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Journal of Veterinary Internal Medicine 2012A comparison of transvascular occlusion methods for closing patent ductus arteriosus (PDA) in dogs has not been done. (Comparative Study)
Comparative Study
BACKGROUND
A comparison of transvascular occlusion methods for closing patent ductus arteriosus (PDA) in dogs has not been done.
OBJECTIVES
To determine if clinically important differences exist between the approaches and devices currently used.
ANIMALS
A total of 112 client-owned dogs with left-to-right shunting PDA.
METHODS
Retrospective study. Records from dogs that underwent attempted transvascular PDA occlusion from January 2006 to December 2009 were examined. Dogs were placed into 4 groups: Group 1: Amplatz Canine Duct Occluder (ACDO) (transarterial) - 36 dogs; Group 2: Gianturco or MReye Flipper Detachable Embolization (Flipper) coil (transarterial) - 38 dogs; Group 3: Amplatzer Vascular Plug (AVP) (transarterial) - 23 dogs; Group 4: Flipper coil (transvenous) - 15 dogs.
RESULTS
The overall success rate of the procedures was high (92%) with comparable success rates among groups (87-97%). There were significantly fewer complications (P < .0001) in dogs receiving an ACDO than in the remaining groups (3% for ACDO versus 26-33% for the other groups). Fluoroscopy time for the transvenous method was significantly longer (median, 13 minutes) than for the other groups (median, 6 minutes) (P < .0001). Severity of residual flow 24 hours postprocedure was significantly less in the ACDO group than in the remaining groups (P = .0001-.05).
CONCLUSIONS
The ACDO appears superior in ease of use, complication rate, and completeness of occlusion. The remaining limiting factor with this device is patient size. Until a smaller ACDO device is marketed, coils remain the only choice for interventional closure in very small dogs.
Topics: Animals; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Embolization, Therapeutic; Female; Male; Retrospective Studies; Statistics, Nonparametric; Treatment Outcome
PubMed: 22211471
DOI: 10.1111/j.1939-1676.2011.00859.x -
Anatolian Journal of Cardiology Apr 2018To report clinical and procedural characteristics of twelve patients who received a covered stent for the treatment of aortic coarctation and concurrent patent ductus...
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.
Topics: Adolescent; Adult; Aortic Coarctation; Child; Coronary Angiography; Databases, Factual; Drug-Eluting Stents; Ductus Arteriosus, Patent; Female; Humans; Male; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 29578201
DOI: 10.14744/AnatolJCardiol.2018.61257 -
PloS One 2013Patent ductus arteriosus is a life-threatening condition frequent in premature newborns but also present in some term infants. Current mouse models of this malformation...
Patent ductus arteriosus is a life-threatening condition frequent in premature newborns but also present in some term infants. Current mouse models of this malformation generally lead to perinatal death, not reproducing the full phenotypic spectrum in humans, in whom genetic inheritance appears complex. The ductus arteriosus (DA), a temporary fetal vessel that bypasses the lungs by shunting the aortic arch to the pulmonary artery, is constituted by smooth muscle cells of distinct origins (SMC1 and SMC2) and many fewer melanocytes. To understand novel mechanisms preventing DA closure at birth, we evaluated the importance of cell fate specification in SMC that form the DA during embryonic development. Upon specific Tyr::Cre-driven activation of Wnt/β-catenin signaling at the time of cell fate specification, melanocytes replaced the SMC2 population of the DA, suggesting that SMC2 and melanocytes have a common precursor. The number of SMC1 in the DA remained similar to that in controls, but insufficient to allow full DA closure at birth. Thus, there was no cellular compensation by SMC1 for the loss of SMC2. Mice in which only melanocytes were genetically ablated after specification from their potential common precursor with SMC2, demonstrated that differentiated melanocytes themselves do not affect DA closure. Loss of the SMC2 population, independent of the presence of melanocytes, is therefore a cause of patent ductus arteriosus and premature death in the first months of life. Our results indicate that patent ductus arteriosus can result from the insufficient differentiation, proliferation, or contractility of a specific smooth muscle subpopulation that shares a common neural crest precursor with cardiovascular melanocytes.
Topics: Animals; Cell Differentiation; Cell Lineage; Cell Proliferation; Ductus Arteriosus, Patent; Embryonic Development; Female; Humans; Melanocytes; Mice; Muscle Contraction; Myocytes, Smooth Muscle; Pregnancy; Premature Birth; Wnt Signaling Pathway
PubMed: 23382837
DOI: 10.1371/journal.pone.0053183 -
Journal of Veterinary Internal Medicine 2014Published information regarding survival and long-term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited.
BACKGROUND
Published information regarding survival and long-term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited.
OBJECTIVES
To report outcome and identify prognostic variables in dogs with PDA, and to identify risk factors for persistent remodeling in dogs with a minimum of 12 months of follow-up after closure.
ANIMALS
Five hundred and twenty client-owned dogs.
METHODS
Retrospective review of medical records of 520 dogs with PDA. Outcome was determined by contacting owners and veterinarians. Dogs with PDA closure and ≥ 12 months of follow-up were asked to return for a re-evaluation.
RESULTS
In multivariable analysis of 506 dogs not euthanized at the time of diagnosis, not having a PDA closure procedure negatively affected survival (HzR = 16.9, P < .001). In 444 dogs undergoing successful PDA closure, clinical signs at presentation (HzR = 17, P = .02), concurrent congenital heart disease (HD) (HzR = 4.8, P = .038), and severe mitral regurgitation (MR) documented within 24 hours of closure (HzR = 4.5, P = .028) negatively affected survival. Seventy-one dogs with ≥ 12 months follow-up demonstrated a significant reduction in radiographic and echocardiographic measures of heart size (P = 0) and increased incidence of acquired HD (P = .001) at re-evaluation. Dogs with increased left ventricular size and low fractional shortening at baseline were more likely to have persistent remodeling at re-evaluation.
CONCLUSIONS AND CLINICAL IMPORTANCE
Patent ductus arteriosus closure confers important survival benefits and results in long-term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital HD, and severe MR negatively affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling.
Topics: Animals; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Female; Male; Prognosis; Risk Factors; Survival Analysis; Ventricular Remodeling
PubMed: 24372855
DOI: 10.1111/jvim.12267 -
Open Veterinary Journal 2021The Branham sign is a baroreceptor response that follows patent ductus arteriosus (PDA) closure. Although described in dogs following both interventional and surgical...
BACKGROUND
The Branham sign is a baroreceptor response that follows patent ductus arteriosus (PDA) closure. Although described in dogs following both interventional and surgical ductal closure, a direct comparison of the Branham sign elicited by these two techniques has not been made.
AIM
Since closure with an Amplatz canine ductal occluder (ACDO) occurs over 10 minutes and surgical ligation (SL) is more rapid, we hypothesized that the Branham sign following occlusion of a PDA with an ACDO would be less severe than following SL.
METHODS
Clinical records of dogs diagnosed with left-to-right shunting PDA between 2008 and 2018 were retrospectively reviewed. Of 139 dogs undergoing PDA occlusion, only 41 dogs (ACDO = 32, SL = 9) were included after applying exclusion criteria. Heart rate (HR) and blood pressure (BP) from occlusion time ( ) until 30 minutes post occlusion ( ) were recorded. Signalment and anesthetic protocol were also recorded. The influence of age and weight on the hemodynamic variations was assessed. Hemodynamic variables and calculations were compared between and within groups using a repeated measures general linear model, and tests were applied if significance was identified.
RESULTS
A mild Branham sign was present in both groups, and hemodynamic changes were not significantly different between groups. In both groups, there was a significant decrease in HR (11 bpm, 5.3-16.3; < 0.001) (10.4%, 5.4-15.5; < 0.001) and increase in diastolic BP (9.5 mmHg, 3-16; = 0.002) (23.5%, 7.1-39.9; = 0.002), but systolic BP did not change significantly ( = 0.824). Age and weight did not influence Branham sign.
CONCLUSION
The Branham sign in dogs is mild in both groups, lasts for at least 30 minutes, and is independent of the method of PDA closure.
Topics: Animals; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Heart Rate; Retrospective Studies
PubMed: 35070855
DOI: 10.5455/OVJ.2021.v11.i4.10 -
The Journal of Thoracic and... Dec 2013The purpose of this study was to evaluate the hemodynamic changes in left ventricular function before and after patent ductus arteriosus ligation in premature infants...
OBJECTIVE
The purpose of this study was to evaluate the hemodynamic changes in left ventricular function before and after patent ductus arteriosus ligation in premature infants with regard to the energetic efficiency of left ventricular pumping.
METHODS
Thirty-five premature infants who underwent patent ductus arteriosus ligation were enrolled in this study. Left ventricular efficiency was evaluated at 4 points: within 24 hours before patent ductus arteriosus ligation, within 24 hours after patent ductus arteriosus ligation, between postoperative days 2 and 4, and on postoperative day 7. The indices of contractility (end-systolic elastance) and afterload (effective arterial elastance) were approximated on the basis of the systemic blood pressure and systolic or diastolic left ventricular volume. The ratio of stroke work and pressure-volume area, representing the ventricular efficiency, was estimated using the following theoretic formula: the ratio of stroke work and pressure-volume area = 1/(1 + 0.5 ventriculoarterial coupling).
RESULTS
Left ventricular efficiency was transiently deteriorated within 24 hours after patent ductus arteriosus ligation because of the marked increase of the afterload and the slight increase of contraction, and then recovered to preoperation levels by 2 to 4 days after patent ductus arteriosus ligation.
CONCLUSIONS
Analysis of indices representing the afterload, contractility, and energetic efficiency of the left ventricle may provide practical information for the management of premature infants during the postoperative period after patent ductus arteriosus ligation.
Topics: Analysis of Variance; Blood Pressure; Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Female; Gestational Age; Hemodynamics; Humans; Infant, Newborn; Infant, Premature; Ligation; Male; Models, Cardiovascular; Myocardial Contraction; Recovery of Function; Retrospective Studies; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
PubMed: 23473013
DOI: 10.1016/j.jtcvs.2013.02.019 -
Indian Heart Journal 2020Transcatheter closure is the first-choice strategy for the management of appropriate patients with patent ductus arteriosus (PDA). The management of large PDAs is...
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.
Topics: Adolescent; Cardiac Catheterization; Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Equipment Design; Female; Follow-Up Studies; Humans; Male; Retrospective Studies; Septal Occluder Device; Treatment Outcome
PubMed: 32534682
DOI: 10.1016/j.ihj.2020.03.009 -
Pediatric Research Sep 2014We evaluated the clinical effectiveness of variable courses of paracetamol on patent ductus arteriosus (PDA) closure and examined its effect on the in vitro term and... (Comparative Study)
Comparative Study
BACKGROUND
We evaluated the clinical effectiveness of variable courses of paracetamol on patent ductus arteriosus (PDA) closure and examined its effect on the in vitro term and preterm murine ductus arteriosus (DA).
METHODS
Neonates received one of the following three paracetamol regimens: short course of oral paracetamol (SCOP), long course of oral paracetamol (LCOP), and intravenous paracetamol (IVP) for 2-6 d. Pressure myography was used to examine changes in vasomotor tone of the preterm and term mouse DA in response to paracetamol or indomethacin. Their effect on prostaglandin synthesis by DA explants was measured by mass spectroscopy.
RESULTS
Twenty-one preterm infants were included. No changes in PDA hemodynamics were seen in SCOP infants (n = 5). The PDA became less significant and eventually closed in six LCOP infants (n = 7). PDA closure was achieved in eight IVP infants (n = 9). On pressure myograph, paracetamol induced a concentration-dependent constriction of the term mouse DA, up to 30% of baseline (P < 0.01), but required >1 µmol/l. Indomethacin induced greater DA constriction and suppression of prostaglandin synthesis (P < 0.05).
CONCLUSION
The clinical efficacy of paracetamol on PDA closure may depend on the duration of treatment and the mode of administration. Paracetamol is less potent than indomethacin for constriction of the mouse DA in vitro.
Topics: Acetaminophen; Administration, Intravenous; Administration, Oral; Animals; Blood Pressure; Cyclooxygenase Inhibitors; Dose-Response Relationship, Drug; Drug Administration Schedule; Ductus Arteriosus; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Ligation; Prostaglandin Antagonists; Retrospective Studies; Time Factors; Treatment Outcome; Vasoconstriction; Vasoconstrictor Agents
PubMed: 24941212
DOI: 10.1038/pr.2014.82 -
Anales de Pediatria (Barcelona, Spain :... Jun 2017Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent... (Observational Study)
Observational Study
INTRODUCTION
Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of hemodynamic overload in PDA.
PAIENTS AND METHODS
A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 grams. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics.
RESULTS
Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA. Higher values of proBNP were found in patients with HS-PDA (33338±34494.47pg/mL; p=.000) compared with patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30596.8±14910.9; p=.004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68±24.69% vs -12.22±99.4%; p=.030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5pg/mL (Specificity: 100%, Sensitivity: 94.6%).
CONCLUSIONS
ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA.
Topics: Ductus Arteriosus, Patent; Female; Hemodynamics; Humans; Infant, Newborn; Infant, Premature; Male; Natriuretic Peptide, Brain; Protein Precursors; Retrospective Studies; Sensitivity and Specificity
PubMed: 26936584
DOI: 10.1016/j.anpedi.2016.01.007 -
Journal of the American College of... Jul 2004This study was designed to assess the safety, efficacy, medium-term outcome, and complications of patent ductus arteriosus (PDA) stenting in duct-dependent pulmonary...
OBJECTIVES
This study was designed to assess the safety, efficacy, medium-term outcome, and complications of patent ductus arteriosus (PDA) stenting in duct-dependent pulmonary circulation.
BACKGROUND
Patent ductus arteriosus stenting has been proposed as an alternative to surgical shunt on account of postoperative morbidity and complications of surgical shunting.
METHODS
Between April 2000 and February 2003, 69 patients with duct-dependent pulmonary circulation underwent cardiac catheterization with the intent of PDA stenting as first palliative procedure. Patients with critical pulmonary stenosis and pulmonary atresia with intact ventricular septum post-radiofrequency valvotomy who had PDA stenting were excluded. Thirteen more patients were excluded because of branch pulmonary artery (PA) stenosis. The follow-up was by clinical examination, echocardiography, and repeat cardiac catheterization at six to nine months following the procedure.
RESULTS
Patent ductus arteriosus stenting was successful in 51 patients (91.1%) and failed in 5 patients (8.9%). The mean narrowest PDA diameter was 1.9 +/- 0.6 mm. The mean procedure and fluoroscopy time were 95.7 min and 29.4 min, respectively. In one patient the stent dislodged and migrated to the left femoral artery and another patient developed transient intravascular hemolysis. There was no procedure-related mortality. Three patients (5.9%) died one day to two months after the procedure. At follow-up (3.2 months to 2.4 years), 8 patients developed significant stent stenosis requiring reintervention. Seven patients developed worsening of preexisting branch PA stenosis. The freedom from reintervention was 89% and 55% at 6 months and 1 year, respectively.
CONCLUSIONS
Patent ductus arteriosus stenting is an attractive alternative to surgical shunt in a majority of patients with duct-dependent circulation. An absolute contraindication to this technique is the presence of branch pulmonary stenosis.
Topics: Child, Preschool; Ductus Arteriosus; Ductus Arteriosus, Patent; Follow-Up Studies; Humans; Infant; Infant, Newborn; Pulmonary Circulation; Radiography; Stents
PubMed: 15261945
DOI: 10.1016/j.jacc.2004.03.066