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PubMed2001

Surgical closure of patent ductus arteriosus in very-low-birth-weight infants.

In many very-low-birth-weight (VLBW) infants the ductus arteriosus fails to close spontaneously, and they subsequently develop signs and symptoms of poor tissue perfusion and heart failure. This study evalutes the results of early surgical closure of patent ductus arteriosus (PDA). We retrospectively reviewed the records of all 101 VLBW infants who weighed 1,500 g or less when their PDA was surgically ligated in Turku University Hospital between 1988 and 1998. The mean gestational age at birth was 27.2 weeks and mean birth weight 963+/-239 g. The operation was performed at 12+/-8 days of age; the infants' weight at operation was 969+/-231 g and they were tracheally extubated 11+/-14 days after the operation. The surgery-related mortality was 3% (3/101) and overall mortality 10% (10/101). We conclude that surgical closure of PDA is safe and effective in VLBW infants.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

[Patent foramen ovale: conservative or surgical therapy?].

Notwithstanding the difficulties in definitely confirming paradoxical embolism, the association between patent foramen ovale (PFO) and cryptogenic stroke has repeatedly been demonstrated in clinical studies. Moreover, the recurrence rate of cerebral ischemia in patients with PFO and an unexplained stroke was found to be 3-4% per year in two recently published series. With the exception of right atrial pressure elevation in the setting of major pulmonary embolism, a reliable risk stratification of patients with PFO based on clinical or echocardiographic findings is not yet possible. The presence of atrial septal aneurysm, a wide opening of the defect during the cardiac cycle and a large atrial shunt have been implicated as risk factors by some investigators. Long-term prevention of paradoxical embolism with oral anticoagulants seems to be of questionable benefit. Besides, these agents are poorly tolerated and carry the risk of significant or fatal bleeding at a rate of 2-5% per year. Surgery of the atrial septum has been performed for many decades in patients with atrial septal defect and evidence accumulates that it is a safe and highly effective procedure in patients with PFO. At present, surgical closure of the PFO appears to be the treatment of choice for secondary prevention of paradoxical embolism. However, further studies are needed to define the appropriate candidates for surgical treatment. Devices for catheter-based sealing of PFO are also available and are currently being evaluated in clinical trials. However, experience with their use remains confined to specialized centers. Furthermore, further technical improvements of these systems are needed in order to optimize successful delivery and positioning, increase their long-term stability, and reduce periprocedural complications.

Cardiac Catheterization↗
PubMed2000

Effect of patent ductus arteriosus and indomethacin treatment on serum cardiac troponin T levels in preterm infants with respiratory distress syndrome.

UNLABELLED: Cardiac troponin T (cTnT) represents a sensitive and specific marker of ischemic myocardial damage in adult and neonatal populations. The aim of this study was to detect the potential ischemic effect of persistent patent ductus arteriosus (PDA) and indomethacin treatment on the coronary vascular bed by measuring cTnT concentrations. cTnT levels were measured in 23 preterm infants (<32 weeks of gestational age) with respiratory distress syndrome (RDS), 11 with PDA and 12 without, at 2, 4, and 7 days after birth. cTnT concentrations (mean +/- SEM) significantly decreased (P<0.05) from the 2nd (0.63+/-0.09 microg/l) and the 4th (0.77+/-0.13 microg/l) to the 7th postnatal day (0.28+/-0.04 microg/l). At day 2 after birth, cTnT levels in preterm infants with RDS were significantly higher (P<0.05) than our reference values for healthy preterm neonates (0.63+/-0.09 microg/l vs. 0.18+/-0.04 microg/l). No differences were found between RDS infants with and without PDA at 2 (0.65+/-0.13 vs. 0.61+/-0.14 microg/l), 4 (0.71+/-0.21 vs. 0.87+/-0.16 microg/l), and 7 (0.26+/-0.05 vs. 0.29+/-0.07 microg/l) days of life. In infants with PDA, cTnT levels did not differ before the first dose of indomethacin was given (0.65+/-0.14 microg/l) or 2 h (0.65+/-0.15 microg/l) and 48 h (0.71+/-0.21 microg/l) afterwards. CONCLUSION: In preterm infants with RDS the occurrence of PDA and indomethacin treatment are not associated with ischemic cardiac damage as detected by cTnT measurements.

Cardiovascular Agents↗
PubMed1999

The use of multiplane transesophageal echocardiography to evaluate residual patent ductus arteriosus during video-assisted thoracoscopy in adults.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for interruption of patent ductus arteriosus (PDA), while intraoperative transesophageal echocardiography (TEE) has proven to be an effective monitor in the evaluation of residual patency. Previous reports on the adequacy of surgical interruption of PDA under VATS and TEE are available for pediatric patients, but only limited information is available for adults with PDA. MATEIALS AND METHODS: Between August 1995 and October 1997, we monitored 35 adult patients undergoing PDA interruption via VATS with Hewlett-Packard color Doppler multiplane TEE throughout the procedure. The average PDA diameter was 10.2 +/- 1.8 mm. All the PDA were completely ligated. RESULTS: Thirty-two patients showed no ductal flow after double ligation. In the other three patients, residual flow was detected intraoperatively after double ligation, but it was quickly abolished by the third ligation. One patient showed faint ductal flow by transthoracic echocardiography at postoperative follow-up, but no reintervention was needed. CONCLUSIONS: Our study showed that, with the refinement of adult PDA interruption via VATS, intraoperative multiplane TEE provides higher resolution for direct evaluation of the entire course of PDA ligation without interrupting the surgical procedure and minimizes the incidence of complications.

Adult↗
PubMed2005

Urinary ET-1, AVP and sodium in premature infants treated with indomethacin and ibuprofen for patent ductus arteriosus.

The relative potency and interrelationship between vasoactive and natriuretic mediators are thought to be important in the transition from fetal to neonatal life. The relationship between urinary vasoactive factors and sodium excretion has not been adequately addressed in premature infants receiving indomethacin and ibuprofen for therapy of patent ductus arteriosus. Excretion rates of AVP, ET-1 and sodium were measured in premature infants with RDS receiving indomethacin or ibuprofen. Forty-four RDS premature infants (<34-week gestation) with PDA received either ibuprofen (n=22) in an initial dose of 10 mg/kg followed by two doses of 5 mg/kg each after 24 and 48 h or 3 doses at 12-h intervals of indomethacin (n=24), 0.2 mg/kg, infused continuously over a period of 15 min. Urinary ET-1, AVP and sodium excretion were measured before and after treatment. Indomethacin treatment caused a significant decrease in urinary ET-1 and AVP excretion (UET-1/Ucr 0.14+/-0.01 vs. 0.10+/-0.05 fenton/mmol; P<0.05; 24.42+/-6.18 vs. 12.63+/-3.06 pg/mmol; P<0.05, respectively), along with a significant reduction in urinary sodium (92.1+/-36.1 vs. 64.8+/-35.6 mmol/l; P<0.01), fractional excretion of sodium (6.8+/-37.1 vs. 4.5+/-37.1%; P<0.01) and urinary osmolality (276.2+/-103.9 vs. 226.4+/-60.3 mOsmol/kg; P<0.05). Ibuprofen treatment caused a significant decrease in urinary AVP (UAVP/Ucr 24.5+/-3.4 vs. 16.3+/-2.04 pg/mmol; P<0.01), along with a significant decrease in urinary sodium (78.0+/-8.4 vs. 57.0+/-8.0 mmol/l; P<0.05) and in fractional excretion of sodium (7.5+/-1.3 vs. 3.9+/-3.0%; P<0.05), while it did not modify urinary ET-1 excretion. The association of renal ET-1 and AVP activity with sodium excretion in premature infants treated with indomethacin and ibuprofen supports the hypothesis that these factors may play a role in the physiologic changes in sodium excretion.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

One-lung ventilation for video-assisted thoracoscopic interruption of patent ductus arteriosus.

PURPOSE: Video-assisted endoscopic techniques have recently been employed in congenital heart surgery for patent ductus arteriosus (PDA) interruption. We report our preliminary experience of using a new technique of single-lung ventilation to perform video-assisted thoracoscopic PDA interruption (VATS-PDA) in small infants and children. METHODS: Sixteen infants with a mean body weight of 6.5 +/- 2.4 kg (range 2.6-12.8 kg) underwent VATS-PDA under selective right-lung ventilation using a 2-F balloon catheter for arterial embolectomy. RESULTS: We did not need to reposition the retractor or reinflate the atelectatic lung, as there was no transient hypoxia or hypercarbia. The mean procedure time was 81 +/- 27 min (range 45-145 min) and all patients, with the exception of one with a total anomalous pulmonary venous connection, were extubated in the operating room. CONCLUSION: This technique using single-lung ventilation for infants and small children was safe and effective in providing pediatric thoracic access and exposure within confined and delicate anatomic spaces.

Cardiac Catheterization↗
PubMed2005

Aortic dissection with extension to a patent ductus arteriosus.

An 81-year-old woman presented with shortness of breath and fever of 3 days duration. An enhanced CT of the chest revealed a patent ductus arteriosus (PDA) communicating with the true lumen of an aortic arch dissection. Neither the aortic dissection nor the PDA was suspected. The patient had no history of a connective tissue abnormality or other condition which would predispose to dissection other than systemic hypertension. It is likely that propagation of the aortic dissection partially re-opened the ductus arteriosus.

Aged, 80 and over↗
PubMed2003

Less invasive surgical closure of patent ductus arteriosus in extremely low birth weight infants.

Minimally invasive surgery is widely used in pediatric surgery. Extremely low birth weight infants (ELBWI) are literally so fragile to surgical stress that the minimum invasive procedures should be required. We report 15 ELBWI cases with patent ductus arteriosus (PDA), who underwent surgical closure. All of them had failed treatment with indomethacin to close PDA or had contraindicated to its use. The mean gestational age at birth was 26.0+/-2.7 weeks (24-34 weeks) and birth weight 702+/-140 g (479-966 g). The mean age at operation was 23+/-11 days (2-48 days) and body weight at operation 679+/-151 g (428-969 g). The surgery-related mortality was none. No complications were also encountered. Our surgical procedures consist of 2 modalities, one is clipping PDA, not ligation. Clipping technique attributes to minimize the dissection of surrounding tissue of PDA. The other is posterolateral muscle sparing thoracotomy, which would reduce long-term physical impairment and deformity. We believe our surgical technique can be accomplished safely and would be an alternative approach for ELBWI with a lower probability of PDA closure with indomethacin or an increased risk of complications for medical treatment.

Ductus Arteriosus, Patent↗
PubMed2005

A full house: complications from an uncorrected patent ductus arteriosus.

True aneurysms of the pulmonary artery are rare, and are most often due to pulmonary hypertension arising from congenital heart defects. We report the case of a 40-year-old man with an uncorrected patent ductus arteriosus who presented with pulmonary infarction and pneumonia, and subsequently died of cardiac arrest. Autopsy revealed a large pulmonary artery aneurysm, in situ pulmonary artery thrombosis complicated by pulmonary infarction, pulmonary artery dissection, and cardiac tamponade. Although each of these complications is rare in and of itself, this case demonstrates the entire spectrum of complications from a single uncorrected congenital cardiac anomaly.

Adult↗
PubMed2005

Some ethical and legal issues in Germany involving informed consent and patenting.

This paper elaborates on discussions in Germany regarding some of the ethical and legal issues in the area of the use and patenting of inventions involving human tissue. The issues discussed pertain to the benefits and problems regarding informed consent and the issue of property rights as they relate to the donation of cells and tissue.

Germany↗
PubMed2002

Congenital sternal cleft with patent ductus arteriosus: report of a case.

We report a rare case of a congenital sternal cleft. The patient was a full-term baby girl with a superior incomplete sternal cleft with patent ductus arteriosus (PDA). A primary repair of the sternum and ligation of the PDA were performed during the neonatal period without cardiac compression. Primary repair during the neonatal period is the optimal procedure for cases of congenital sternal cleft.

Ductus Arteriosus, Patent↗
PubMed1991

Potential diagnosis of hemodynamic abnormalities in patent ductus arteriosus by cine magnetic resonance imaging.

Cine magnetic resonance imaging was performed in 11 patients with communication between systemic and pulmonary circulation. In five patients with uncomplicated patent ductus arteriosus (PDA), ductus arteriosus was delineated by a persistent band of low signal intensity, whereas in two patients who also had severe pulmonary hypertension the signal intensity was varied. Two separate low signal intensities in the main pulmonary artery and the descending aorta were each uniformly recorded in the five patients with uncomplicated PDA, consistent with continuous left-to-right shunt and turbulent flow acceleration, respectively. In one of the patients with severe pulmonary hypertension but not Eisenmenger's syndrome, the areas of low signal intensity from left-to-right shunt and turbulent flow acceleration diminished. In the patient with Eisenmenger's PDA the right-to-left shunt was also characterized by an area of low signal intensity but with a reversal in direction. Cine MR imaging has the potential to be a noninvasive and supplemental method for evaluating PDA.

Adolescent↗
PubMed1994

Transcatheter occlusion of patent ductus arteriosus by Rashkind umbrella device: follow-up results.

Seventy-six patients (36 boys and 40 girls) with patent ductus arteriosus who had successful ductal occlusion with a Rashkind umbrella device were monitored for a period of 6 to 60 months (mean 26.7 +/- 12.3 months). All patients were evaluated by pulsed and color Doppler echocardiography before and after the procedure. The prevalence of residual left-to-right shunt and main pulmonary artery flow pattern were assessed. Residual left-to-right shunt was seen in 12 (15.7%) patients 24 hours after the procedure, but the shunt was small with a pulmonary-to-systemic blood flow ratio of < 1.3:1. Repeat echo Doppler study at 14 days showed residual left-to-right shunt in 10 (13.1%) patients. None of these patients showed further decrease in prevalence of residual left-to-right shunt. The patients with residual left-to-right shunt had larger ductii (mean 5.17 +/- 0.88 mm, range 4.23 to 6.6 mm) as compared to patients with no residual left-to-right shunt (3.31 +/- 0.86 mm, range 1.8 to 4.69 mm; p < 0.001). Two patients with residual shunt had successful ductus reocclusion, with 12 and 17 mm devices, respectively, at 28 month of follow-up. The Rashkind umbrella device is effective in closing ducti with diameters of < 5 mm in majority of patients.

Adolescent↗
PubMed1985

Transcatheter closure of patent ductus arteriosus in piglets.

To better determine the risks of transcatheter closure of a patent ductus arteriosus (PDA), a model of PDA was made in newborn piglets by using 5- to 7-mm angioplasty catheters to dilate the probe PDA. This maneuver resulted in a permanent PDA in most piglets. Four to 6 weeks later PDA closure was attempted using the Rashkind PDA occluder. Twelve such procedures were attempted, using clean but nonsterile technique. Nine of 12 PDAs were successfully closed. Two failures were the result of inability to successfully traverse the PDA. This problem was solved by using a long sheath to position the device properly. Four complications occurred, all related to device release: left pulmonary artery embolization in 1 case, femoral artery embolization in 1, torn pulmonic valve cusp in 1 and lodgment of a prosthesis on a pulmonic valve cusp. Two successfully implanted devices were infected at necropsy. This study demonstrates the value of a piglet model in testing transcatheter PDA occlusion devices, the importance of sterile technique in such procedures, the hazards of device retrieval through the right heart and the feasibility of transcatheter PDA closure.

Angioplasty, Balloon↗
PubMed1993

Transcatheter occlusion of patent ductus arteriosus in adults.

This study examines whether transcatheter closure of a patent ductus arteriosus (PDA) using a Rashkind PDA occluder device is safe and effective in adults, or if adults have complications not sited in children owing to prolonged aorticopulmonary communication, high surgical risks or calcified PDAs. Fifteen patients aged 22 to 76 years (mean 42 +/- 14) were referred for transcatheter PDA occlusion. Exercise intolerance was the most frequent clinical manifestation. Eleven of 15 patients had surgical risk factors that included left ventricular failure (n = 10), biventricular failure (n = 1), elevated pulmonary pressures (n = 1), and a calcified PDA (n = 5). Twelve millimeter devices were placed in 4 PDAs < or = 3 mm in diameter; 17 mm devices were placed in 11 PDAs 3 to 6 mm in diameter. Seven (47%) were occluded angiographically shortly after device placement; another 5 PDAs (33%) were occluded echocardiographically within 24 hours of the procedure. Completed occlusion in this time interval was more likely to occur in PDAs < 5 mm in diameter (p = 0.0009). Of the 3 remaining PDAs with follow-up ranging from 9 to 38 months, 2 have demonstrated gradual diminution of shunting and have trivial leaks by color/Doppler flow. The other patient with a residual PDA has no ductal flow after placement of a second device. No complications related to device implantation or closure of the PDA occurred in any patient. No complications were reported in the follow-up patients who received evaluation (14 of 15 patients; range 1 to 38 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Results of anterograde transcatheter closure of patent ductus arteriosus using single or multiple Gianturco coils.

Retrograde coil embolization of the patent ductus arteriosus (PDA) has been reported for ducts < 3.3 mm in diameter using 5 to 5.5Fr catheters. Our objective was to assess the immediate and short-term results of anterograde transcatheter closure of the PDA using single or multiple Gianturco coils. Thirty-three patients (11 males and 22 females) underwent an attempt at transcatheter closure of the PDA anterogradely at a median age of 2.8 years (range 0.1 to 19) and median weight of 14 kg (range 2.3 to 64). The median PDA diameter at its narrowest segment was 2.8 mm (range 0.5 to 5.3). A 4Fr catheter was used for delivery of the coils in 30 patients and a 3Fr catheter was used in 3 patients. Eighteen patients underwent multiple coil closure for a PDA diameter of > or = 2.5 mm (using 2 coils in 9, 3 coils in 6, 4 coils in 1, and 5 coils in 2 patients). Follow-up evaluation was performed with color flow mapping of the main pulmonary artery. Thirty-one of the 33 patients had complete closure by the coil technique. The 2 unsuccessful attempts were in 2 patients with a large ductus measuring > or = 4.3 mm and of angiographic type B. For all 13 patients in whom a single coil and in 17 patients in whom multiple coils were placed, there was immediate complete closure that persisted at a median follow-up period of 3.8 months. The median fluoroscopy time was 24 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1979

Premature onset of labor, neonatal patent ductus arteriosus, and prostaglandin synthetase antagonists--a rat model of a human problem.

Premature labor and patent ductus arteriosus are two potentially fatal hazards of the human newborn infant. Prostaglandin synthetase antagonists have thus been used to suppress early labor and to close the ductus of the neonate. Indomethacin has been most effective but not free of significant complications. Neuronal necrosis may result from numerous systemic aberrations. A controlled rat model study was therefore devised to investigate fetal neuronal necrosis in relation to maternal indomethacin dose. Dams were given various treatments of 2 mg/kg of 4 mg/kg indomethacin within the last 3 days of gestation. Liquid chromatography was used to assess serum maternal and fetal drug levels. From light microscopy of more than 200 brains it was apparent that fetal neuronal necrosis correlates with maternal dose.

Animals↗
PubMed1981

Ligation of patent ductus arteriosus in very low birth weight infants.

Twenty-five low birth weight, premature neonates who were refractory to aggressive medical management underwent ligation of symptomatic patent ductus arteriosus. The mean birth weight was 1,007 g and the mean gestational age 29 weeks. Six patients (24 percent) died before discharge, two from continued cardiorespiratory failure. Echocardiography showed significant improvement in left atrial and left ventricular dimensions after ligation. In the premature neonate with respiratory distress and congestive heart failure refractory to aggressive medical management, surgical ligation may be accomplished with an acceptable hospital mortality in very low birth weight infants.

Cardiac Surgical Procedures↗