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Journal of the American College of... Jan 2021Since the development of balloon angioplasty and balloon-expandable endovascular stent technology in the 1970s and 1980s, percutaneous transcatheter intervention has... (Review)
Review
Since the development of balloon angioplasty and balloon-expandable endovascular stent technology in the 1970s and 1980s, percutaneous transcatheter intervention has emerged as a mainstay of therapy for congenital heart disease (CHD) lesions throughout the systemic and pulmonary vascular beds. Congenital lesions of the great vessels, including the aorta, pulmonary arteries, and patent ductus arteriosus, are each amenable to transcatheter intervention throughout the lifespan, from neonate to adult. In many cases, on-label devices now exist to facilitate these therapies. In this review, we seek to describe the contemporary approach to and outcomes from transcatheter management of major CHD lesions of the great vessels, with a focus on coarctation of the aorta, single- or multiple-branch pulmonary artery stenoses, and persistent patent ductus arteriosus. We further comment on the future of transcatheter therapies for these CHD lesions.
Topics: Angiography; Angioplasty, Balloon; Aortic Coarctation; Aortography; Ductus Arteriosus, Patent; Humans; Stenosis, Pulmonary Artery; Stents
PubMed: 33413945
DOI: 10.1016/j.jacc.2020.11.019 -
The Journal of Thoracic and... Nov 2018
Topics: Acetaminophen; Ductus Arteriosus, Patent; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Ligation
PubMed: 30119903
DOI: 10.1016/j.jtcvs.2018.06.073 -
Brazilian Journal of Cardiovascular... Mar 2022Although technically simple, surgical correction of patent ductus arteriosus can have serious complications. In this context, acute ventricular failure must be...
Although technically simple, surgical correction of patent ductus arteriosus can have serious complications. In this context, acute ventricular failure must be remembered, as its prompt diagnosis and proper management can change clinical outcomes.
Topics: Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Heart Ventricles; Humans; Ligation; Syndrome
PubMed: 35274523
DOI: 10.21470/1678-9741-2020-0278 -
Taiwanese Journal of Obstetrics &... May 2021To evaluate the association between intrauterine growth restriction (IUGR) and the incidence of fetuses with patent ductus arteriosus (PDA) and Hemodynamically... (Observational Study)
Observational Study
OBJECTIVE
To evaluate the association between intrauterine growth restriction (IUGR) and the incidence of fetuses with patent ductus arteriosus (PDA) and Hemodynamically significant PDA (Hs-PDA) in dichorionic twins (DC) with selective IUGR.
MATERIALS AND METHODS
This is an observational cohort study and retrospective case assessment, involved twins born at Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan between 2013 and 2018. DC twins with selective IUGR (sIUGR) were defined as the presence of a birth weight discordance of >25% and a smaller twin with a birth weight below the tenth percentile. PDA was diagnosed using echocardiography between postnatal day 3 and 7. Hs-PDA was defined as PDA plus increased pulmonary circulation, poor systemic perfusion, cardiomegaly, pulmonary edema, or hypotension requiring pharmacotherapeutic intervention.
RESULT
A total of 1187 twins were delivered during the study period, and 53 DC twins with selective IUGR were included in this study. DC twins with PDA have higher rate of preterm birth, lower gestational age of delivery, and lower mean birth weight of both twins compared with DC twins without PDA. In a comparison of the sIUGR twin with the appropriate for gestational age co-twin, both the incidences of PDA (28.30% vs. 7.55%, respectively; P = 0.003) and Hs-PDA (24.53% vs. 5.66%, respectively; P = 0.002) were higher in sIUGR fetuses than in the appropriate for gestational age co-twins. Small gestational age of delivery was the only variable to predict PDA and Hs-PDA [p = 0.002, Odds ratio = 0.57 (0.39-0.82), p = 0.009, Odds ratio = 0.71 (0.55-0.92), respectively].
CONCLUSION
An analysis of dichorionic twins with sIUGR indicated that IUGR increased the risk of PDA and hemodynamically significant PDA.
Topics: Adult; Birth Weight; Diseases in Twins; Ductus Arteriosus, Patent; Echocardiography; Female; Fetal Growth Retardation; Gestational Age; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Small for Gestational Age; Odds Ratio; Pregnancy; Pregnancy, Twin; Premature Birth; Retrospective Studies; Taiwan; Twins, Dizygotic
PubMed: 33966739
DOI: 10.1016/j.tjog.2021.03.023 -
Journal of Perinatology : Official... Jun 2021Investigate relationship between management of patent ductus arteriosus (PDA) and acute kidney injury (AKI) in very low birthweight neonates.
OBJECTIVE
Investigate relationship between management of patent ductus arteriosus (PDA) and acute kidney injury (AKI) in very low birthweight neonates.
STUDY DESIGN
Retrospective cohort study of neonates, <1500 g, admitted to 24 NICUs, 1/1/14 - 3/31/14. AKI diagnosed using the neonatal modified KDIGO definition; diagnosis and treatment of PDA extracted from the medical record. Demographics, clinical characteristics, and AKI stage compared using chi-square and analysis of variance. A general estimating equation logistic regression used to estimate adjusted odds ratios.
RESULTS
Of 526 neonates with sufficient data to diagnose AKI, 157 (30%) had PDA (61 conservative management, 62 pharmacologic treatment only, 34 surgical ligation). In analyses adjusted for sex, birthweight, gestational age, caffeine, nephrotoxin exposure, vasopressor and mechanical ventilation use, with conservative management as reference, there were no differences among treatment cohorts in the odds of AKI.
CONCLUSION
The underlying physiology of PDA, not management strategy, may determine the likelihood of AKI in neonates <1500 g.
Topics: Acute Kidney Injury; Ductus Arteriosus, Patent; Humans; Retrospective Studies
PubMed: 33875795
DOI: 10.1038/s41372-021-01054-1 -
Medicine Aug 2022This study aimed to evaluate the short-term morbidities and efficacy of single-dose prophylactic intravenous ibuprofen for patent ductus arteriosus (PDA) on the first...
This study aimed to evaluate the short-term morbidities and efficacy of single-dose prophylactic intravenous ibuprofen for patent ductus arteriosus (PDA) on the first day of life in preterm infants. Data of 69 preterm infants with birth weight < 1250 g and gestational age < 30 weeks admitted to the neonatal intensive care unit were analyzed. Of these, 37 infants were assigned to the prophylactic treatment (PT) group and 32 were assigned to the nonprophylactic treatment (non-PT) group. Only the PT group administered intravenous ibuprofen (10 mg/kg) once within 6 hours after birth. Until postnatal day 7, ductal closure occurred in 11 (34.4%) infants in the non-PT group, and in 35 (94.6%) infants in the PT group, of which 30 (81.1%) infants had ductal closure on postnatal day 1. There were 2 (5.4%) infants in the PT group and 9 (28.1%) in the non-PT group who needed ibuprofen treatment due to moderate-to-large PDA after postnatal day 7. Preterm infants in the PT group were less likely to develop an intraventricular hemorrhage (≥grade 2) (adjusted odds ratio 0.007, 95% confidence interval 0.01-0.45), had a shorter duration of invasive ventilatory support and central venous catheter, and earlier postnatal age to achieve feeding of 50 and 100 mL/kg/day compared with those in the non-PT group. Single-dose prophylactic intravenous ibuprofen on the first day of life decreased the occurrence of a persistent PDA and intraventricular hemorrhage (≥grade 2), and reduced the duration of invasive ventilatory support, central venous catheter use, and hospital stay.
Topics: Cerebral Hemorrhage; Ductus Arteriosus, Patent; Humans; Ibuprofen; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight
PubMed: 35945745
DOI: 10.1097/MD.0000000000029915 -
International Journal of Molecular... Nov 2022Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal... (Review)
Review
Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal infections and the inflammation process can contribute to PDA, and intrauterine inflammation is a known risk factor of PDA. A variety of inflammatory biomarkers have been reported to be associated with PDA. Chorioamnionitis induces the fetal inflammatory process via several cytokines that have been reported to be associated with the presence of PDA and may have a role in the vascular remodeling process or vessel dilation of the ductus. On the other hand, anti-inflammatory agents, such as antenatal steroids, decrease PDA incidence and severity in patients born to those with chorioamnionitis. Proinflammatory cytokines, which are expressed more significantly in preterm neonates and chorioamnionitis, are associated with the presence of PDA. In this review, we focus on the pathogenesis of PDA in preterm infants and the role of biomarkers associated with the perinatal inflammatory process.
Topics: Infant; Humans; Infant, Newborn; Female; Pregnancy; Ductus Arteriosus, Patent; Infant, Premature; Chorioamnionitis; Infant, Premature, Diseases; Biomarkers; Inflammation; Cytokines
PubMed: 36430355
DOI: 10.3390/ijms232213877 -
BMC Cardiovascular Disorders May 2022The percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic...
BACKGROUND
The percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic inflammatory markers' levels after PDA in children are not fully reported.
METHODS
We have conducted a retrospective analysis of the medical records of 385 pediatric patients in our hospital from January 2017 to December 2019. The patients were distributed into five groups. The first four (A, B, C and D) included patients divided by the type of the surgical closure methods, namely ligation, clamping, ligation-combined suturing and ligation-combined clamping, respectively. The fifth group E comprised of percutaneous device PDA patients. All recorded medical and trial data from the five groups were statistically studied.
RESULTS
No serious complications in the patients regardless of the classification group were reported. Our results suggested that there were no considerable differences between the groups at the baseline (with all P > 0.05). Group E demonstrated a significantly smaller operative time (42.39 ± 3.88, min) and length of hospital stay (LOS) (4.49 ± 0.50, day), less intraoperative blood loss (7.12 ± 2.09, ml) while on the other hand, a higher total hospital cost (24,001.35 ± 1152.80, RMB) than the other four groups (with all P < 0.001). Interestingly, the comparison of the inflammatory factors such as white blood cells (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), as well as the myocardial injury markers (CKMB and troponin I) did not show a significant increase (P > 0.05) among the four groups. On the contrary, when the aforementioned factors and markers of all the surgical groups were compared to those in group E, we observed significantly higher speed and magnitude of changes in group E than those in groups A, B, C, and D (with all P < 0.001).
CONCLUSION
Although the percutaneous device closure of PDA is more comforting and drives fast recuperation in comparison to conventional surgery, it provokes myocardial injury and overall inflammation. Timely substantial and aggressive intervention measures such as the use of antibiotics before operation and active glucocorticoids to suppress inflammation and nourish the myocardium need be applied if the myocardial and inflammatory markers are eminent.
Topics: Cardiac Catheterization; Child; Ductus Arteriosus, Patent; Heart Injuries; Humans; Infant, Newborn; Infant, Premature; Inflammation; Ligation; Retrospective Studies; Treatment Outcome
PubMed: 35585489
DOI: 10.1186/s12872-022-02666-x -
BMC Cardiovascular Disorders Dec 2020Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidences of...
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.
Topics: Adult; Antihypertensive Agents; Arterial Pressure; Cardiac Catheterization; Combined Modality Therapy; Drug Therapy, Combination; Ductus Arteriosus, Patent; Eisenmenger Complex; Female; Humans; Male; Pulmonary Artery; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome; Vasodilator Agents; Young Adult
PubMed: 33261574
DOI: 10.1186/s12872-020-01795-5 -
Jornal de Pediatria 2020
Topics: Conservative Treatment; Ductus Arteriosus, Patent; Habits; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases
PubMed: 30550757
DOI: 10.1016/j.jped.2018.12.003