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Catheterization and Cardiovascular... May 2024Transcatheter closure of the patent ductus arteriosus (PDA) in premature infants is currently dependent on fluoroscopic guidance and transportation to the...
BACKGROUND
Transcatheter closure of the patent ductus arteriosus (PDA) in premature infants is currently dependent on fluoroscopic guidance and transportation to the catheterization laboratory.
AIM
We describe a new echocardiographically guided technique to allow our team to move to the bedside at the neonatal intensive care unit (NICU) of the referring center for percutaneous treatment of PDA in premature infants.
METHODS
This is a single-center, retrospective, primarily descriptive analysis. Clinical details about the procedure, its outcomes, and complications were collected.
RESULTS
Fifty-eight neonates with a median weight of 1110 g (range 730-2800) and postnatal age of 28 days (range 9-95) underwent percutaneous PDA closure. Five of them were treated in our center with ultrasound guidance only and the other 53 in 18 different neonatology units in 12 towns. The median duration of the procedure was 40 min (range 20-195 min). There were no procedural deaths. There was one residual shunt for 3 weeks, in all other patients the duct closed completely in the first few hours after the intervention. In one patient the procedure had to be interrupted because of a pericardial effusion which had to be drained, the PDA was closed successfully interventionally 5 days later. One device-related aortic coarctation had to be stented. One embolization and one late migration occurred and required treatment.
CONCLUSIONS
Echocardiographically guided transcatheter closure of the PDA in prematures was repeatedly possible and allowed that the procedure is performed at the bedside at the NICU with an acceptable rate of complications.
Topics: Humans; Ductus Arteriosus, Patent; Infant, Newborn; Retrospective Studies; Cardiac Catheterization; Treatment Outcome; Ultrasonography, Interventional; Gestational Age; Predictive Value of Tests; Male; Female; Time Factors; Severity of Illness Index; Infant, Premature; Infant, Extremely Premature; Intensive Care Units, Neonatal; Point-of-Care Systems; Point-of-Care Testing; Septal Occluder Device; Infant
PubMed: 38584522
DOI: 10.1002/ccd.31046 -
Arquivos Brasileiros de Cardiologia Mar 2022It is important which medicine to use as a first-line treatment to close the duct.
BACKGROUND
It is important which medicine to use as a first-line treatment to close the duct.
OBJECTIVES
The aim of this study is to compare the effectiveness and side effects of intravenous (IV) forms of ibuprofen and paracetamol and to contribute to the literature investigating the first drug selected in the medical treatment of patent ductus arteriosus (PDA).
METHODS
Our study was conducted between January 2017 and December 2019. Premature infants with birth weight (BW) ≤1500 g and gestational age (GA) ≤32 weeks were included in the study. In the study period, all infants with hemodynamically significant patent ductus arteriosus (hsPDA) were given rescue intravenous (IV) ibuprofen as a primary medical treatment or IV paracetamol treatment if there were contraindications for ibuprofen. The patients were divided into two groups: patients receiving IV ibuprofen and patients receiving IV paracetamol.
RESULTS
Of these patients, 101 were given IV paracetamol and 169 were given IV ibuprofen. The success rate of PDA closure with first-course treatment was 74.3% in the IV paracetamol group and 72.8% in the IV ibuprofen group (p=0.212).
CONCLUSIONS
Our results show that IV paracetamol is as effective as IV ibuprofen in the first-line treatment of hsPDA, and can become the preferred treatment for the management of hsPDA.
Topics: Acetaminophen; Ductus Arteriosus, Patent; Humans; Ibuprofen; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature
PubMed: 35137787
DOI: 10.36660/abc.20201361 -
Cardiology in the Young Jan 2024In this multi-centre study, the mid- to long-term efficacy and safety of the Amplatzer Piccolo Occluder in patent ductus arteriosus closure in premature and term infants...
In this multi-centre study, the mid- to long-term efficacy and safety of the Amplatzer Piccolo Occluder in patent ductus arteriosus closure in premature and term infants as well as children were discussed. Methods. Between 2016 and 2021, 645 patients, 152 of whom were less than 1 month old, underwent ductus closure with the Piccolo device from five different centres in Turkey. The median age of the patients was 2.2 years, and the mean narrowest point of duct diameter was 1.8 mm. Sixty-two patients weighed ≤ 1.5 kg, 90 patients 1.5-3 kg, and the mean follow-up was 20.4 months. In 396, the duct was closed by the retrograde route. Ductal anatomy was Type A in 285, C in 72, E in 171, and F in 64 patients. Fluoroscopy duration was 6.2 min. The procedure success rate was 99.1%. Device embolisation occurred in 13 patients (2%), and 11 were retrieved with a snare. Cardiac perforation and death developed in one premature baby. The left pulmonary artery and the descending aorta stenosis were observed in 3 (0.4%) and in 5 patients (0.5%). Results. Piccolo device is safe and effective in closing ductus in all age groups. It has low profile for use in premature and newborn babies, a small embolisation risk, and a low residual shunt rate after closure. Conclusion. The Piccolo device can be considered as close an ideal occluder. The lower profile, smaller delivery catheter size, and symmetry of this device allow for a venous or arterial approach.
Topics: Child; Infant; Infant, Newborn; Female; Humans; Adolescent; Child, Preschool; Treatment Outcome; Ductus Arteriosus, Patent; Cardiac Catheterization; Infant, Premature; Septal Occluder Device; Premature Birth
PubMed: 37283091
DOI: 10.1017/S1047951123001385 -
Heliyon Jul 2023The aim of our study is to describe the various anesthetic techniques and intraoperative management used during transcatheter closure of hemodynamically significant PDAs...
Perioperative anesthetic management of premature neonates weighing less than 1500 grams undergoing transcatheter PDA (TC-PDA) closure: An institutional anesthetic experience.
OBJECTIVES
The aim of our study is to describe the various anesthetic techniques and intraoperative management used during transcatheter closure of hemodynamically significant PDAs in VLBW premature infants weighing less than 1.5 kg and their potential impact on postoperative outcomes using a retrospective chart review.
DESIGN
A retrospective electronic medical chart review was performed in infants who underwent Transcatheter Patent Ductus Arteriosus (TC-PDA) closure at an academic institution between January 1, 2008 and October 4th 2019. Only premature patients with isolated PDA weighing less than 1500 g at the time of the procedure were included in the study.
SETTING
Single Institutional Hospital.
PARTICIPANTS
Premature patients with isolated PDA weighing less than 1500 g at the time of the procedure.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Interprocedurally, there was no evidence of device embolization or clinically significant vascular obstruction on follow-up echocardiography, and inotropic or vasoactive infusions were not required. All patients survived and were discharged from the hospital after a mean of 86.4 ± 48.49 days (median 74, range 40-180) following initial admission to the NICU. At 7 post-operative days, freedom from ventilatory support reached 70% in all patients. Incidences of device embolization or clinically significant vascular obstruction were not noted on follow-up echocardiography.
CONCLUSIONS
Though our preliminary findings show promising outcomes following TC-PDA closure relative to traditional surgical approaches, further investigations with higher patient volume are needed to validate these promising observations.
PubMed: 37456008
DOI: 10.1016/j.heliyon.2023.e17465 -
European Journal of Pediatrics May 2024Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome... (Comparative Study)
Comparative Study
Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study.
Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24 h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000 g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2 weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.
Topics: Humans; Ductus Arteriosus, Patent; Retrospective Studies; Infant, Newborn; Female; Ligation; Male; Cardiac Catheterization; Infant, Premature; Postoperative Complications; Infant, Low Birth Weight; Incidence; Cardiac Surgical Procedures; Syndrome; Propensity Score; Septal Occluder Device; Risk Factors; Infant, Premature, Diseases
PubMed: 38381375
DOI: 10.1007/s00431-024-05481-y -
Prevention Science : the Official... Apr 2021Mentoring programs are a popular approach to preventing problem behavior and promoting positive youth development. However, mentoring relationships that end prematurely...
Mentoring programs are a popular approach to preventing problem behavior and promoting positive youth development. However, mentoring relationships that end prematurely may have negative consequences for youth. Previous research has investigated match-level indicators of premature match closure, highlighting possible individual mentor- or mentee-level characteristics that might influence the match staying together. However, less work has investigated the importance of program-level variables in match retention. Mentor training and support may be one key modifiable program-level feature that could curtail the risk of premature match closure. In this study, we used data from a national survey of youth mentoring programs (N = 1451) to examine training and other potential predictors of premature match closures (Garringer et al. 2017). We used a Bayesian Additive Regression Trees (BART) model to predict program-reported premature match closure rates from a set of four training-related variables and 26 other covariates (e.g., program size, budget, demographic composition). Findings indicate that the set of predictors explained about one-fifth of the variation in reported rate of premature match closure (cumulative pseudo R = .21), and the strongest, and only statistically significant, predictor of premature match closure was the frequency of ongoing training and support contacts per month. Overall, findings indicate that there is substantial noise in predicting program-reported premature match closure, but program-reported provision of ongoing training and support seems to emerge as a relatively stable signal in the noise.
Topics: Adolescent; Bayes Theorem; Humans; Mentoring; Mentors; Problem Behavior
PubMed: 33400133
DOI: 10.1007/s11121-020-01200-9 -
Journal of Interventional Cardiology Apr 2015Transcatheter closure of a patent ductus arteriosus (PDA) has always been considered risky for infants weighing <6 kg and preterms. We present our findings regarding...
BACKGROUND
Transcatheter closure of a patent ductus arteriosus (PDA) has always been considered risky for infants weighing <6 kg and preterms. We present our findings regarding transcatheter closures of PDA.
METHODS
The inclusion criteria were a weight of <6 kg and the presence of PDA symptoms. The study subjects were divided into two groups: <6 kg and premature infants.
RESULTS
A total of 69 infants were included. The mean ages and weights of the <6 kg and the preterms were 5.4 ± 2.7 months and 30.3 ± 19.9 days, and 4.6 ± 0.8 and 1.7 ± 0.3 kg, respectively. Type C PDAs were most frequently observed in the premature group, and type A was in <6 kg. Sixteen of the patients were premature infants, and 81.2% of them had an extremely low birth weight. All of the premature infants had comorbidities, and had been receiving respiratory support therapy. Transcatheter closure was successfully completed in 81.2% of the premature infants and 94.3% of the <6-kg infants. Major complications occurred in 4 patients (one death and three device embolizations). The patient's age was found to be the main risk factor. The most frequently used device was the Amplatzer duct occluder II in additional sizes (84.6%) in the preterms and the Amplatzer duct occluder I (34%) and II (34%) in the <6-kg group.
CONCLUSION
The transcatheter closure of PDA is relatively safe and effective in preterms and in infants <6 kg. The selection of a suitable device based on the type of PDA is critical to the success of the procedure.
Topics: Body Weight; Cardiac Catheterization; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Male; Retrospective Studies; Risk Factors; Septal Occluder Device; Treatment Outcome
PubMed: 25832591
DOI: 10.1111/joic.12196 -
The Journal of Maternal-fetal &... 2009Patency of the ductus arteriosus (PDA), a common complication of preterm birth, has been associated to increased risk for intraventricular cerebral hemorrhage,... (Review)
Review
Patency of the ductus arteriosus (PDA), a common complication of preterm birth, has been associated to increased risk for intraventricular cerebral hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and death. Consequently, prophylactic or curative treatment has been advocated before the critical left-to-right shunting occurs. A host of studies has shown that both pharmacological agents and surgical closure are effective in closing the ductus arteriosus in premature infants. Indomethacin has long been the drug of choice. However, renal and cerebral haemodynamic side effects have been frequently reported. Strategies to minimise adverse effects of indomethacin, such as the association with frusemide, dopamine or the use of low-dose prolonged treatment with indomethacin have failed or shown partial benefit. Other NSAIDs have been investigated. But either the profile of adverse effects was unfavourable, as in the case of mefenamic acid, or their efficacy was less than that of indomethacin for PDA closure. More recently, ibuprofen has been proposed for the treatment of PDA as it was shown to induce less adverse effects on cerebral blood flow, intestinal and renal hemodynamics, while retaining similar efficacy to indomethacin. However, since renal perfusion, GFR and diuresis in early neonatal life strongly depend on the vasodilator effects of PGs on the afferent glomerular arterioles, ibuprofen, as other COX-inhibitors may not be exempt of some renal undesirable effects. While numerous studies have shown that PDA is a risk factor associated with immaturity and with increased incidence of complications of preterm birth, including broncho-pulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis and death, there is little evidence that such association is causative. Moreover, still little evidence exists from even recent randomized controlled trials that the pharmacological closure of PDA benefits to premature infants in terms of clinically significant short-term or medium-term outcomes, beyond a positive effect on DA patency. The use of COX-inhibitors for the prophylaxis or closure of PDA during the first hours or days of life should thus be cautious and based on an individual evaluation of benefit and risk. There is need of a randomized, placebo-controlled trials designed to assess the benefits in terms of mortality and morbidity outcomes of an early, or even very early pharmacological closure of PDA in extremely low gestational age infants.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Ductus Arteriosus, Patent; Evidence-Based Medicine; Gestational Age; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases
PubMed: 19925358
DOI: 10.1080/14767050903198132 -
The Journal of Maternal-fetal &... 2009Low-weight premature neonates (LWPNs) frequently have haemodynamically significant patent ductus arteriosus (PDA) responsible for serious complications. Cyclooxygenase...
UNLABELLED
Low-weight premature neonates (LWPNs) frequently have haemodynamically significant patent ductus arteriosus (PDA) responsible for serious complications. Cyclooxygenase inhibitors are used for ductal closure. If the medical treatment fails, the PDA can be legated surgically. We present our experience, since 2006, on PDA surgical closure.
MATERIAL AND METHODS
From 2006 to 2009, of the 518 LWPNs, PDA was present in 109 (21%) infants. The mean gestational age was 29.1 weeks. All patients underwent a medical treatment for PDA closure. Because of the failure of medical treatment, 19 patients (17%) underwent surgical closure. The shift from medical to surgical treatment was related to clinical condition and the echocardiographic appearance of PDA. At operation, the mean age was 17 days (9-42 days). The operation was performed through a left lateral thoracotomy in third intercostal space. PDA was clipped with metallic haemoclipps.
RESULTS
No LWPN died as a result of operation (0% early mortality). Post-operative period required inotrophic and diuretic infusion and a more aggressive ventilatory management.
DISCUSSION
In LWPNs, surgical PDA closure is usually given when medical treatment fails. The shift from medical to surgical closure should be based on clinical conditions being surgical PDA closure in the neonatal intensive care unit safe and effective also in extremely LWPNs.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Retrospective Studies; Survival Analysis
PubMed: 19925366
DOI: 10.1080/14767050903195484 -
Journal of Perinatology : Official... Feb 2020To compare the incidence of post-PDA ligation syndrome after surgical vs. percutaneous closure of PDAs in very low birth weight (VLBW) infants. (Comparative Study)
Comparative Study
OBJECTIVE
To compare the incidence of post-PDA ligation syndrome after surgical vs. percutaneous closure of PDAs in very low birth weight (VLBW) infants.
STUDY DESIGN
Cohort study comparing 59 infants who underwent surgical ligation with 25 infants who underwent percutaneous closure. Comparisons between groups were made using two-sample t-tests and a Fisher's exact test. Comparisons of pre vs. post variables within each group were made using paired t-tests.
RESULTS
Patients who underwent surgical ligation had a higher need for initiation of post-procedure hemodynamic support (12/59 vs. 0/24, p = 0.016), a higher post-procedure peak FiO (0.64 vs. 0.43, p = 0.004), and a larger absolute change in peak FiO (0.23 vs. 0.09, p = 0.008).
CONCLUSION
VLBW infants who had percutaneous closure of their PDA did not experience post ligation syndrome and had less escalation of respiratory support compared with infants who underwent surgical ligation.
Topics: Cardiac Catheterization; Cohort Studies; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Ligation
PubMed: 31578421
DOI: 10.1038/s41372-019-0513-8