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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 -
Early Human Development Mar 2024This study aimed to determine long-term neurodevelopmental outcome and cerebral oxygenation in extremely preterm infants, comparing those with a hemodynamic significant...
OBJECTIVE
This study aimed to determine long-term neurodevelopmental outcome and cerebral oxygenation in extremely preterm infants, comparing those with a hemodynamic significant patent ductus arteriosus (hsPDA) to those without.
STUDY DESIGN
We included infants born before 28 weeks of gestation from 2008 to 2010 with routine echocardiography. Prior to echocardiography, regional cerebral oxygen saturation was measured. At 5 years of age, we evaluated neurodevelopmental outcomes using the Movement Assessment Battery for Children 2nd Dutch edition for motor skills and the Wechsler Preschool and Primary Scale of Intelligence 3rd Dutch edition for cognition.
RESULTS
A total of 66 infants (gestational age 26.6 ± 0.9 weeks, birth weight 912 ± 176 g) were included, 34 infants with a hsPDA (including treatment). The group infants with hsPDA showed lower pre-closure cerebral saturation levels (58.2 % ±7.8 % versus 62.8 % ±7.0 %; p = 0.01). At 5 years, impaired motor outcome occurred more often in infants with hsPDA (17 (53 %) vs. 7 (23 %); p = 0.01). In multivariate analysis existence of hsPDA remained unfavourably related to the motor subdomain "aiming and catching". There were no potential effects of hsPDA on cognitive performance at 5 years of age.
CONCLUSION
Treatment-receiving infants with hsPDA appear to exhibit motor deficits, specifically in "aiming and catching", by the age 5. Persistent ductal patency could be a contributing factor.
Topics: Infant; Child, Preschool; Child; Infant, Newborn; Humans; Ductus Arteriosus, Patent; Birth Weight; Gestational Age; Infant, Extremely Premature; Hemodynamics
PubMed: 38330542
DOI: 10.1016/j.earlhumdev.2024.105953 -
Journal of the American College of... Jan 1996The purpose of this study was to determine in preterm newborn infants the effects of ductal ligation on ventricular performance and its determinants: preload, afterload...
OBJECTIVES
The purpose of this study was to determine in preterm newborn infants the effects of ductal ligation on ventricular performance and its determinants: preload, afterload and contractility.
BACKGROUND
Neonatal ventricular performance is highly sensitive to afterload. Therefore, the increase in systemic vascular resistance associated with ligation of a patent ductus arteriosus might worsen ventricular performance in the preterm infant.
METHODS
All 14 premature infants undergoing patent ductus arteriosus ligation in a 1-year period at our institution underwent echocardiography at three times: before, immediately after and 24 h after ligation. Indexes studied included ventricular performance (fractional area change), preload (left ventricular end-diastolic dimension), afterload (end-systolic wall stress) and contractility (the difference between the measured and predicted velocity of circumferential fiber shortening). Blood pressure was measured; systemic resistance was calculated. These data were compared with those of 14 preterm infants without patent ductus arteriosus.
RESULTS
The infants with patent ductus arteriosus had higher values for ventricular performance (mean +/- SD fractional area change 60 +/- 9% vs. 52 +/- 11%, p < 0.05) and lower values for wall stress (22 +/- 6 vs. 44 +/- 17 g/cm2, p < 0.05) before ligation than did the control group. At 24 h after ligation, ventricular performance was not significantly changed (fractional area change 60 +/- 9% to 57 +/- 12%). There were significant increases in blood pressure and systemic vascular resistance but no changes in wall stress or contractility.
CONCLUSIONS
Ventricular performance is higher in premature infants with than in those without patent ductus arteriosus because afterload is lower in the former group. Although ductal ligation increases blood pressure and systemic resistance, wall stress and ventricular performance are maintained. Our results suggest that the premature newborn maintains ventricular performance during stress, at least in part, by manipulating afterload.
Topics: Blood Pressure; Chi-Square Distribution; Ductus Arteriosus, Patent; Echocardiography; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Ligation; Myocardial Contraction; Stress, Mechanical; Vascular Resistance; Ventricular Function, Left
PubMed: 8522694
DOI: 10.1016/0735-1097(95)00452-1 -
BMC Pediatrics Jun 2021This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management,...
BACKGROUND
This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 - 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome.
RESULTS
Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge.
CONCLUSION
This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.
Topics: Child; Ductus Arteriosus, Patent; Gestational Age; Humans; Infant; Infant, Newborn; Ligation; Male; Patient Discharge; Retrospective Studies
PubMed: 34107888
DOI: 10.1186/s12887-021-02734-9 -
Hellenic Journal of Cardiology : HJC =... 2010Surgical closure of a patent ductus arteriosus (PDA) in cases with pulmonary hypertension, a short and wide PDA, and/or calcification of the wall of the vessel can be a...
INTRODUCTION
Surgical closure of a patent ductus arteriosus (PDA) in cases with pulmonary hypertension, a short and wide PDA, and/or calcification of the wall of the vessel can be a hazardous procedure. The use of extracorporeal circulation provides the necessary safety for effective closure.
METHODS
Four patients (one male), aged 7, 22, 54 and 60 years old, underwent PDA closure. All had pulmonary hypertension (pulmonary artery pressure, PAP 55-85 mmHg, PAP-to-systemic pressure ratio 0.6-0.8) and a wide, short PDA (diameter 9-12 mm) with a calcified wall in 2 cases. The surgical technique involved transpulmonary PDA closure with a synthetic patch under extracorporeal circulation and mild hypothermia (n=2); or double ligation and purse-string suture of the PDA with extracorporeal circulation and normothermia on a beating heart (n=1), or with heart-lung machine on standby (n=1).
RESULTS
Mortality was nil. The postoperative course was mild in all cases. Follow up 3 to 8 years post surgery showed effective PDA closure, PAP within normal (n=3) or at upper normal limits (n=1), and no other sequelae.
CONCLUSIONS
The use of extracorporeal circulation allows safe and uncomplicated surgical closure of a PDA in "difficult" cases.
Topics: Adult; Child; Ductus Arteriosus, Patent; Extracorporeal Circulation; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Treatment Outcome
PubMed: 20118039
DOI: No ID Found -
Texas Heart Institute Journal 2013The aim of this study was to evaluate a new type of occluder for patent ductus arteriosus. Patent ductus arteriosus was established in a canine model by anastomosing a...
The aim of this study was to evaluate a new type of occluder for patent ductus arteriosus. Patent ductus arteriosus was established in a canine model by anastomosing a length of autologous jugular vein to the descending aorta and the left pulmonary artery in an end-to-side fashion. Transcatheter closure of each patent ductus arteriosus was performed on 10 dogs, which were then monitored for as long as 6 months with aortography, echocardiography, and histologic evaluation. Transcatheter closure with use of the novel pan-nitinol device was successful in all canine models. Postoperative echocardiography showed that the location and shape of the occluders were normal, without any residual shunting. Further histologic evaluation confirmed that the occluder surface was completely endothelialized 3 months after implantation. Transcatheter patent ductus arteriosus closure with the pan-nitinol occluder can be performed safely and successfully in a canine model and shows good biological compatibility and low mortality rates.
Topics: Alloys; Anastomosis, Surgical; Animals; Aorta, Thoracic; Aortography; Cardiac Catheterization; Disease Models, Animal; Dogs; Ductus Arteriosus, Patent; Echocardiography; Equipment Design; Feasibility Studies; Jugular Veins; Materials Testing; Microscopy, Electron, Scanning; Pulmonary Artery; Septal Occluder Device; Time Factors
PubMed: 23466429
DOI: No ID Found -
Journal of the American Veterinary... Jun 2013To investigate cardiovascular changes and survival times following complete interventional device occlusion of uncomplicated left-to-right shunting patent ductus...
OBJECTIVE
To investigate cardiovascular changes and survival times following complete interventional device occlusion of uncomplicated left-to-right shunting patent ductus arteriosus in dogs.
DESIGN
Retrospective cohort study.
ANIMALS
24 dogs with uncomplicated patent ductus arteriosus that was fully occluded and reevaluated within 24 hours, approximately 3 months, and 1 year after the procedure.
PROCEDURES
Information on medical history, diagnostic imaging findings, treatment received, and survival times were obtained from medical records. Patients were allocated into 2 groups on the basis of age (< 1 year [n = 14] and ≥ 1 year [10]) at the time of the procedure. Additional follow-up information was obtained through interviews of owners and referral veterinarians.
RESULTS
Following ductal occlusion, decreases were detected in vertebral heart scale size, left ventricular chamber diameter in diastole and in systole, left atrial dimension, fractional shortening, aortic velocity, and ventricular wall thickness. There were no differences between age groups for postocclusion changes except vertebral heart scale size. Systolic dysfunction was detected in 14 (58%) patients on the final visit. Median survival time for all dogs after ductal occlusion was > 11.5 years.
CONCLUSIONS AND CLINICAL RELEVANCE
Complete ductal occlusion resulted in immediate removal of the volume overload state and eventual return of cardiac chamber dimensions to reference range, suggesting regression of eccentric hypertrophy. Systolic dysfunction persisted in some dogs but appeared to be clinically unimportant. Most cardiovascular changes were independent of patient age at the time of the procedure.
Topics: Animals; Blood Flow Velocity; Cohort Studies; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Female; Heart Ventricles; Male; Retrospective Studies; Ventricular Function, Left
PubMed: 23725436
DOI: 10.2460/javma.242.12.1722 -
International Journal of... 2023This pilot study aimed to explore the effectiveness and safety of dexibuprofen suppository in the treatment of PDA in preterm infants. Preterm infants with gestational... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness and safety of rectal dexibuprofen versus oral ibuprofen for closure of patent ductus arteriosus in preterm infants with gestational age<34 weeks: A pilot study.
This pilot study aimed to explore the effectiveness and safety of dexibuprofen suppository in the treatment of PDA in preterm infants. Preterm infants with gestational age <34 weeks and color Doppler echocardiographic evidence of hemodynamically significant PDA (hs PDA) with systemic hypoperfusion was intended to be included into this study since January 2020. As of January 1, 2021, this trial had recruited 87 preterm infants who met the inclusion criteria. Neonates were admitted into hospital within 1 hour after birth and were randomly assigned into two groups. Group one included 44 preterm newborns administered with oral ibuprofen. Group two included 43 preterm newborns administered with dexibuprofen suppository. This preliminary study showed that rectal dexibuprofen and oral ibuprofen were both effective for the closure of PDA, and the closure rate of dexibuprofen suppository was comparable to that of oral ibuprofen after the 1st and 2nd courses of treatment. In addition, rectal dexibuprofen did not increase the incidence of adverse outcomes, including bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, and necrotising enterocolitis. This pilot study showed dexibuprofen suppository is as effective and safe as oral ibuprofen; yet, better designed, muticenter controlled studies are still needed.
Topics: Humans; Infant; Infant, Newborn; Ductus Arteriosus, Patent; Gestational Age; Ibuprofen; Infant, Low Birth Weight; Infant, Premature; Pilot Projects
PubMed: 36744872
DOI: 10.1177/03946320231152993 -
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 -
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