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PubMed1999

[Bland-White-Garland syndrome co-existing with ventricular septal defect and patent ductus arteriosus--diagnostic difficulties].

A case of a 14 month-old boy suffering from unrecognized Bland-White-Garland syndrome with no typical clinical and electrocardiological features was reported. Diagnostic difficulties were caused by ventricular septal defect and patent ductus arteriosus co-existing with the anomaly of left coronary artery. Death caused by myocardial ischemia occurred after surgical closure of VSD and PDA.

Abnormalities, Multiple↗
PubMed1999

Residual patent ductus arteriosus shunting after single Gianturco coil occluding.

Transcatheter occlusion with Gianturco coils has become the treatment of choice for small patent ductus arteriosus (PDA). Coil occlusion was attempted in 20 patients with ductus diameter less than 4 mm who did not require other cardiac surgery. Sixteen of 20 patients had successful implantation. The mean age was 4.2 years. Their mean weight was 14.1 +/- 5.9 kg. The mean ductus diameter was 2.21 +/- 0.91 mm (range 1-3.7 mm). Nine patients had complete occlusion but 7 had residual shunting immediately after the procedure. However, 4 patients had spontaneous resolution of residual shunts at 6 months after the procedure. The other 3 who had diameter of ductus greater than 3 mm still had significant residual shunt at 6 months and 1 year after the procedure. The second coil was successfully implanted in one of these 3 patients and the closure of PDA was accomplished. We concluded that the second coil should be implanted if the ductus diameter is greater than 3 mm and significant residual shunt is still demonstrated angiographically after the first coil implantation.

Child↗
PubMedDate not supplied

[Gianturco-Grifka device in the percutaneous closure of patent ductus arteriosus].

We present our early experience with the Gianturco-Grifka device for transcatheter closure of patent ductus arteriosus. Grifka occlusion was attempted in 13 patients (7 female, 6 male), median patient age was 6.5 years. Echocardiographic evaluation showed a mean ductal diameter of 5.47 +/- 1.09 mm, and the morphology was type C in 7 patients, type A in 5 and type E in 1 patient. The angiographic ductal morphology was 6 type A, 5 type C and 2 type E. Mean PDA diameter was 5.69 +/- 1.15 mm. Three patients had pulmonary hypertension. They were given supplemental oxygen (100%), decreasing their pulmonary pressures. A total of 13 devices were implanted, 5 of 7 mm and 8 of 9 mm. Twelve patients had complete ductal occlusion documented by aortic angiography (92%), one patient presented residual shunt (8%). Color echocardiography at 24 hrs documented complete occlusion in 12 cases. One device embolized to the descending aorta 2 hours after closure, and it was successfully retrieved in the catheterization lab. We conclude that the Gianturco-Grifka device is an appropriate alternative for transcatheter closure of the PDA. This technique can be performed in ductus arteriosus type C, D and E, with diameter < 9 mm. More clinical trials are needed to establish the long-term results of this technique.

Cardiac Surgical Procedures↗
PubMed2000

Closure of calcified patent ductus arteriosus.

Patent ductus arteriosus (PDA) in adults is occasionally associated with calcification and pulmonary hypertension, for which an anterior approach through a median sternotomy with cardiopulmonary bypass is often used. Sutures are placed without circulatory arrest by using a transpulmonary balloon catheter as an occluder. To secure the suture tie, we used Nélaton's catheters as tourniquets.

Calcinosis↗
PubMed2000

[Non-surgical closure of patent ductus arteriosus: acute and long-term results].

INTRODUCTION: Closure of a patent ductus arteriosus (PDA) even with small shunt volumes in asymptomatic patients is recommended because of the risk of endocarditis (1.5% per year) and the potential development of congestive heart failure or pulmonary hypertension. METHODS: 16 patients (9 adults [5 men/4 women] and 7 children [3 boys/4 girls]) underwent transcatheter closure of a PDA. The intervention was performed using the Rashkind umbrella in 12 cases, the Amplatzer duct occluder in 2 cases, a coil in 2 cases, and the Sideris self-adjusting device in one case. Echocardiographic controls were carried out one day, 6 months, 12 months and 24 months after the intervention. RESULTS: PDA closure was complete immediately following the intervention in 9 of 16 patients (56%). At follow-up (mean 19 months) complete closure was observed in 14 of 16 patients (87%). All residual shunts were trivial. The complete closure rate in adults was 100% and in children 71%. Complications such as device embolism, endarteritis and haemolysis did not occur. CONCLUSION: Non-surgical closure of a PDA is a safe and effective technique.

Adult↗
PubMedDate not supplied

[A comparative study of Rashkind, Grifka and coil devices in percutaneous closing of patent ductus arteriosus].

This study was performed to evaluate the efficacy of transcatheter Coil and Grifka closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Ninety seven patients (36 male and 61 females) underwent occlusion of the PDA. The following variables were compared: age, sex, ductus diameter, morphology, device, occlusion time, residual shunt, multiple device and complications. Data obtained were compared using the Student's test and Chi 2. Median patient age was 7.82 +/- 6.89, forty five patients underwent transcatheter Rashkind-17 closure, 19 patients with Rashkind-12, 18 patients with Coil and 13 patients with Grifka device, in two patients the closure could not be performed. There were differences between the morphology and device used (p = 0.008), between the ductus diameter and device used (p < 0.001). There was immediate closure in 26.7% in the Rashkind-17 group compared with, 57.9% for the Rashkind-12 group, 83.3% for Coil group and of 91.7% for Grifka group. The occlusion within 24 hrs of implantation was 60% with Rashkind-17, 78.9% with Rashkind-12, 94.4% with Coil and 100% with Grifka. Residual shunt persisted for more than a year in 7 patients with Rashkind-17 and 1 with Rashkind 12, (p = 0.001), in 4 patients two devices wore placed. The complications were, 15.5% for Rashkind-17, 26.3% for Rashkind-12, 5.2% for Coil and 30% for Grifka, (p = 0.004), one coil and one Grifka embolized. Transcatheter Coil and Grifka occlusion are more effective in achieving immediate closure than the Rashkind device. The indication to use each device is made according to the morphology and size of the ductus.

Adolescent↗
PubMed2000

[Anesthetic management of an extremely low birth weight neonate for two thoracic surgeries of patent ductus arterious and coarctation of the aorta].

An extremely low birth weight (832 g) and 29 gestational week neonate underwent surgical ligation of patent ductus arterious 20 days after birth and repair of coarctation of the aorta two months after the first operation. She developed asphyxia neonatorum and was artificially ventilated because of IRDS and attack of apnea. At the first operation, anesthesia was maintained with fentanyl and sevoflurane. The only perioperative complication was severe hypothermia (34.5 degrees C). At the second operation, anesthesia maintenance was identical to the first operation. The only perioperative complication was mild hyperthermia (37.7 degrees C). The key points of anesthetic management were the use of a low inspired oxygen fraction to avoid retrolental fibroplasia at a gestational age before 32 weeks and management of the baby's temperature.

Anesthesia, Intravenous↗
PubMed1975

[Certain difficulties of diagnosis and treatment of patent ductus arteriosus].

The diagnosis of patent arterial duct (PAD) is not felt to be difficult in the presence of systolic-diastolic murmur, and in 91.7% of cases it would be established on general clinical investigations. In 8.3% of cases the main ausculatatory sign of this defect was distorted or utterly absent. In such cases the correct diagnosis was somewhat difficult. The absence of systolic-diastolic murmur in patients with PAD with conditioned by pulmonary hypertension, insufficiency of pulmonary artery valves, mitral defect, a small diameter of the duct, aneurysm-like changes in the aorta and pulmonary artery, decreased elastic properties of the latter walls, as well. In the absence of PAD pathognomonic signs catheterization of heart cavities and aortography should be employed. Surgical therapy for the lesion concerned in complicated cases shows some specificity. Utilization of the posterolateral approach, controlled hypotension, provisional application of holders to the aorta and below the duct, its being ligated on synthetic pads made it possible to improve the results of treatment of the lesion involved.

Adolescent↗
PubMed2001

Retrograde transcatheter occlusion of patent ductus arteriosus: preliminary experience in Gianturco coil technique without heparinization.

BACKGROUND: The aim of this study was to report the initial experience of using the Gianturco coil (Cook Cardiology, Bloomington, Indiana) without heparinization to close patent ductus arteriosus (PDA). PATIENTS AND METHODS: Forty consecutive patients (30 females, 10 males) underwent transcatheter closure of a PDA via the right femoral artery approach without heparinization. Patients ages ranged from 7 months to 55 years (median, 6.8 years); weights ranged from 7.8 65 kg (median, 18.3 kg). Twenty-one patients had cardiomegaly (n = 21), congestive heart failure (n = 10), or both (n = 10). The PDAs measured 0.8 4.5 mm (median, 2.6 mm) at the narrowest diameter; the mean Qp/Qs ranged from 1.0 2.6 (1.4 +/- 0.4). The helical diameter of the coil that we chose was 1.7 times the narrowest PDA diameter. The length of the coil was sufficient to produce 4 or 5 loops. RESULTS: Successful coil placement was accomplished in all 40 patients. Thirty-five patients (87.5%) underwent single coil implantation, 2 patients (5%) had 2 coils, and 3 patients (7.5%) had 3 coils. Complete ductus occlusion was achieved in 80% of cases at the end of the procedure, while 8 patients had minimal shunt detected by aortography or echocardiography. The occlusion rate increased to 87.5% by the next day, 90% by 1 month, 92.5% by 3 months, 95% by 6 months, and 97.5% by 9 and 12 months. Only one asymptomatic patient had minimal residual shunt detected by color Doppler at 12 months follow-up. At a median follow-up of 17 months (range, 5 25 months), no patient had thromboembolism, endocarditis, coil migration, diminished femoral pulse or hemolysis. CONCLUSION: Our preliminary results suggest that retrograde transcatheter closure of PDA with the Gianturco coil without heparinization is feasible, safe and efficacious. A single coil allowed complete occlusion of PDA 3 mm in diameter.

Adolescent↗
PubMed2000

[Patent ductus arteriosus. A common clinical problem in extremely premature infants].

An analysis was made of the incidence and treatment regimen of symptomatic patent ductus arteriosus (PDA) in 95 preterm infants treated 1997-1999 in a level three intensive care unit in Stockholm. 47 infants (49 percent) had PDA. Of these 17 infants were managed conservatively (fluid restriction and diuretics), 13 were treated with indomethacin, 10 underwent primary surgical ligation and 7 were treated with indomethacin first and surgery later on. The proportion of infants given "active" therapy (surgery and/or indomethacin) rose from 50 percent in 1997 to 85 percent in 1999. In a stepwise multiple regression analysis low birthweight, septicaemia and need for mechanical ventilation were all independently associated with PDA.

Cyclooxygenase Inhibitors↗
PubMed2000

Surgery for patent ductus arteriosus. Still the gold standard.

The surgical treatment of Patent Ductus Arteriosus (PDA) at the University Hospital of the West Indies, Kingston, Jamaica, was examined over an eight-year period. The results of standard surgical modalities were comparable to large published series. A review of the literature regarding the treatment options for PDA does not support a change in management strategy in favour of non-surgical methods. The treatment of PDA at this centre has shown excellent long-term results, with minimal mortality and morbidity.

Adolescent↗
PubMed2000

Patent review: therapeutic applications for antisense oligonucleotides 1999-2000.

Over 200 patents disclosing antisense sequences have been published in the last year. 30 Of these, in which a therapeutic application is claimed, have been reviewed in this article. We have classified these under the headings of antibacterial, antiviral, inflammation, cardiovascular, apoptosis and anticancer. Although not exhaustive or covering all diseases, major areas of antisense research have been addressed.

Animals↗
PubMed2001

[A case of central nervous system anomalies (agenesis of corpus callosum, colpocephaly, hydrocephalus, congenital dermal sinus) associated with congenital heart disease(double-outlet right ventricle, complete endocardial cushion defect, atrial septal defect, pulmonary arterial stenosis, patent ductus arteriosus)].

A case of central nervous system anomalies(agenesis of corpus callosum, colpocephaly, hydrocephalus, congenital dermal sinus) associated with congenital heart disease(double-outlet right ventricle, complete endocardial cushion defect, atrial septal defect, pulmonary arterial stenosis, patent ductus arteriosus) is reported. Female patient had been already diagnosed as hydrocephalus during pregnancy and ventricular drainage was performed soon after the delivery. Prostaglandin E 1 was also applied for heart disease, but saturation of O2 decreased to 80% on arterial blood gas analysis. Blalock-Taussig operation and ligation of ductus arteriosus was done 41 days after the delivery and ventricle-peritoneal shunt was also made for the progressive hydrocephalus on the same day. Chromosome analysis showed no abnormality. The genesis of this complicated brain and heart anomaly is discussed from the viewpoint of neural crest cell abnormality.

Abnormalities, Multiple↗
PubMed2001

Complicated persistent patent ductus arteriosus with acute pneumonia in an adult.

Patent ductus arteriosus (PDA) is a malady usually identified during childhood. Prompt surgical correction provides definitive therapy with long-term survival. When not corrected, PDA leads to significant morbidity and mortality, making it a rare condition in the adult population. We report the case of a 44-year-old man with a history of persistent PDA admitted for worsening dyspnea and fever. Radiographic studies are illustrative of this complex syndrome. We review the complications and treatment alternatives in these patients.

Acute Disease↗
PubMedDate not supplied

Transcatheter closure of secundum atrial septal defects, a ventricular septal defect, and a patent arterial duct.

We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.

Adolescent↗
PubMed2001

Ever heard of percutaneous transvenous selective coronary angiography? Unusual approach in a patient with patent ductus arteriosus.

Arterial access for coronary angiography is usually achieved by the use of direct arterial puncture or, less frequently, by arterial cutdown. We present the case of a 39-year-old woman in whom a patent ductus arteriosus was used to enter the arterial system for left ventriculography, aortography, and selective coronary angiography. To our knowledge, this is the 1st reported case of selective coronary angiography with use of a transvenous approach.

Adult↗
PubMed2001

Role of natriuretic hormones in the diagnosis of patent ductus arteriosus in newborn infants.

UNLABELLED: Haemodynamically significant patent ductus arteriosus worsens respiratory distress by initiating pulmonary congestion and inactivating of surfactant. Excepting size of the ductus, several factors influence ductal flow. CONCLUSION: Atrial natriuretic hormones provide clinically useful data, especially in serial follow-up of the patient.

Atrial Natriuretic Factor↗
PubMed2001

Reversed patent ductus arteriosus in a dog.

A 5-year-old cocker spaniel with tachycardia, > 2 s capillary refill time, arrhythmia, split S2 heart sound, right ventricular enlargement, flattened interventricular septum, dilated pulmonary artery, and slight tricuspid valve insufficiency was diagnosed with reversed patent ductus arteriosus (right-to-left vs the more common left-to-right shunt). Two years later, the dog was still stable.

Animals↗