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The Journal of Thoracic and... Nov 2018
Topics: Acetaminophen; Ductus Arteriosus, Patent; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Ligation
PubMed: 30029789
DOI: 10.1016/j.jtcvs.2018.06.018 -
Revista Paulista de Pediatria : Orgao... 2020To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital.
OBJECTIVE
To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital.
METHODS
Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored.
RESULTS
There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001).
CONCLUSIONS
The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.
Topics: Acetaminophen; Ductus Arteriosus, Patent; Female; Gestational Age; Humans; Ibuprofen; Indomethacin; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Male; Premature Birth; Retrospective Studies; Tertiary Care Centers
PubMed: 33263696
DOI: 10.1590/1984-0462/2021/39/2020013 -
Scientific Reports Nov 2019This study investigated the characteristics of congenital rubella syndrome (CRS)-associated cardiac complications, particularly patent ductus arteriosus (PDA). We...
This study investigated the characteristics of congenital rubella syndrome (CRS)-associated cardiac complications, particularly patent ductus arteriosus (PDA). We reviewed the medical records of patients with CRS who were admitted to the Children's Hospital 1 in Vietnam between December 2010 and December 2012, and patients with CRS who underwent PDA transcatheter occlusion therapy at the cardiology department between December 2009 and December 2015. We compared the characteristics of PDA treated with transcatheter closure between children with CRS (CRS-PDA) and those without CRS (non-CRS-PDA) who underwent PDA transcatheter closure between July 2014 and December 2015. One-hundred-and-eight children with CRS were enrolled. Cardiac defects (99%), cataracts (72%), and hearing impairment (7%) were detected. Fifty CRS-PDA and 290 non-CRS-PDA patients were examined. CRS-PDA patients had smaller median birthweight (p < 0.001), more frequent pulmonary (p < 0.001) and aortic stenosis (p < 0.001), higher main pulmonary artery pressure, and higher aortic pressure in systole/diastole (p < 0.001 for each) than did non-CRS-PDA patients. The proportion of tubular-type PDA was higher in CRS-PDA patients (16%) than in non-CRS-PDA patients (3%) (p = 0.020). Tubular-type PDA was frequently seen in patients with CRS and accompanied by pulmonary/systemic hypertension and pulmonary/aortic stenosis; in these patients, more cautious device selection is needed for transcatheter PDA closure.
Topics: Aortic Valve Stenosis; Child, Preschool; Ductus Arteriosus, Patent; Female; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Male; Retrospective Studies; Rubella Syndrome, Congenital; Septal Occluder Device
PubMed: 31745134
DOI: 10.1038/s41598-019-52936-6 -
Anatolian Journal of Cardiology Nov 2021Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge...
BACKGROUND
Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up.
METHODS
A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed.
RESULTS
A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case.
CONCLUSIONS
Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.
Topics: Adolescent; Ductus Arteriosus, Patent; Echocardiography; Endarteritis; Humans; Pulmonary Valve; Retrospective Studies
PubMed: 34734810
DOI: 10.5152/AnatolJCardiol.2021.36156 -
Romanian Journal of Morphology and... 2022In contemporary practice, percutaneous closure of the patent ductus arteriosus (PDA) has become the procedure of choice. While the surgical ligation of ductus arteriosus...
In contemporary practice, percutaneous closure of the patent ductus arteriosus (PDA) has become the procedure of choice. While the surgical ligation of ductus arteriosus ensures an immediate and definitive obliteration of the ductus, this therapeutic option is rarely used and reserved for situations when percutaneous solution is unsuitable. In this manuscript, we summarize the clinical and intraoperative findings of consecutive adult patients referred to our Institution in an interval of 10 years for surgical treatment of PDA. A total of five cases of surgical closure for PDA were performed in our Center. Four subjects were not suitable for percutaneous closure, and one was discovered intraoperatively, during surgery for another cardiac condition. In all patients, the closure of the PDA was carried out by means of a suture with reinforced patch threads, in a double layer. The intervention was performed in total cardiopulmonary bypass and mild or moderate hypothermia, through a transpulmonary approach. Total circulatory arrest was not required, in any of the cases. The occlusive balloon technique was applied to all patients. All patients survived the intervention and did not suffer perioperative complications. Postoperative follow-up at 36 months did not show repermeabilization of the arterial duct or aneurysmal dilation of the adjacent aorta. Moreover, all patients showed postoperative improvement in the performance of the left ventricle. In adult patients with PDA and contraindication to percutaneous closure or in those who require surgical sanction for other cardiac diseases, surgical closure of the duct is safe and associated with favorable clinical evolution.
Topics: Humans; Adult; Ductus Arteriosus, Patent; Treatment Outcome
PubMed: 36808198
DOI: 10.47162/RJME.63.4.05 -
The Journal of Pediatrics Nov 2015
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Female; Humans; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Patient Discharge
PubMed: 26316368
DOI: 10.1016/j.jpeds.2015.08.023 -
Brazilian Journal of Cardiovascular... Oct 2020Patent ductus arteriosus (PDA) is a clinical condition mostly found in premature newborns. Among several medical, surgical and interventional treatment options,...
Patent ductus arteriosus (PDA) is a clinical condition mostly found in premature newborns. Among several medical, surgical and interventional treatment options, extrapleural ligation through a left minithoracotomy is recognized as a safe, efficient and less expensive technique. In fact, it requires short surgical times, grants good exposure of the duct and nearby structures (e.g., thoracic duct, left recurrent laryngeal nerve), and avoids pleural space opening and subsequent pulmonary complications in preterm patients. This approach seems ideal due to its lower costs, especially in developing countries with a high birth rate and limited resources.
Topics: Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Ligation; Pleura; Thoracotomy
PubMed: 33118750
DOI: 10.21470/1678-9741-2019-0473 -
JACC. Cardiovascular Interventions Jun 2016
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Septal Occluder Device
PubMed: 27339847
DOI: 10.1016/j.jcin.2016.05.022 -
Diagnostic and Interventional Imaging Mar 2023
Topics: Humans; Ductus Arteriosus, Patent; Pulmonary Artery; Aneurysm; Vascular System Injuries; Ductus Arteriosus
PubMed: 36641245
DOI: 10.1016/j.diii.2023.01.001 -
Journal of the American Heart... Jul 2022Background In patients with ductal-dependent pulmonary blood flow, initial palliation includes catheter-based patent ductus arteriosus (PDA) stent or surgical... (Meta-Analysis)
Meta-Analysis Review
Patent Ductus Arteriosus Stent Versus Surgical Aortopulmonary Shunt for Initial Palliation of Cyanotic Congenital Heart Disease with Ductal-Dependent Pulmonary Blood Flow: A Systematic Review and Meta-Analysis.
Background In patients with ductal-dependent pulmonary blood flow, initial palliation includes catheter-based patent ductus arteriosus (PDA) stent or surgical aortopulmonary shunt (APS). This meta-analysis aimed to compare outcomes between PDA stent and APS. Methods and Results A comprehensive literature search yielded six retrospective observational studies. Pooled adjusted hazard ratios (HR) were included to control for covariates and assess time to event analysis. Of 757 patients, 243 (32.1%) underwent PDA stent and 514 (67.9%) underwent APS. Pulmonary atresia with intact ventricular septum and expected biventricular repair were more common with PDA stent compared with APS (39.6% versus 21.2%, <0.001 and 57.9% versus 46.6%, =0.007, respectively). There was no statistically significant difference in mortality between PDA stent and APS (HR, 0.71; [95% CI, 0.26-1.93]; =0.50). PDA stent was associated with lower risk of postprocedural complications (odds ratio [OR], 0.45; [95% CI, 0.25-0.81]; =0.008), mechanical circulatory support (OR, 0.27; [95% CI, 0.09-0.79]; =0.02), and shorter intensive care unit length of stay (-4.03 days; [95% CI, -5.99 to -2.07]; <0.001), hospital length of stay (-5.54 days; [95% CI, -9.20 to -1.88]; =0.003), and duration of mechanical ventilation (-3.41 days; [95% CI, -5.29 to -1.52]; <0.001). There was no difference in pulmonary artery growth or hazard of unplanned reintereventions. Conclusions PDA stent has a similar hazard of mortality compared with APS. Benefits to PDA stent include shorter duration of mechanical ventilation, shorter hospital length of stay, and fewer complications. Differences in patient characteristics exist with more patients with pulmonary atresia with intact ventricular septum and expected biventricular repair undergoing PDA stent.
Topics: Cardiac Catheterization; Cyanosis; Ductus Arteriosus, Patent; Heart Defects, Congenital; Humans; Hypoxia; Pulmonary Atresia; Pulmonary Circulation; Retrospective Studies; Stents; Treatment Outcome
PubMed: 35766251
DOI: 10.1161/JAHA.121.024721