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At least 1,261 records · Page 70Linked to original sources

Validation of color Doppler measurements of minimum patent ductus arteriosus diameters: significance for coil embolization.

BACKGROUND: Echocardiography is sometimes performed to identify candidates for coil embolization of patent ductus arteriosus (PDA). Therefore we attempted to determine the validity of color Doppler echocardiography to accurately determine the minimum PDA diameter. METHODS AND RESULTS: We reviewed data from 27 children (median 3.8 years, range 1 to 15 years) with PDAs and measured their minimum ductal diameters by color flow Doppler echocardiography and by angiography. We found that there were significant mean differences between the color Doppler and angiographic measurements (2.7+/-0.8 vs 1.6+/-0.7 mm, P< .001) with color Doppler exceeding angiographic measurements by > or = 1.0 mm in 15 (56%) of 27 patients. More importantly, color Doppler measured a PDA > or = 4.0 mm (usually greater than that recommended for coiling) in 3 (11%) patients in whom the angiographic measurement was <4.0 mm. Correlation analysis demonstrated no correlation between the color Doppler and angiographic measurements (r2 = 0.17, P= .04, SEE = 0.2 mm). CONCLUSIONS: These data suggest that color Doppler echocardiography often overestimates the true minimum PDA diameter, therefore we recommend that a color Doppler-based recommendation that a PDA is too large for transcatheter coil occlusion not be used exclusively to exclude a patient from this treatment modality.

Adolescent↗

Transcatheter closure of patent ductus arteriosus with the use of Rashkind occluders and/or Gianturco coils: long-term follow-up in 123 patients and special reference to comparison, residual shunts, complications, and technique.

BACKGROUND: This report describes the long-term follow-up of transcatheter closure of patent ductus arteriosus (PDA) with 2 different modalities in 123 patients of diverse ages. METHODS AND RESULTS: Between October 1990 and August 1997, 123 patients underwent transcatheter PDA (1.9 to 7.5 mm) closure at a mean age of 6.8 +/- 8.9 years (range 0.06 to 52) and mean weight of 20.9 +/- 17. 6 kg (range 2.7 to 83). In the initial procedure, the Rashkind device was used in 60, the Gianturco coil(s) in 60, and the Rashkind device with a coil in 3 patients. Six-month closure rate for the Rashkind group was 77% versus 90% for the coil group. The second procedure was carried out for residual shunt in 19 (14 in the Rashkind group and 5 in the coil group) and a third procedure in 1 patient from the Rashkind group. A balloon wedge catheter was used in 50 of 78 coil procedures to prevent coil embolization. One device and 11 coils (8 without balloon aid) embolized to the pulmonary arteries. The device and all coils except 2 were retrieved successfully. Overall, 122 (99%) patients showed complete PDA closure. The mean uneventful follow-up period was 44.11 +/- 23.77 months (range 8.7 to 90.28). CONCLUSIONS: Transcatheter closure of PDA is feasible in infants as well as in patients >50 years of age without significant complications. The coils are easy to implant, less expensive, and multiple coils may be used in moderately large (>3.5 mm) ducts more effectively than with the Rashkind device. The use of a balloon wedge catheter prevents immediate coil embolization. Multiple procedures are feasible and safe to achieve complete closure.

Adolescent↗

Doppler derivation of complete pulmonary artery pressure curves in patent ductus arteriosus.

Doppler echocardiography can be used in patients with a patent ductus arteriosus to generate complete pulmonary artery pressure curves. This technique provides a dynamic evaluation of changes in pulmonary artery pressures throughout the cardiac cycle and provides more hemodynamic information than single-point Doppler velocity methods of estimating pulmonary artery pressures.

Aorta↗

Single therapeutic catheterization to treat coexisting coarctation of the aorta and patent ductus arteriosus.

A case of a pediatric patient found to have coexisting coarctation of the aorta and patent ductus arteriosus who underwent balloon dilation of the coarctation and coil occlusion of the ductus in a single cardiac catheterization is presented. Review of the English literature revealed no previous reports of this combination of transcatheter interventions during a single catheterization procedure.

Aortic Coarctation↗

Transcatheter closure of patent ductus arteriosus using coils.

Ninety-seven of 100 patients had a successful attempt at coil closure of the patent ductus arteriosus. For all 46 patients in whom a single coil and in 47 patients in whom multiple coils were placed, there was immediate complete closure that persisted at a median follow-up period of 1.9 years.

Adolescent↗

Coil occlusion versus conventional surgical closure of patent ductus arteriosus.

This retrospective cohort study evaluated the clinical outcome and cost-effectiveness of 2 treatment strategies for children with an isolated restrictive patent ductus arteriosus. Results indicate a superior cost-effectiveness of transcatheter coil occlusion compared with conventional surgery for these patients.

Cardiac Catheterization↗

Comparison of hospital charges for closure of patent ductus arteriosus by surgery and by transcatheter coil occlusion.

Hospital charges for coil occlusion were significantly less than for surgical closure of patent ductus arteriosus, and were reduced over time as experience permitted refinement of the coil occlusion protocol. The expected hospital charges for closure by a coil occlusion strategy, including the charges for surgical closure in patients with failed coil occlusion, was less than the hospital charges for surgical closure strategy under any reasonable estimate of coil occlusion efficacy.

Adolescent↗

Transvenous "snare-assisted" coil occlusion of patent ductus arteriosus.

Sixty consecutive patients underwent successful transcatheter closure of patent ductus arteriosus without morbidity using a modified transvenous "snare-assisted" approach and a single elongated Gianturco coil. This technique ensures complete occlusion and avoids inadvertent embolization of the coil to undesirable sites, making transcatheter occlusion a viable alternative to surgical ligation.

Adolescent↗

Results of transvenous buttoned device occlusion of patent ductus arteriosus in adults. International Buttoned Device Trial Group.

Examination of the immediate and follow-up results of transvenous buttoned device occlusion of patent ductus arteriosus suggests that the method is feasible, safe, and effective irrespective of the size and shape of the ductus. Although residual shunts are present, they tend to disappear during follow-up, and complete occlusion at the time of implantation may be achieved by incorporation of a folding plug over the button loop of the device.

Adolescent↗

Follow-up after coil closure of patent ductus arteriosus.

A prospective serial follow-up after coil closure of patent ductus arteriosus in 84 patients showed a cumulative duct closure up to 96% at the end of 2 years. Five patients underwent transient recanalization, and 4 patients required repeat procedure for residual shunt or recanalization.

Adolescent↗

[False aneurysm complicating ligation of patent ductus arteriosus operated on successfully].

Postoperative aneurysm of ductus arteriosus is a rare complication but may be lethal without treatment. It is less frequent than spontaneous aneurysm of ductus arteriosus. We report the case of 5 years-old girl who underwent a ligation of patent ductus arteriosus complicated, 6 months later, with a false aneurysm of ductus arteriosus and endocarditis of the ductus and the aortic valve. The diagnosis of the aneurysm was suspected on the anteroposterior chest X-ray which showed a left superior mediastinal opacity and confirmed by echocardiography. Through bilateral thoracotomy, an anevrismorraphy and aortic repair was carried out without problem. The postoperative course was unremarkable.

Aneurysm, False↗

Patent ductus arteriosus and microdeletion 22q11 in a patient with Klinefelter syndrome.

We describe an uncommon association of deletion 22q11 in a patient with Klinefelter syndrome. Even though congenital heart defects (CHD) are not associated with Klinefelter syndrome, further investigation of this patient with patent ductus arteriosus showed a microdeletion of chromosome 22q11.2. While this finding may be coincidental, it is important to further evaluate patients when the clinical features are suggestive of a secondary abnormality.

Adult↗