation and PDA. The procedure was successful and stable results were obtained during follow-up in all cases.
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Parekh D, Krajcer Z. Patent ductus arteriosus and pulmonary arterial hypertension: Is it closer to closure? Catheter Cardiovasc Interv 2017; 89:726-727. [DOI: 10.1002/ccd.27011] [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: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Dhaval Parekh
- Department of Cardiology; Texas Heart Institute; Houston Texas
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Lehner A, Ulrich S, Happel CM, Fischer M, Kantzis M, Schulze-Neick I, Haas NA. Closure of very large PDA with pulmonary hypertension: Initial clinical case-series with the new Occlutech®PDA occluder. Catheter Cardiovasc Interv 2016; 89:718-725. [DOI: 10.1002/ccd.26856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/19/2016] [Accepted: 10/12/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Christoph M. Happel
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Marinos Kantzis
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Germany
| | - Ingram Schulze-Neick
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Nikolaus A. Haas
- Department for Pediatric Cardiology and Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
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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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Tomita H, Bolormaa T, Haneda N. Transcatheter occlusion of gigantic persistent ductus arteriosus (PDA) using a custom-made persistent ductus arteriosus occluder. Catheter Cardiovasc Interv 2016; 87:1138-1141. [DOI: 10.1002/ccd.26295] [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: 05/18/2015] [Revised: 06/29/2015] [Accepted: 10/02/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Hideshi Tomita
- Cardiovascular Center, Showa University Northern Yokohama Hospital; Yokohama Kanagawa Japan
| | | | - Noriyuki Haneda
- Division of Pediatrics and Pediatric Cardiology; Doremi Clinic; Izumo Japan
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Jin M, Liang YM, Wang XF, Guo BJ, Zheng K, Gu Y, Lyu ZY. A Retrospective Study of 1,526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus. Chin Med J (Engl) 2015; 128:2284-9. [PMID: 26315073 PMCID: PMC4733798 DOI: 10.4103/0366-6999.163398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices. Methods: One thousand five hundred and twenty-six patients (537 boys, 989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications. Results: Median age and median weight were 4.0 years (range: 0.3–52.0 years old) and 15.3 kg (range: 4.5–91.0 kg), respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 mm, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I (ADO I, 1280, 85.8%), Cook detachable coils (116, 7.8%), ADO II (ADO II, 68, 4.6%), muscular VSD occluder (12, 0.8%), and Amplatzer vascular plug (16, 1.0%). Conclusions: Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.
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Affiliation(s)
- Mei Jin
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Frank DB, Hanna BD. Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics. Minerva Pediatr 2015; 67:169-185. [PMID: 25604592 PMCID: PMC4382100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pulmonary arterial hypertension (PAH) is an uncommon but serious disease characterized by severe pulmonary vascular disease and significant morbidity and mortality. PAH associated with congenital heart disease (APAH-CHD) is one etiology of PAH that has innate characteristics delineating it from other forms of PAH. The patient with APAH-CHD presents with unique challenges consisting of not only pulmonary vascular disease but also the complexity of the cardiac lesion. Eisenmenger syndrome (ES) represents the severe end of the spectrum for disease in APAH-CHD. Over time, systemic-to-pulmonary shunting through cardiac defects increases pulmonary vascular resistance to levels significant enough to reverse shunting across the defect. Historically, ES patients have been reported to have better outcomes than IPAH despite similarities in pulmonary vascular disease. However, recent studies are challenging this notion. Nonetheless, APAH-CHD survival has improved with the advent of modern PAH targeted therapies. New therapeutic options have allowed us to reconsider the dogma of inoperability in APAH-CHD patients with unrepaired defects. Certainly advances have been made, however, investigators must continue to advance the field through controlled clinical trials in both adult and pediatric APAH-CHD patients.
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Affiliation(s)
- D B Frank
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA -
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VIJAYALAKSHMI ISHWARAPPABALEKUNDRI, SETTY NATRAJ, NARASIMHAN CHITRA, SINGLA VIVEK, MANJUNATH CHOLENAHALLINANJAPPA. Percutaneous Device Closure of Patent Ductus Arteriosus with Pulmonary Artery Hypertension: Long-Term Results. J Interv Cardiol 2014; 27:563-9. [PMID: 25490863 DOI: 10.1111/joic.12156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - NATRAJ SETTY
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru; Bangalore Karnataka India
| | - CHITRA NARASIMHAN
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru; Bangalore Karnataka India
| | - VIVEK SINGLA
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru; Bangalore Karnataka India
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Aboulhosn JA. The Role of Catheter-Based and Surgical Treatments in Patients With Congenital Heart Disease and Pulmonary Hypertension. ACTA ACUST UNITED AC 2013. [DOI: 10.21693/1933-088x-11.4.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This manuscript is intended to provide a brief overview of the indications for and outcomes of surgical and transcatheter interventions for congenital heart disease and pulmonary hypertension (PH). Pulmonary hypertension is frequently encountered in children and adults with congenital heart disease and is most commonly related to large “central” shunts, ie, those occurring at the ventricular or great arterial level (Figure 1). If uncorrected early in infancy or childhood, large central shunts result in increased pulmonary blood flow, left heart volume overload, PH, and heart failure. If the child survives this initial period of volume overload and heart failure, they will very likely develop effacement of the normal pulmonary arterial architecture and severe elevations in pulmonary arterial resistance, eventually resulting in cyanosis and Eisenmenger syndrome.1
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Affiliation(s)
- Jamil A. Aboulhosn
- Director, Ahmanson/UCLA Adult Congenital, Heart Disease Center, Los Angeles, CA
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Aboulhosn J. Rotational angiography and 3D overlay in transcatheter congenital interventions. Interv Cardiol 2013. [DOI: 10.2217/ica.13.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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22
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Tharakan J, Venkateshwaran S. Large patent ductus arteriosus: To close or not to close. Ann Pediatr Cardiol 2012; 5:141-4. [PMID: 23129902 PMCID: PMC3487201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jaganmohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India,Address for correspondence: Prof. Jaganmohan Tharakan, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum- 695 011, India. E-mail:
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