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Jenab Y, Salehi Omran H, Hosseini K, Tofighi S, Ghaderian H, Ates I. Case report: Thoracic endovascular aortic repair using a non-touch exclusion technique with a custom-made device for the treatment of a large patent ductus arteriosus. Front Cardiovasc Med 2023; 10:1218158. [PMID: 37663416 PMCID: PMC10469619 DOI: 10.3389/fcvm.2023.1218158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Patent ductus arteriosus (PDA) is a common congenital heart disease affecting roughly one in every 2,000 term births. Although most of the patients are diagnosed and treated during childhood, few cases may persist into adulthood. We presented a 27-year-old male patient with a 20.2 mm diameter PDA who was referred to our hospital with progressive fatigue and exertional dyspnea. Given the potential complications, usual techniques such as coil occlusion and duct occluders were deemed inappropriate for this patient. Thoracic endovascular aortic repair (TEVAR) using a non-touch exclusion technique was successfully performed for this patient. The patient was discharged with no major post-surgical complications. TEVAR could be a new, safe, and effective alternative treatment to other transcatheter procedures for complicated PDAs in some patients.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Salehi Omran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Tofighi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Ghaderian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ismail Ates
- Department of Cardiology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
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Mitsuoka H, Orimoto Y, Arima T, Ishiguchi T, Ishibashi H. Thoracic Endovascular Aortic Repair for Pseudoaneurysms After Repair of Patent Ductus Arteriosus. Vasc Endovascular Surg 2020; 54:741-746. [PMID: 32729388 DOI: 10.1177/1538574420945068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pseudoaneurysms that develop after surgical repair of a patent ductus arteriosus (PDA) are more likely to rupture, but open surgery including a repeat thoracotomy would be highly invasive. We report 2 cases of thoracic endovascular aortic repair (TEVAR) for such pseudoaneurysms. METHODS/RESULTS A 59-year-old woman who underwent PDA surgical ligation at 13 years of age presented with sudden hemoptysis. She was diagnosed with a ruptured distorted pseudoaneurysm sized 26 mm; emergency TEVAR was performed. A 23-year-old woman with a history of Down syndrome, endocardial cushion defect, and PDA underwent 2 thoracotomy surgeries including PDA ligation. During a medical checkup, an abnormal shadow was detected on chest radiography. She was diagnosed with a 15-mm pseudoaneurysm after PDA surgical repair; TEVAR was performed. In both cases, the postoperative course was uneventful. CONCLUSIONS To the best of our knowledge, this is the first report of emergency TEVAR for ruptured pseudoaneurysms after PDA ligation. Thoracic endovascular aortic repair is an important therapeutic option for such cases as it eliminates the need for repeat thoracotomy.
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Affiliation(s)
- Hiroki Mitsuoka
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuki Orimoto
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takahiro Arima
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroyuki Ishibashi
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Mikael A, Andacheh I, Yufa A, Nurick H. Pseudoaneurysm of Patent Ductus Arteriosus Following Previous PDA Closure: Case Report and Literature Review. Vasc Endovascular Surg 2019; 54:165-168. [PMID: 31707973 DOI: 10.1177/1538574419886191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pseudoaneurysm developing after repair of a patent ductus arteriosus (PDA) is uncommon, with only a handful of cases reported in the literature. While older literature cites infection, recent series suggest that formation of pseudoaneurysm off of a ligated PDA attributed to breakdown in the suture line. Thoracic endovascular aortic repair (TEVAR) for this rare pathology has been demonstrated in selected case reports. METHODS/RESULTS A 61-year-old woman presented with enlarging left chest mass and shortness of breath. The patient reported a history of a PDA with 2 attempts at closure. At age 6, she had undergone an attempt at endovascular closure of the PDA; this subsequently resulted in right lower extremity limb ischemia with resultant below-knee amputation. At age 12, she underwent open thoracotomy with ligation of the PDA; at this procedure, she had injury to her recurrent laryngeal nerve, resulting in permanent hoarseness of voice. A computed tomography angiogram of the chest was obtained, which demonstrated a saccular 4.5 × 3.8 cm pseudoaneurysm in the region of the PDA with calcific wall changes. Recommendation was made to proceed with operative repair and she agreed. A TEVAR was performed using a commercially available stent graft. During the procedure, intravascular ultrasound was performed; however, the connection between the PDA pseudoaneurysm and the aorta was not visualized. She had an uncomplicated operative and postoperative course. Follow-up imaging showed complete thrombosis of the pseudoaneurysm. CONCLUSIONS Pseudoaneurysm from previous PDA repair is a rare pathology. We present a unique case in which the patient had undergone attempts at both endovascular and open surgical repair. Open repair for PDA is still advocated; however, TEVAR appears to be a safe treatment in adults with this pathology following failed open closure.
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Affiliation(s)
| | - Iden Andacheh
- UC Riverside/Riverside Community Hospital, CA, USA.,UC Riverside School of Medicine, CA, USA
| | - Ann Yufa
- UC Riverside School of Medicine, CA, USA
| | - Harvey Nurick
- UC Riverside/Riverside Community Hospital, CA, USA.,UC Riverside School of Medicine, CA, USA
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Orimoto Y, Ishibashi H, Sugimoto I, Yamada T, Maruyama Y, Hagihara M, Ishiguchi T. A Case of Patent Ductus Arteriosus in an Elderly Patient Treated by Thoracic Endovascular Aortic Repair. Ann Vasc Dis 2016; 9:326-329. [PMID: 28018507 DOI: 10.3400/avd.cr.16-00046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/24/2016] [Indexed: 11/13/2022] Open
Abstract
The patient described herein was a 75-year-old female. Echocardiography showed patent ductus arteriosus (PDA). Heart failure symptoms gradually appeared, and she was referred to our department for treatment. Contrast-enhanced computed tomography (CT) revealed a tubular structure communicating between the aortic arch and pulmonary artery trunk, suggesting adult PDA. Thoracic endovascular aortic repair (TEVAR) was performed to close PDA. Completion angiography confirmed the disappearance of PDA. Post-TEVAR CT revealed no endoleak. The patient was discharged from the hospital on the 11th day after surgery. TEVAR is more useful and less invasive for adult PDA than conventional open surgery.
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Affiliation(s)
- Yuki Orimoto
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroyuki Ishibashi
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ikuo Sugimoto
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tetsuya Yamada
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuki Maruyama
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Makiyo Hagihara
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
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Tatsuishi W, Kataoka G, Asano R, Sato A, Nakano K. Use of a Stent Graft for Patent Ductus Arteriosus in an Octogenarian Eliminates Ductus Flow. Ann Thorac Cardiovasc Surg 2016; 22:193-5. [PMID: 26345436 DOI: 10.5761/atcs.cr.15-00217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Closure of a patent ductus arteriosus (PDA) in the elderly is a high-risk procedure because of tissue fragility and many possible complications. The patient in our case was an 81-year-old woman with a window-type PDA caused by cardiac failure. Based on the anatomy of the PDA and aorta and to minimize invasion, we used a stent graft to close the PDA. This approach was successful; hemodynamics improved and ductus flow was eliminated during the follow-up period without intervention from the pulmonary artery side.
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Affiliation(s)
- Wataru Tatsuishi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
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Successful stent graft insertion for endovascular aneurysm repair and closure of patent ductus arteriosus in an adult patient. Case Rep Cardiol 2015; 2015:317061. [PMID: 25737784 PMCID: PMC4336929 DOI: 10.1155/2015/317061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/14/2015] [Indexed: 11/17/2022] Open
Abstract
Patent ductus arteriosus (PDA) is sometimes undetected until adulthood, and surgical closure of a PDA is dangerous because of the calcification of the ductus. Percutaneous approaches such as coil embolization and use of a PDA occluder are less invasive; however, these devices are not suitable for PDA with thoracic aortic aneurysm (TAA). We present the case of a 72-year-old female patient who underwent successful stent graft insertions for PDA with TAA.
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Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure. Gen Thorac Cardiovasc Surg 2014; 64:280-2. [PMID: 25056455 DOI: 10.1007/s11748-014-0457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery.
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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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Lu H, Yan T, Wang J, Zhang W. Successful stent for a pseudoaneurysm after the patent ductus arteriosus closure procedure. Interact Cardiovasc Thorac Surg 2013; 17:1038-9. [PMID: 23966575 DOI: 10.1093/icvts/ivt339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe the case of a large pseudoaneurysm after transcatheter closure of patent ductus arteriosus in a 42-year old male who developed back pain and dyspnoea 6 months subsequent to the first procedure. The patient's pseudoaneurysm was successfully treated using Talent prostheses (Medtronic AVE, Santa Rosa, CA, USA), though the postoperative course was without incident.
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Affiliation(s)
- Hua Lu
- Department of Cardiovascular Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
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Morishita A, Tomioka H, Katahira S, Hoshino T, Hanzawa K. Simultaneous surgery for patent ductus arteriosus associated with papillary fibroelastoma. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:797-800. [PMID: 23801176 DOI: 10.5761/atcs.cr.12.02114] [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] Open
Abstract
We describe a case of patent ductus arteriosus (PDA) in a 76-year-old woman with a history of stroke, atrial fibrillation, and chronic obstructive pulmonary disease. Cranial diffusion-weighted imaging (DWI) performed for preoperative assessment showed a hyperintense lesion in the left cerebellum. Preoperative transesophageal echocardiography (TEE) demonstrated two highly mobile masses approximately 5 mm in diameter adherent to the left and non-coronary cusps of the aortic valve. We performed transpulmonary patch closure of PDA under hypothermic circulatory arrest. Subsequently, two frond-like masses were completely shaved off the cusps, preserving the native aortic leaflets. Pathological examination confirmed the diagnosis of papillary fibroelastoma (PFE). To our knowledge, this is the first report of PDA associated with PFE. Perioperative use of TEE is an effective tool for management of cardiovascular patients with suspected cardiogenic embolism.
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Affiliation(s)
- Atsushi Morishita
- The Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, Numata, Gunma, Japan
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