-
Orphanet Journal of Rare Diseases Jul 2009Patent arterial duct (PAD) is a congenital heart abnormality defined as persistent patency in term infants older than three months. Isolated PAD is found in around 1 in... (Review)
Review
Patent arterial duct (PAD) is a congenital heart abnormality defined as persistent patency in term infants older than three months. Isolated PAD is found in around 1 in 2000 full term infants. A higher prevalence is found in preterm infants, especially those with low birth weight. The female to male ratio is 2:1. Most patients are asymptomatic when the duct is small. With a moderate-to-large duct, a characteristic continuous heart murmur (loudest in the left upper chest or infraclavicular area) is typical. The precordium may be hyperactive and peripheral pulses are bounding with a wide pulse pressure. Tachycardia, exertional dyspnoea, laboured breathing, fatigue or poor growth are common. Large shunts may lead to failure to thrive, recurrent infection of the upper respiratory tract and congestive heart failure. In the majority of cases of PAD there is no identifiable cause. Persistence of the duct is associated with chromosomal aberrations, asphyxia at birth, birth at high altitude and congenital rubella. Occasional cases are associated with specific genetic defects (trisomy 21 and 18, and the Rubinstein-Taybi and CHARGE syndromes). Familial occurrence of PAD is uncommon and the usual mechanism of inheritance is considered to be polygenic with a recurrence risk of 3%. Rare families with isolated PAD have been described in which the mode of inheritance appears to be dominant or recessive. Familial incidence of PAD has also been linked to Char syndrome, familial thoracic aortic aneurysm/dissection associated with patent arterial duct, and familial patent arterial duct and bicuspid aortic valve associated with hand abnormalities. Diagnosis is based on clinical examination and confirmed with transthoracic echocardiography. Assessment of ductal blood flow can be made using colour flow mapping and pulsed wave Doppler. Antenatal diagnosis is not possible, as PAD is a normal structure during antenatal life. Conditions with signs and symptoms of pulmonary overcirculation secondary to a left-to-right shunt must be excluded. Coronary, systemic and pulmonary arteriovenous fistula, peripheral pulmonary stenosis and ventricular septal defect with aortic regurgitation and collateral vessels must be differentiated from PAD on echocardiogram. In preterm infants with symptomatic heart failure secondary to PAD, treatment may be achieved by surgical ligation or with medical therapy blocking prostaglandin synthesis (indomethacin or ibuprofen). Transcatheter closure of the duct is usually indicated in older children. PAD in preterm and low birth weight infants is associated with significant co-morbidity and mortality due to haemodynamic instability. Asymptomatic patients with a small duct have a normal vital prognosis but have a lifetime risk of endocarditis. Patients with moderate-to-large ducts with significant haemodynamic alterations may develop irreversible changes to pulmonary vascularity and pulmonary hypertension.
Topics: Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Prevalence
PubMed: 19591690
DOI: 10.1186/1750-1172-4-17 -
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 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2019
[Characteristics of patients with patent ductus arteriosus and/or pulmonary hypertension living at moderate to high altitude and important considerations while performing transcatheter closure].
Topics: Altitude; Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Hypertension, Pulmonary
PubMed: 31483304
DOI: 10.5543/tkda.2019.40909 -
Biomolecules Aug 2022Complications to preterm birth are numerous, including the presence of a patent ductus arteriosus (PDA). The biological understanding of the PDA is sparse and treatment...
Complications to preterm birth are numerous, including the presence of a patent ductus arteriosus (PDA). The biological understanding of the PDA is sparse and treatment remains controversial. Herein, we speculate whether the PDA is more than a cardiovascular imbalance, and may be a marker in response to immature core molecular and physiological processes driven by biological systems, such as inflammation. To achieve a new biological understanding of the PDA, we performed echocardiography and collected plasma samples on day 3 of life in 53 consecutively born neonates with a gestational age at birth below 28 completed weeks. The proteome of these samples was analyzed by mass spectrometry (nanoLC-MS/MS) and immunoassay of 17 cytokines and chemokines. We found differences in 21 proteins and 8 cytokines between neonates with a large PDA (>1.5 mm) compared to neonates without a PDA. Amongst others, we found increased levels of angiotensinogen, periostin, pro-inflammatory associations, including interleukin (IL)-1β and IL-8, and anti-inflammatory associations, including IL-1RA and IL-10. Levels of complement factors C8 and carboxypeptidases were decreased. Our findings associate the PDA with the renin-angiotensin-aldosterone system and immune- and complement systems, indicating that PDA goes beyond the persistence of a fetal circulatory connection of the great vessels.
Topics: Angiotensinogen; Ductus Arteriosus, Patent; Female; Hemodynamics; Humans; Infant, Extremely Premature; Infant, Newborn; Interleukin 1 Receptor Antagonist Protein; Interleukin-10; Interleukin-8; Premature Birth; Proteome; Tandem Mass Spectrometry
PubMed: 36139018
DOI: 10.3390/biom12091179 -
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 -
The Journal of Invasive Cardiology Jan 2016Transcatheter closure is the usual treatment for patent ductus arteriosus (PDA), but its safety and efficacy have not been reported in adult PDA patients with severe...
BACKGROUND
Transcatheter closure is the usual treatment for patent ductus arteriosus (PDA), but its safety and efficacy have not been reported in adult PDA patients with severe mitral regurgitation.
STUDY DESIGN
A retrospective study on 27 consecutive patients diagnosed with PDA and severe mitral regurgitation and treated using transcatheter closure between September 2010 and September 2012 at the Department of Cardiology of Changhai Hospital in Changhai, China. Left ventricular (LV) diastolic volume and function, pulmonary artery pressure, and instantaneous reverse-flow volume were examined by echocardiography before PDA closure, immediately after closure, and 1 year after closure.
RESULTS
After the procedure, the LV diastolic volume (P<.05) and instantaneous reverse-flow volume (P<.001) were significantly decreased. There was no effect on the ejection fraction (P>.05). Pulmonary arterial systolic pressure was unchanged 1 year after closure (from 46.41 ± 19.92 mm Hg to 45.43 ± 13.64 mm Hg; P=.58). All procedures were uneventful and only mild complications occurred (hemolysis in 2 cases, subcutaneous hematoma in 4 cases, and fever in 2 cases).
CONCLUSION
Transcatheter closure can decrease the LV volume and instantaneous reverse-flow volume in adult PDA patients with severe mitral regurgitation. This procedure is effective and has a good safety profile.
Topics: Adult; Cardiac Catheterization; Cardiac Surgical Procedures; China; Ductus Arteriosus, Patent; Echocardiography; Female; Humans; Male; Mitral Valve Insufficiency; Outcome and Process Assessment, Health Care; Postoperative Complications; Retrospective Studies; Septal Occluder Device; Severity of Illness Index
PubMed: 26716592
DOI: No ID Found -
Pediatrics and Neonatology Oct 2012
Comparative Study
Topics: Cardiac Surgical Procedures; Combined Modality Therapy; Ductus Arteriosus, Patent; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Ligation; Male; Prognosis; Survival Rate; Taiwan
PubMed: 23084717
DOI: 10.1016/j.pedneo.2012.08.002 -
Pediatric Research Mar 2022DNA polymorphisms in PTGIS and TFAP2B have been identified as risk factors for patent ductus arteriosus (PDA) in a population composed of preterm infants with European...
BACKGROUND
DNA polymorphisms in PTGIS and TFAP2B have been identified as risk factors for patent ductus arteriosus (PDA) in a population composed of preterm infants with European genetic ancestry but not in more genetically diverse populations.
GOAL
To determine if the effects of TFAP2B and PTGIS polymorphisms on ductus arteriosus (DA) gene expression differ based on genetic ancestry.
METHODS
DA from 273 human second trimester fetuses were genotyped for TFAP2B and PTGIS polymorphisms and for polymorphisms distributing along genetic ancestry lines. RT-PCR was used to measure the RNA expression of 49 candidate genes involved with DA closure.
RESULTS
Seventeen percent of the DA analyzed were of European ancestry. In multivariable regression analyses we found consistent associations between four PDA-related TFAP2B polymorphisms (rs2817399(A), rs987237(G), rs760900(C), and rs2817416(C)) and expression of the following genes: EPAS1, CACNB2, ECE1, KCNA2, ATP2A3, EDNRA, EDNRB, BMP9, and BMP10, and between the PTGIS haplotype rs493694(G)/rs693649(A) and PTGIS and NOS3. These changes only occurred in DA with European ancestry. No consistent positive or negative associations were found among DA samples unless an interaction between the polymorphisms and genetic ancestry was taken into account.
CONCLUSION
PTGIS and TFAP2B polymorphisms were associated with consistent changes in DA gene expression when present in fetuses with European ancestry.
IMPACT
DNA polymorphisms in PTGIS and TFAP2B have been identified as risk factors for patent ductus arteriosus (PDA) in a population composed primarily of preterm infants with European genetic ancestry but not in more genetically diverse populations. The same PTGIS and TFAP2B polymorphisms are associated with changes in ductus gene expression when present in ductus from fetuses with European genetic ancestry. No consistent associations with gene expression can be found unless an interaction between the polymorphisms and genetic ancestry is taken into account.
Topics: Bone Morphogenetic Proteins; DNA; Ductus Arteriosus; Ductus Arteriosus, Patent; Gene Expression; Humans; Infant; Infant, Newborn; Infant, Premature
PubMed: 33837257
DOI: 10.1038/s41390-021-01506-6 -
Archives of Cardiovascular Diseases Nov 2011Over the last three decades, knowledge about fundamental and clinical aspects of the ductus arteriosus has substantially improved, leading to considerable progress in... (Review)
Review
Over the last three decades, knowledge about fundamental and clinical aspects of the ductus arteriosus has substantially improved, leading to considerable progress in the management of various cardiac diseases involving the ductus. The identification of the mechanisms regulating ductal patency led to design pharmacological drugs to achieve medical closure of PDA in premature infants, or inversely to maintain patency in neonates with duct-dependent congenital heart diseases. Concurrently, widespread availability of echocardiography has improved the detection of congenital PDA, resulting in earlier treatment. Closure of PDA, by either surgery or transcatheter techniques, can now be achieved safely, resulting in a decrease in the incidence of severe complications of PDA.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Cardiovascular Agents; Ductus Arteriosus; Ductus Arteriosus, Patent; Echocardiography, Doppler, Color; Electrocardiography; Hemodynamics; Humans; Infant, Newborn; Infant, Premature; Predictive Value of Tests; Treatment Outcome
PubMed: 22117910
DOI: 10.1016/j.acvd.2010.06.006 -
Journal of Veterinary Internal Medicine Mar 2019German Shepherd dogs (GSD) are predisposed to developing patent ductus arteriosus (PDA) and are reportedly prone to type III (tubular) PDA anatomy. Dogs with type III...
BACKGROUND
German Shepherd dogs (GSD) are predisposed to developing patent ductus arteriosus (PDA) and are reportedly prone to type III (tubular) PDA anatomy. Dogs with type III anatomy are not considered favorable candidates for device-based intervention.
OBJECTIVE
To describe the PDA anatomy, baseline characteristics, and procedural outcome of GSD with PDA.
ANIMALS
Twenty-eight client-owned GSD.
METHODS
Retrospective review of medical records of 28 GSD diagnosed with PDA that underwent surgical ligation or transcatheter device closure between 2007 and 2017.
RESULTS
German Shepherd dogs with PDA often presented with clinical signs (50%), concurrent congenital heart disease (35.7%), and arrhythmias (29%). Dogs were typically mature at presentation (median age, 12.1 months) and evenly distributed by sex (57% female). The PDA anatomy was classified in 24 of 28 GSD, with type II anatomy being most common (21/24). Three dogs had unusual anatomy (type IV in 1, type V in 2). Median minimal ductal diameter (MDD) in this population was larger than previously reported in a mixed population and ranged between 4.4 and 4.9 mm depending upon imaging modality. Successful closure was achieved using an Amplatz canine duct occluder (ACDO) in 22 dogs or by surgical ligation in 6 dogs. No cases of type III anatomy were confirmed.
CONCLUSIONS AND CLINICAL IMPORTANCE
The majority of GSD in this population had type II PDA anatomy that was amenable to ACDO deployment. Predisposition for large MDD and occasional, unusual PDA anatomy suggests that transesophageal echocardiography may be beneficial for optimal procedural planning in this breed.
Topics: Animals; Cardiac Surgical Procedures; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Female; Genetic Predisposition to Disease; Ligation; Male; Retrospective Studies; Treatment Outcome
PubMed: 30556180
DOI: 10.1111/jvim.15401