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Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2019The incidence of patent ductus arteriosus (PDA) is greater among patients living at high altitude. In this po-pulation, the ductal diameter is often larger and pulmonary...
OBJECTIVE
The incidence of patent ductus arteriosus (PDA) is greater among patients living at high altitude. In this po-pulation, the ductal diameter is often larger and pulmonary hypertension is more frequent. The aim of this study was to evaluate the hemodynamic and morphological features of PDA and transcatheter closure procedures performed with various devices in a group of patients living at high altitude in Turkey.
METHODS
The data of 327 patients who lived at an altitude of at least 1600 m above sea level and who had undergone cardiac catheterization for isolated PDA between May 2010 and July 2018 were retrospectively analyzed.
RESULTS
The mean age was 7.33±7.67 years, and 62.4% of the patients were female. The mean ductal diameter was 3.74±2.14 mm. Pulmonary hypertension was present in 57.8%. Transcatheter closure was performed in 322 patients, with a 97.3% success rate. The Amplatzer duct occluder I (ADO I) was used most often, as well as off-label use of the Amplatzer vascular plug II (AVP) and the Amplatzer muscular ventricular septal defect occluder (AMVSDO). Pulmonary artery pressure decreased immediately in the vast majority after percutaneous closure. Transient left ventricular systolic dysfunction after ductal closure was seen only rarely. Follow-up was uneventful.
CONCLUSION
Transcatheter PDA closure can be performed with high success rate in highlanders. Off-label devices may be required for these procedures. Pulmonary hypertension is frequent but regresses after ductal closure. Transient left ventricular dysfunction after transcatheter closure is rarely seen in these patients and resolves without any medication.
Topics: Adolescent; Adult; Altitude; Cardiac Surgical Procedures; Child; Child, Preschool; Ductus Arteriosus, Patent; Female; Humans; Infant; Male; Retrospective Studies; Treatment Outcome; Turkey; Young Adult
PubMed: 31483299
DOI: 10.5543/tkda.2019.20805 -
Congenital Heart Disease 2010Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2-4 per 1000 term births. Closure of the... (Review)
Review
Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2-4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk:benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.
Topics: Adolescent; Adult; Cardiac Catheterization; Cardiac Surgical Procedures; Child; Child, Preschool; Ductus Arteriosus, Patent; Endocarditis; Evidence-Based Medicine; Hemodynamics; Humans; Infant; Patient Selection; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Treatment Outcome; Young Adult
PubMed: 20653702
DOI: 10.1111/j.1747-0803.2010.00435.x -
Journal of Cardiothoracic Surgery Apr 2020Patent ductus arteriosus (PDA) is a common congenital heart disease. Interventional therapy is an important treatment for PDA. Nevertheless, few studies have...
Short-term results of interventional therapy for infants (7-36 months old) with patent ductus arteriosus and moderate-to-severe pulmonary hypertension: a retrospective study.
BACKGROUND
Patent ductus arteriosus (PDA) is a common congenital heart disease. Interventional therapy is an important treatment for PDA. Nevertheless, few studies have investigated the safety and effectiveness of interventional therapy for infants (age, 0-36 months) with PDA and moderate-to-severe pulmonary hypertension. Therefore, this study aimed to analyze the short-term (6 months) results and interventional therapy experience for infants with PDA and moderate-to-severe pulmonary hypertension.
METHODS
Clinical records, echocardiographic data, and angiocardiography data of 28 infants (age, 7-36 months) who underwent interventional therapy for PDA and moderate-to-severe pulmonary hypertension between December 2011 and January 2017 at our hospital were retrospectively analyzed. All infants were treated using an Amplatzer occluder with local and deep sedation anesthesia under radiographic guidance.
RESULTS
Infants with PDA and moderate-to-severe pulmonary hypertension had poor growth. Trace residual shunts were found in two infants immediately after procedure; both had disappeared by 6 months after procedure. No significant interventional therapy-related complications occurred in the other cases. Pulmonary systolic pressure, left atrial dimension, and left ventricular end-diastolic dimension immediately after interventional therapy and 6 months later were lower than the preoperative levels (P < 0.05). The left atrial and left ventricular end-diastolic dimensions at 6 months after interventional therapy were smaller than those immediately after interventional therapy (P < 0.05). Pulmonary systolic pressure rates immediately after interventional therapy and 6 months later were not significantly different (P = 0.505). Moreover, there were no significant differences in the left ventricular ejection fraction before, immediately after, and at 6 months after interventional therapy (P = 0.628).
CONCLUSIONS
For infants (age, 7-36 months) with PDA and moderate-to-severe pulmonary hypertension, interventional therapy can achieve excellent immediate and short-term (6 months) results with careful preoperative evaluations, strict operative procedures, and careful follow-up.
Topics: Child, Preschool; Ductus Arteriosus, Patent; Echocardiography; Female; Humans; Hypertension, Pulmonary; Infant; Male; Postoperative Complications; Retrospective Studies; Septal Occluder Device; Severity of Illness Index; Treatment Outcome
PubMed: 32321548
DOI: 10.1186/s13019-020-01110-5 -
Vascular Health and Risk Management 2020Hemitruncus arteriosus refers to an uncommon congenital cardiovascular abnormality. It usually presents in infancy and leads to the development of pulmonary...
Hemitruncus arteriosus refers to an uncommon congenital cardiovascular abnormality. It usually presents in infancy and leads to the development of pulmonary hypertension, heart failure, and in severe cases maybe death. Herein, we reported hemitruncus arteriosus in a 10-day-old neonate with respiratory distress, patent ductus arteriosus, and thrombocytopenia.
Topics: Disease Progression; Ductus Arteriosus, Patent; Fatal Outcome; Humans; Infant, Newborn; Male; Respiratory Distress Syndrome, Newborn; Thrombocytopenia; Truncus Arteriosus, Persistent
PubMed: 32280232
DOI: 10.2147/VHRM.S245033 -
Archives of Disease in Childhood. Fetal... Nov 2007Patent ductus arteriosus (PDA) is a common diagnosis among extremely premature infants, especially in those with lung disease. Treatments are often used to close the... (Review)
Review
Patent ductus arteriosus (PDA) is a common diagnosis among extremely premature infants, especially in those with lung disease. Treatments are often used to close the PDA. Despite nearly three decades of research, the question of whether the benefits of treatments to prevent ductal patency or promote closure outweigh the risks of these treatments remains unanswered. The authors rarely use treatments designed to close the PDA. This article reviews three considerations in support of this restrained approach: rates of spontaneous closure of the ductus arteriosus; adverse effect of persistent ductal patency; and benefits and risks of treatments for closure.
Topics: Chemoprevention; Cyclooxygenase Inhibitors; Decision Making; Ductus Arteriosus, Patent; Evidence-Based Medicine; Humans; Infant, Newborn; Infant, Premature; Ligation; Remission, Spontaneous
PubMed: 17951552
DOI: 10.1136/adc.2005.092734 -
Pediatrics and Neonatology Feb 2020To determine the rate of patent ductus arteriosus after prophylactic low-dose paracetamol administration, the impact on outcome parameters, possible treatment...
BACKGROUND
To determine the rate of patent ductus arteriosus after prophylactic low-dose paracetamol administration, the impact on outcome parameters, possible treatment side-effects and the influence on pain perception.
METHODS
We report retrospective single-centre outcome data of premature infants ≤ 32 weeks of gestation (n = 476). The intervention group received intravenous paracetamol, the control group obtained no preventive therapy. Ductal closure rate and outcome parameters were compared between the two groups. Adverse effects were determined by laboratory parameters. For the assessment of pain the Bernese Pain Scale for Neonates was used.
RESULTS
The rate of patent ductus arteriosus was significantly lower in the paracetamol-treated group compared to the control group (13.6% vs. 38.2%, p < 0.001). With regard to secondary outcome parameters, severe and moderate bronchopulmonary dysplasia (2.7% vs. 7.4%, p = 0.023), severe retinopathy of prematurity (0% vs. 4.4%, p = 0.002) and late onset sepsis (2.7% vs. 8.3%, p = 0.009) were significantly less frequent in the paracetamol group. Except for a 1.5-fold increased risk for hyperbilirubinemia (86.0% vs. 77.6%, p = 0.035) in the paracetamol group following treatment, no significant differences in laboratory parameters were found. Relating to pain, the administration of Glucose 33% was significantly more often necessary in the control group compared to the paracetamol-treated group (mean 13.48 vs. 8.71, p < 0.001), just as the need for additional treatment with systemic analgesics, which was more frequent in the control group (mean 0.72 vs. 0.57, p = 0.361).
CONCLUSION
In our study we were able to show a significantly lower rate of patent ductus arteriosus after prophylactic paracetamol administration without serious adverse effect, but a beneficial influence of this regime on the patient's pain perception.
Topics: Acetaminophen; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Pain Perception; Retrospective Studies
PubMed: 31345732
DOI: 10.1016/j.pedneo.2019.06.011 -
Journal of Clinical Laboratory Analysis Nov 2018The role of red cell distribution width-to-platelet ratio (RPR) has not previously been mentioned in reports on patent ductus arteriosus (PDA). Our objective was to...
BACKGROUND
The role of red cell distribution width-to-platelet ratio (RPR) has not previously been mentioned in reports on patent ductus arteriosus (PDA). Our objective was to evaluate whether RPR would have a role in the diagnosis and/or prediction of pharmacological closure of PDA.
METHODS
Preterm infants' gestational age ≤30 weeks and ≤1500 g who were given first ibuprofen treatment in the first week of life for hemodynamically significant PDA (hsPDA) were included in the study. The patients were matched for gestational age, birthweight, and sex. Patients were subdivided into two groups based on the response to medical treatment (open and closed PDA). Hemogram parameters were recorded before and after medical therapy. Groups were compared with regard to demographic and clinical characteristics and for three sequential hematological parameters. RPR was calculated. Patients with sepsis, anemia, perinatal asphyxia, and congenital/chromosomal anomaly were not included in the study.
RESULTS
A total of 112 infants had medically treated hsPDA. Of those, ductus closed in 70 neonates (closed PDA). A total of 96 infants constituted the control group. Mean gestational age and birthweight of the patients were 28.9 ± 2.4 weeks and 1207 ± 372 g. While RPR was significantly increased, PCT was lower in both hsPDA and open PDA groups (P < 0.05 and P < 0.05, respectively). In multivariate analysis, high RPR (OR 3.3, 95% CI 1.438-5.872, P < 0.05) and RDS (OR 2.9, 95% CI 1.903-4.811, P < 0.01) were detected as independent risk factors for hsPDA.
CONCLUSION
Red cell distribution width-to-platelet ratio and PCT may be promising supportive tools for the diagnosis and prediction of pharmacotherapy success.
Topics: Blood Platelets; Cohort Studies; Ductus Arteriosus, Patent; Echocardiography, Doppler; Erythrocyte Indices; Female; Gestational Age; Hematologic Tests; Humans; Infant; Infant, Premature; Infant, Premature, Diseases; Male; ROC Curve
PubMed: 29978492
DOI: 10.1002/jcla.22616 -
Journal of Veterinary Internal Medicine Sep 2017Deployment of the Amplatz Canine Duct Occluder (ACDO) is the preferred method for minimally invasive occlusion of patent ductus arteriosus (PDA) in dogs, with...
BACKGROUND
Deployment of the Amplatz Canine Duct Occluder (ACDO) is the preferred method for minimally invasive occlusion of patent ductus arteriosus (PDA) in dogs, with appropriate device sizing crucial to successful closure. Dogs of any body weight can be affected by PDA.
OBJECTIVES
To describe the range of ACDO sizes deployed in dogs of various body weights for improved procedural planning and inventory selection and to investigate for correlation between minimal ductal diameter (MDD) and body weight.
ANIMALS
A total of 152 dogs undergoing ACDO deployment between 2008 and 2016.
METHODS
Body weight, age, breed, sex, and MDD obtained by angiography (MDD-A), MDD obtained by transesophageal echocardiography (MDD-TEE), and ACDO size deployed were retrospectively evaluated.
RESULTS
Correlation between body weight and ACDO size, MDD-A and MDD-TEE was poor, with R-squared values of 0.4, 0.36, and 0.3, respectively. Femoral artery diameter in the smallest population of dogs placed inherent limitations on the use of larger device sizes, with no limitations on the wide range of device sizes required as patient size increased. The most commonly used ACDO devices were size 3 through 6, representing 57% of the devices deployed within the entire study population.
CONCLUSIONS AND CLINICAL IMPORTANCE
Patent ductus arteriosus anatomy varies on an individual basis, with poor correlation between MDD and body weight. Weight-based assumptions about expected ACDO device size for a given patient are not recommended.
Topics: Animals; Body Weight; Cardiac Surgical Procedures; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Echocardiography; Female; Male
PubMed: 28782853
DOI: 10.1111/jvim.14797 -
British Medical Journal (Clinical... Dec 1981
Topics: Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases
PubMed: 6799036
DOI: 10.1136/bmj.283.6305.1490 -
Journal of Cardiothoracic Surgery Mar 2022Profound pulmonary arterial hypertension with end-stage right heart failure is considered to be the main cause of death in children with un-repaired congenital heart...
BACKGROUND
Profound pulmonary arterial hypertension with end-stage right heart failure is considered to be the main cause of death in children with un-repaired congenital heart disease, and the traditional surgical treatment is heart-lung transplantation. We performed bilateral lung transplantation (LTx) with concomitant cardiac repair, and the patient has uplifting outcome.
CASE PRESENTATION
We have reported the case of a patient with congenital hypoplasia of the bilateral pulmonary arteries and patent ductus arteriosus. The patient's clinical condition was gradually worsening and severely limited his ability to perform the activities of daily life. Bilateral LTx with concomitant patent ductus arteriosus repair was performed at the age of 11 years. The postoperative course was smooth and cardiopulmonary function nearly returned to normal according to radiological and laboratory examinations.
CONCLUSIONS
Bilateral LTx with concomitant cardiac repair may be superior to heart-lung transplantation in the case of the specific congenital heart disease.
Topics: Cardiac Surgical Procedures; Child; Ductus Arteriosus, Patent; Heart Defects, Congenital; Humans; Lung Transplantation; Pulmonary Artery
PubMed: 35321729
DOI: 10.1186/s13019-022-01792-z