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PubMed2000

[New methods of percutaneous closure of patent ductus arteriosus].

Various devices have been developed for the percutaneous closure of persistent patent ductus arteriosus (PDA). In recent years Gianturco coils have become increasingly widespread for this purpose. Poor control during positioning is a major disadvantage of Gianturco coils, with resultant embolization of coils and residual shunts. Very recently a new screwing detachable coil is available (Cook Cardiology, Europe). Between January 1996 and January 2000, 34 consecutive patients with PDA underwent cardiac catheterization. Thirty cases were judged suitable for this procedure, on the base of diameter and morphology of the ductus. Three cases were excluded because of the ductal diameter was too large (> 4.2 mm) and one because of its morphology (type B). In 28 patients a single coil was positioned, while in one case 2 coils were simultaneously used. In 29 cases (97%) complete closure was obtained (in 18 cases immediately, in 6 after 24 hours, in 5 after 1 month). One case showed a residual shunt and a second coil was applied eighteen months later with complete closure. So, considering also this last case, the closure was achieved in 100%. There were neither embolization or other complications. In conclusion, screwing detachable coil for PDA closure is a safe, very effective and at low cost technique. Therefore nowadays this procedure represents the method of choice for occlusion of small PDA (minimal diameter < or = 4 mm).

Adolescent↗
PubMedDate not supplied

Subadventitial hematoma of a patent ductus arteriosus and thrombus formation within the aorta secondary to cardiac catheterization.

An 18-month-old boy with patent ductus arteriosus (PDA) underwent surgical closure of PDA. Cardiac catheterization determined the PDA was not suitable for transcatheter closure. After the chest was opened, subadventitial hematoma was seen on the aortic end of the PDA. Incision of the aorta revealed a thrombus secondary to intimal laceration. The thrombus was extracted and the PDA was closed using division technique. Because no similar report was found in English-language literature, the technique and the surgical strategy are discussed.

Aorta↗
PubMedDate not supplied

Hydroxyurea for treatment of polycythemia secondary to right-to-left shunting patent ductus arteriosus in 4 dogs.

Four adult dogs with polycythemia secondary to reversed patent ductus arteriosus (rPDA) were treated with hydroxyurea, a myelosuppressive agent, for 6-22 months. Regardless of initial hematocrit, clinical signs attributed to the presence of polycythemia improved with hydroxyurea treatment. Chronic hydroxyurea therapy (40-50 mg/kg PO q48h) was well tolerated in this group of animals; mild, clinically silent thrombocytopenia and leukopenia were detected in some animals but resolved with decreased dosage or dose frequency. Chronic hydroxyurea therapy may provide an alternative to repeated phlebotomy for therapy of polycythemia secondary to rPDA.

Animals↗
PubMedDate not supplied

Unusual giant patent ductus arteriosus associated with ventricular septal defect and discrete aortic coarctation. A case report.

The authors present the case of a 26 years old female, 56 kg weight and 154 cm height, with a giant patent ductus arteriosus (2.4 cm of internal diameter), ventricular septal defect, discrete preductal narrowing of the aortic arch and pulmonary artery hypertension that did not diminished after 100% oxygen breathing. The authors speculate about the origin of the giant ductus here presented, based on hemodynamic and embryological data.

Adult↗
PubMed2001

False aneurysm and mediastinal hematoma: complications of simultaneous transcatheter therapy for coarctation of the aorta and patent ductus arteriosus in an infant.

We report an infant with intractable congestive heart failure caused by coarctation of the aorta, patent ductus arteriosus, atrial septal defect, and multiple muscular ventricular septal defects. He had received balloon angioplasty for dilating the aortic coarctation and a Gianturco coil for closing the ductus at a single therapeutic catheterization session at 4 months old. After balloon angioplasty, his heart failure had dramatically resolved. A false aneurysm and mediastinal hematoma were noted on the following day. The hematoma revealed total resolution 10 weeks later. He was asymptomatic throughout 12 months of follow-up.

Aneurysm, False↗
PubMed1996

[The first invention patents in general anaesthesia].

Dra, Zimmer describes in this work the evolution of general anaesthesia for surgeries, quoting the recorded invention patents, since the 1st one performed in France - an ether anaesthesia - in 1846, 2 years after Wells had used nitrous oxide as gas for a surgery (december 1844).

Anesthesia, Dental↗
PubMed2001

Patent ductus arteriosus closure using the new Amplatzer Duct Occluder. Preliminary results and review of the literature.

BACKGROUND: Patent ductus arteriosus (PDA) is the second most common congenital heart disease. A large number of surgical and transcatheter techniques for the interruption or closure of PDA has been reported. The aim of this study was to assess the immediate and short-term results of transcatheter closure of PDA using the new, self-expandable, self-centering, and repositionable Amplatzer Duct Occluder device. METHODS: We attempted occlusion of PDA with the Amplatzer Duct Occluder in seven consecutive patients, one child and six adults, four females and three males, between September 1999 and January 30th 2000. All PDAs but one were approached from the femoral venous site; the Amplatzer Duct Occluder size was selected in order to be 2 mm larger than the duct's diameter at its narrowest site and the mean PDA diameter was 5.4+/-2.5 mm (range 3-9). All patients underwent physical examination, chest X-ray and echocardiography within 48 hours and on first and third month after PDA occlusion. RESULTS: Four patients had a megaphone type (type A), and three had an elongated, conical type (type E) PDA. Four patients had immediate, complete angiographic closure of the ductus 10 minutes after the procedure, one had a trace shunt and two had small shunts which all disappeared within 48 hours. The average fluoroscopy time and procedural time were 34.4+/-10.6 min (range 21-50) and 105+/-38.9 min (range 75-190) respectively. There were no complications at follow-up. CONCLUSIONS: Transcatheter closure of PDA using the new Amplatzer Duct Occluder is an easy and effective technique. Moreover it is safe even in the presence of wide PDAs.

Adolescent↗
PubMedDate not supplied

Diagnosis of haemodynamically significant patent ductus arteriosus in neonates-- is the ECG of diagnostic help?

The presence of a haemodynamically significant patent ductus arteriosis (PDA) in the premature newborn may contribute to the development of brochopulmonary dysplasia, intraventricular haemorrhage and necrotising enterocolitis. It is therefore essential that the diagnosis of such a PDA be made in time in order to intervene medically or surgically. Echocardiography is at present the prime diagnostic tool, but it is mainly available in tertiary hospitals. Chest roentgenography is of little diagnostic value especially in the presence of respiratory disease, which is often present in premature babies. Very little is known about the diagnostic value of the electrocardiogram (ECG) in premature babies. The aim of this study was to describe the standard 12-lead ECG findings in low-birth-weight babies with haemodynamically significant PDAs. Thirty-two babies with haemodynamically significant PDAs, as established by echocardiography, were included in the study. Standard 12-lead ECGs were done in all these babies. In 15 patients ECG abnormalities were found; only 22% had left atrial and left ventricular enlargement indicative of significant left-to-right shunting, while 78% had no ECG changes indicative of left-to-right shunting. In conclusion, the ECG cannot be used to identify haemodynamically significant PDAs.

Cardiovascular Surgical Procedures↗
PubMed2001

Transcatheter closure in 354 pediatric cases of patent ductus arteriosus using five different devices.

OBJECTIVE: To assess the effect of transcatheter closure of patent ductus arteriosus (PDA) by comparing five different devices. METHODS: 354 patients (135 males, 219 females) underwent transcatheter closure of PDA using the Porstmann Ivalon plug, Rashkind double umbrella, Sideris button device, Coils and Amplatzer occluders. The mean PDA diameter at its narrowest segment was 3.1 +/- 1.3 mm. Qp/Qs was 2.2 +/- 0.5. Follow-up evaluation was performed with color flow mapping of the main pulmonary artery at 24 h and 6 months after closure. RESULTS: Successful occlusion was observed in 92% (23/25) for the Porstmann device, 98.7% (77/78) for the Rashkind device, 100% (43/43) for the Sideris device, 100% (69/69) for the Coil and 100% (139/139) for the Amplatzer device. No residual shunts were needed for the Porstmann, while 1.4%-15% of patients who received the Rashkind, Sideris, Coils or Amplatzer needed residual shunts during follow-up. There were complications of 24% (6/25) for the Porstmann, 3.8% (3/78) for the Rashkind, 1.4% (1/69) for Coils and 1.4% (2/139) for the Amplatzer. No complications were found in patients with the Sideris device. CONCLUSION: The results showed that the Sideris device, Coils and the Amplatzer device are more effective and safer than the others for the occlusion of PDA in children.

Adolescent↗
PubMedDate not supplied

Federal court of appeal strikes claim for extending patent term.

In a short October 1999 decision, Pfizer Inc v Canada, the Federal Court of Appeal affirmed a lower court decision that Canadian law currently provides only 17 years protection for drug patents filed before October 1989, and that the 20-year minimum period stated in intellectual property treaties negotiated under the auspices of the World Trade Organization have not (yet) taken effect in Canada with respect to these drugs.

Anti-HIV Agents↗
PubMed2002

[A case report of ross operation and ventricular septal defect closure following correction of type A interruption by modified Blalock-Park, pulmonary artery banding and patent ductus arteriosus division].

A 2-year-old boy who had undergone a correction of a type A interruption using a modified Blalock-Park operation, pulmonary artery banding and the division of a patent ductus arteriosus, underwent a Ross operation and closure of ventricular septal defect (VSD). Although a pre-operative echo cardiogram revealed a bicuspid aortic valve, and a Doppler echocardiogram showed only 10 mmHg of pressure gradient across the aortic valve, Ross procedure was performed as a procedure accompanying the closure of a total conus VSD. The total conus VSD was closed with a Dacron patch using pledget mattress sutures. In addition, a running suture was applied over the denuded aortic root and the cranial margin to achieve water tight closure. An aortic root replacement procedure was our first choice for the Ross operation. After both coronary buttons were re-implanted into pulmonary sinuses, a pulmonary artery autograft was wrapped around by the remaining aortic wall for reinforcement to prevent future dilatation. The main pulmonary artery was reconstructed using a bicuspid pericardial valve conduit with a diameter of 24 mm. A post-operative echocardiogram showed no neoaortic valve regurgitation, good coaptation of tri-leaflets, mild regurgitation of pericardial valve and good cardiac performance.

Abnormalities, Multiple↗
PubMed2002

Video-assisted thoracoscopic surgical (VATS) closure of Patent Ductus Arteriosus: report of three-hundred cases.

BACKGROUND: Video-Assisted Thoracoscopic Surgery (VATS) has recently been used for Patent Ductus Arteriosus (PDA) closure on a routine basis. Our experience with this technique is supporting its efficacy. The results and advantages of VATS are the same as when thoracotomy is being performed. METHODS: From June 1997 to October 2000, there were 300 consecutive patients (mean age: 6 years old) with PDA recognized by echocardiography and/or cardiac catheterization, on whom VATS were studied. With the patients under general anesthesia, three 5 mm holes were made through the left thoracic wall. A video camera and specialized surgical devices were introduced. The ductus was dissected, and two titanium clips were applied for complete closure of the ductus. Exclusion criteria were: 1) Diameter of the ductus > 9 mm, 2) Complicated PDA such as aneurysm formation, endocarditis, and calcification, 3) Pleural adhesion and/or left sided thoracic operation in the past. RESULTS: All cases were re-assessed immediately after the procedure, and followed up by control echocardiography. No significant complication and residual shunt was recorded during the observation period. The procedure was changed to thoracotomy in three adult patients due to an inappropriately dilated canal (>9mm). Moreover, two other patients developed transient recurrent laryngeal nerve dysfunction. Mean procedure time was about 20 +/- 2 minutes. All patients were discharged shortly after the procedure (approximately 20 hours). CONCLUSION: Our results suggest that VATS compared to other techniques for PDA closure is rapid, cost-effective, painless and more cosmetic.

Adolescent↗
PubMed2002

[Roentgeno-endovascular occlusion and surgical correction of patent ductus arteriosus].

To establish the indications to classical surgical correction and roentgenoendovascular occlusion (REO) of patent ductus arteriosus (PDA) results of treatment of patients with PDA were compared. Immediate results of treatment of 209 patients with PDA were analyzed. 110 patients underwent classical surgical operations which were performed successfully in 109 (99%) patients. Complications in early postoperative period were the following: incomplete expanding of the left lung in 1 (0.9%) patient, reactive exudation into left pleural cavity--in 1 (0.9%), and chylothorax--in 1 (0.9%). REO of PDA was performed in 99 patients. Gianturco coils (COOK, Denmark) and Saveliev--Prokubovsky occluders were used. REO was successful in 93 (93.9%) patients. It failed in 6 (6%) cases including 3 cases with coils and 3--with Saveliev--Prokubovsky occluders. According to the results, PDA with diameter less than 4 mm in the narrowest part can be closed by REO with Gianturco coils. In PDA with diameter 4-10 mm Saveliev--Prokubovsky occluders are recommended. In case of PDA with diameter more than 10 mm, aortopulmonary defect or septic botallitis it is necessary to perform thoracotomy and surgical correction.

Balloon Occlusion↗
PubMed1975

[Completely interrupted aortic arch, ventricular septal defect and patent ductus arteriosus. A complete surgical correction in one procedure (author's transl)].

The authors present a case of completely interrupted aortic arch (Type B) associated with ventricular septal defect and patent ductus arteriosus in a child 3 years and 10 months old, who was successfully subjected to complete surgical correction in one procedure. The pre- and post-operative electrocardiographic and hemodynamic data are evaluated. The authors draw attention to the extreme rarity of surgical resolution, in one procedure, of this type of congenital heart disease.

Aorta↗
PubMed2002

[Association of non-compacted myocardium and patent ductus arteriosus in a young asymptomatic male patient: findings in screening for contact sport eligibility].

Spongy or noncompacted myocardium is a rare congenital cardiomyopathy characterized by parietal myocardial structural alterations secondary to intrauterine arrest of myocardial fiber compaction. It can be associated with other congenital cardiovascular malformations or manifest as an isolated disease. It is characterized by a wide variety of clinical presentations that range from complete absence of symptoms to thromboembolic manifestations, ventricular arrhythmias and congestive heart failure; the short- and mid-term prognosis is quite severe. We here describe a casual finding of an advanced form of noncompacted myocardium associated with patent ductus arteriosus in a young asymptomatic athlete during a routine visit for agonistic sports eligibility. Although the patient had a normal functional capacity, transthoracic echocardiography showed left ventricular dilation with a moderately depressed contractile function and the presence of numerous prominent trabeculae and deep intertrabecular recesses which communicated with the left ventricular cavity. These findings which were confirmed by further echocardiographic examinations, and the absence of other cardiovascular disorders associated with this disease, led us to the diagnosis of noncompacted myocardium. The patient was not allowed to perform sports activities and underwent percutaneous closure of the patient ductus arteriosus. He was asymptomatic and because in the recent literature there are no data regarding pharmacological therapy in these patients, the subject was submitted to routine clinical follow-up evaluation with no medical therapy.

Adult↗
PubMed2002

Transcatheter coil occlusion of small patent ductus arteriosus: experience at Siriraj Hospital.

UNLABELLED: Transcatheter coil occlusion of small-to-moderate-size patent ductus arteriosus (PDA, < 3.5 mm) is well established as a procedure of first choice in many institutions. Its much lower cost compared with surgical ligation or other devices makes it an attractive option, especially in Thailand. PATIENTS AND METHOD: Between September 1995 and June 2000, all patients diagnosed with PDA with audible murmur and echo-Doppler confirmation of diameter less than 3.5 mm were scheduled for transcatheter coil occlusion at the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The hemodynamic studies were obtained both pre and post occlusion. The immediate and late outcome, including complication were assessed. RESULTS: A total of 77 cases, 78 procedures of transcatheter PDA coil occlusion were performed. Seventy cases (90.9%), comprised of 19 males (27.1%) and 51 females (72.9%) were successfully deployed with coils. The remainder were unsuccessfully deployed and later referred to surgery. The median age of the successful group was 6 years and 6 months and median weight was 16.5 kg. Twenty cases (28.6%) had other associated intra and extracardiac anomalies. All patients were asymptomatic, except one case having bronchopulmonary dysplasia (BPD) from prolonged ventilation. Single-coil occlusions were performed in 74.3 per cent and double-coil occlusions in 25.7 per cent. Conventional 0.038-inch Gianturco coils were deployed in 86.5 per cent. The mean procedure time was 78.1 +/- 35.1 minutes. The mean fluoroscopic time was 20.2 +/- 15.6 minutes. The total complete occlusion rate was 87.7 per cent. Tiny residual flow of PDA was demonstrated by follow-up echocardiogram in 12.3 per cent. Seven per cent of the patients were lost to follow-up. There was no significant difference in PDA size and hemodynamics between the groups of patients with complete occlusion and having residual shunt. Minor complications occurred in 12.9 per cent, including mild left pulmonary artery stenosis (10%), coil embolization to distal pulmonary artery (8.6%), slippage of catheter with coil (2.9%) and decreased dorsalis pedis pulse (1.4%). One late death was found in a BPD patient from pneumonia 2 months after the procedure. CONCLUSION: Transcatheter coil occlusion of PDA is as effective, feasible, safe and less costly than surgical ligation. With improvement in technique and device selection and appropriate case selection, there should be an increase rate of complete occlusion and a decrease in complications.

Analysis of Variance↗