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PubMedDate not supplied

[Transcatheter occlusion of the patent ductus arteriosus with detachable coils: immediate results and intermediate-term follow-up].

OBJECTIVE: To determine the success rate and safety of percutaneous closure of patent ductus arteriosus (PDA) with a detachable coil. METHODS: Forty-one children with small- to moderate-size PDA (maximum diameter < or = 4 mm) underwent percutaneous coil occlusion. The results were assessed by angiography and echocardiography. The mean age was 2.0 +/- 1.3 years (range 0.6 to 5.6 years); mean weight was 10.0 +/- 3.4 kg (range 4.5 to 18.0 kg). The mean minimum diameter of the PDA was 1.7 +/- 0.6 mm (range, 0.5 to 4.0 mm). RESULTS: The occlusion device was inserted in 39 of 41 patients (95%). The mean coil/PDA ratio was 3.41 +/- 1.1. We observed angiographic cessation of blood flow through the PDA after coil insertion in 18 patients; 18 patients had residual shunt, 3 mild shunt and 2 moderate shunt. No complications were observed during the procedure. Thirty-five patients showed absence of blood flow through PDA 24 hours after coil occlusion by echocardiography. The other four patients with residual shunt showed flow cessation after 2 months in two patients and after 6 months in the other two. Failure of coil insertion in two patients was due to detachment of the pulmonary edge of the coil, which was subsequently removed in one, and due to coil migration in the other, both patients underwent surgical PDA closure. Mean follow-up at 29.5 +/- 16.5 months showed no residual blood flow through the occluded PDA, except for one patient. CONCLUSION: Our results, as many others, suggest that PDA coil occlusion is a safe, effective, and cheap procedure. PDA coil occlusion should be the elective method for PDA closure in patients older than 6 months of age with small- to moderate size PDA (< or = 4 mm). The procedure in newborn infants and patients with larger PDA must be made with a different type of occlusive device.

Cardiac Catheterization↗
PubMed2006

Patent ductus arteriosus endovascular closure by amplatzer duct occluder.

Transcatheter occlusion of patent ductus arteriosus (PDA) using various occluding devices and coils is a widely accepted alternative to surgical closure in most pediatric cardiology centers. In spite of these advantages in transcatheter management, the occlusion of the moderate and the large PDA remains a challenge. The Amplatzer Duct Occluder (ADO) (AGA Medical, Golden Valley, MN, USA) is a new device with easy placement. It is reported to have higher rates of occlusion than other occluders currently available for transcatheter closure of PDA. 18 patients (6 male and 12 female) underwent transcatheter closure of PDA using the ADO. The mean PDA minimal diameter (pulmonary end) was 5,4+/-2,8 mm (range 4,0 mm-12 mm). We do not use ADO for small PDA closure (</=3 mm). The patients weight range was from 11 to 68 kg (mean 14,2 kg); the age range 10 month to 21 years (mean 7,3 years). The pulmonary to systemic flow ratio (Qp/Qs) ranged 2,3-4 (mean 2,6+/-1,4). All patients had no high pulmonary pressure (the highest mean pulmonary artery pressure was 35 mmHg). In all patients device was easily delivered and deployed. Complete angiographic closure at the end of the procedure was present in 16 patients (90%) of 18 patients, but there were evidence of complete PDA closure during first 12 hours. Foaming (minor diffuse leak through the Dacron fabric and no contras jet) was seen in 16 patients (98%) but was disappeared within 8-12 minute. Fluoroscopy time was 6,9+/-5,9 minutes (3,9-15 min). No complications were observed. Our experience indicates that the ADO is a highly efficient device that can be safely applied in most patients with PDA. Closure with ADO results in a 100% (in our limited study) occlusion rate at short and long term results.

Adolescent↗
PubMedDate not supplied

[Patent ductus arteriosus in the adult: transcatheher treatment immediate and medium term results].

INTRODUCTION: The anatomic changes of the patent ductus arteriosus (PDA) in adult patients, such as aortic aneurysm, calcification, or being short and sometimes friable, could complicate the surgical treatment. The transcatheter occlusion of PDA with different devices is currently accepted as safe and effective. We presented our experience with percutaneous occlusion of PDA in adult patients by means of three different devices. METHODS AND RESULTS: Between January 2000 and March 2005, 53 adult patients (47 women and 6 men) with PDA were treated for occlusion by means of percutaneous procedures. Average age was 25.3 years (Range, 16 to 54.7 years). Three different devices were used, 39 patients with Amplatzer for ductus arteriosus, 1 patient with Amplatzer for muscular interventricular communication, 11 with Gianturco coils, and 1 patient with Nit-Occlud. All devices were implanted successfully. Immediate complete closure was achieved in 31 patients (58.4%), in 20 patients (37.7%) with minimal leakage, and in 2 patients (3.89%) with moderate leak. Previous systolic pulmonary pressure had an average of 37.08 +/- 22.8. mm Hg (Range: 12-138 mm Hg) and went down to 28.75 +/- 10.25 mm Hg (Range: 16-57 mm Hg) with p d x 0.001. The average time follow-up was of 16.8 months (Range: 0.9 to 51.8 months) the occlusion was completed in 100%, in neither patients were observed complications related to implant of the devices. CONCLUSION: Transcatheter closure at PDA in adult patients with different devices is safe and feasible.

Adolescent↗
PubMed2006

[Robotically and video-assisted thoracoscopic interruption of patent ductus arteriosus].

Over the past decade, video-assisted thoracoscopic techniques have been used in the pediatric population. Recently, the computer-enhanced robotic system has been applied to video-assisted thoracoscopic interruption of patent ductus arteriosus (VATS-PDA). We focused on the utility of a voice-controlled robotic arm (automated endoscope system for optimal positioning: AESOP 3000) in VATS-PDA. Thirteen infants weighing 4.2 approximately 12.6 (mean 6.6) kg underwent robotically assisted VATS-PDA. Robotically assisted VATS-PDA is comparable with closure by means of the conventional video-assisted thoracoscopic technique.

Child, Preschool↗
PubMed2006

[Transcatheter closure for patent ductus arteriosus in children].

OBJECTIVE: To evaluate the results of transcatheter closure for patent ductus arteriosus (PDA) by different devices in children. METHODS: Seventy-eight cases of PDA in children (7 months to 14 years old), diagnosed by physical examination and transthoracic 2-dimensional echocardiography (TTE), were included in the study. The examination included the cardiac catheterization, photograph of the thoracic aorta and conventional technique of PDA closure. Among these patients, 16 were treated with coils, 9 with Amplatzer duct occluder (ADO), and 53 with native produced PDA occluders. RESULTS: TTE examination on the next day of the operation showed that PDAs were completely occluded in 76 cases, while the other 2 cases treated by coil had minimal residual shunt. Sixty-four patients, who were detected enlargement of the left ventricle before the operation, showed obvious diminishment of the cardiac size. By the end of 3 months, TTE examination showed that the closure of PDA was complete, and the left ventricle size was normal in 77 cases, while one case treated with coil had minimal residual shunt, which persisted for more than 4 years. The 3 - 80 months follow-up showed that the closure of PDA was complete in 77 cases, the configurations of the left ventricle, the thoracic aorta,and the left pulmonary artery were all normal. The occluders were well remained in situ. CONCLUSION: The usual procedures of transcatheter closure for PDA are effective and safe with ADO, native produced occluders and coil in children. Interventional method, which shows minute insult, few complications, and few adverse effects, can substitute the thoracic surgery.

Adolescent↗
PubMedDate not supplied

Combined transcatheter closure of atrial septal defect and patent ductus arteriosus: report of two cases.

Atrial septal defect (ASD) and patent ductus arteriosus (PDA) are common congenital heart defects and usually isolate. The combination of these two defects is infrequent. Nowadays, both defects are amenable to transcatheter closure, without surgery. However, both defects by transcather closure was rarely reported. Here we report that two children with ASD and PDA benefited from combined interventional therapy using the Amplatzer septal occluder for the ASD and Gianturco coils for the PDA. Based on our limited experience, closing the PDA before the ASD may be a better option.

Cardiac Catheterization↗
PubMed2006

Paraplegia after thoracotomy for division and suture Patent Ductus Arteriosus (PDA).

A Thai women, aged 22 years old, came to hospital with Patent Ductus Arteriosis (PDA). Left thoracotomy, with division and suturing PDA, was performed. The second day after operation, she developed paraplegia below umbilical level. The CT-scan detected an extradural hematoma in the spinal cavity from T3-T6. To remove the blood clot, the T spine laminectomy was performed. 6 months after the laminectomy, the patient was able to perform her regular exercise.

Adult↗
PubMed1991

[Morphological changes in patent ductus arteriosus after endovascular occlusion (clinico-experimental study)].

The work is based on a comparison of data gained in experiments with the results of clinical examination of a large group of patients in the late-term period after endovascular occlusion of a patent ductus arteriosus (PDA). The regular features of the course of the morphological process in the zone of the PDA after implantation of a botallo-occluder into it were studied. Clinico-morphological parallels were made. The high efficacy and reliability of the new method of endovascular treatment of PDA, developed at the Moscow Second Medical institute, was substantiated morphologically and confirmed clinically.

Animals↗
PubMed1991

Patent ductus arteriosus in African preterm infants.

During a 7 month period, April to October, 1984, 537 consecutive babies weighing upto 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +/- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001 to 1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants before discharge from hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In another 4 infants there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infants less than 1000 gm in the first few days of life before diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make definitive diagnosis.

Birth Weight↗
PubMed1991

The surgical treatment of patent ductus arteriosus.1955.

Fourteen cases of patent ductus arteriosus operated upon without a fatality have been presented. All were treated by ligation and division of the ductus. The importance of the safety factor provided by the Potts-Smith-Gibson clamp has been discussed. A detailed case report of one patient whose operation was complicated by excessive hemorrhage is given in detail. No cerebral or renal damage followed a prolonged period of cardiac massage and only slight permanent cord damage resulted from complete occlusion of the aorta for over 1 hour.

Cardiac Surgical Procedures↗
PubMed1991

[Determination of pressure gradient across patent ductus arteriosus with simultaneous continuous wave Doppler and catheterization methods and non-invasive estimation of pulmonary artery pressure].

To evaluate the accuracy of Doppler technique for measuring the pressure gradient (delta P) across patent ductus arteriosus (PDA) with a simplified Bernoulli equation (delta P = 4 V2) and estimating the pulmonary artery pressure (PAP) by subtracting delta P from brachial arterial pressure (BAP) measured with cuff sphygmomanometry, Doppler echocardiography and catheterization (both left and right) were performed simultaneously in 20 patients with PDA. For the values of systolic peak delta P (SPPG), mean delta P (MPG) and end-diastolic delta P (EDPG) determined by both Doppler and catheter, the correlation was excellent (r = 0.99, 0.99, 0.99). Doppler determined SPPG also correlated well with catheter determined peak to peak delta P (P-PPG) (r = 0.97). Comparison between Doppler-derived and catheter measured systolic PAP (SPAP), mean PAP (MPAP) and diastolic PAP (DPAP) also showed high correlation (r = 0.95, 0.98, 0.97). This study demonstrates that Doppler echocardiography is valuable for measurement of delta P across PDA and non-invasive estimation of PAP in patients with PDA.

Adolescent↗
PubMed1991

[Closure of patent ductus arteriosus under extracorporeal circulation through pulmonary arteriotomy].

Twenty-nine patients underwent closure of patent ductus arteriosus (PDA) via pulmonary arteriotomy under low-flow extracorporeal circulation combined with profound hypothermia. No complications from air embolism or hemorrhage were encountered during the operation. The early and late results were satisfactory. This technique was used as a safe method for PDA complicated by severe pulmonary hypertension, infective endocarditis, recurrence of ductal patency and for PDA in adults or coexistence of intracardiac anomaly.

Adolescent↗
PubMedDate not supplied

[Indomethacin in the treatment of patent ductus arteriosus in premature newborn infants].

The effectiveness of indomethacin versus usual medical treatment with fluid restriction to 75% of the volume given in the previous days, with or without frusemide (UMT), for the closure of hemodynamically significant patent ductus arteriosus (HSPDA) was retrospectively studied in 87 premature infants under 2,000 g admitted to our nursery from year 1978 throughout 1988. Among 16 babies, treated from the beginning with indomethacin and UMT, HSPDA was closed 72 h later in 14 (87.5%), versus only 14 closures in 71 babies (19.7%) treated by UMT alone (p < 0.01). Of the 57 babies whose HSPDA failed to close with UMT alone, 23 were given indomethacin and successful closure was seen in 16 (69.6%), while among 34 babies remaining on UMT alone, closure resulted in only 7 (20.6%) (p < 0.01). Intravenous route for administration and early use of indomethacin (before age 7 days) proved to have significantly higher success rates than oral route and use of the drug after age 7 days.

Administration, Oral↗
PubMed1991

[Usefulness of pulsed doppler echocardiography in the diagnosis and medical therapy of patent ductus arteriosus in the newborn with respiratory distress].

In preterm infants patent ductus arteriosus (PDA) may worsen the clinical course of Respiratory Distress Syndrome (RDS). Indomethacin is usually effective in producing duct closure in the first days of life, but clinical diagnosis is often difficult to perform in these patients. In recent years Pulsed Doppler Cross-Sectional Echocardiography (PD-CSE) has made it possible to identify the duct and to assess noninvasively the characteristics of blood flow within it. The aim of this study was to verify the utility of PD-CSE in the early diagnosis of PDA and to provide the basis for a more effective drug therapy. Among 51 patients with RDS, a significant PDA was evidenced in 20 with PD-CSE and in only 8/20 with physical and E-TM examination (p less than 0.01). Indomethacin administration produced duct closure in 19/20 patients (95%). In this study PD-CSE has been more sensitive than the other noninvasive procedures in the diagnosis of PDA; moreover, the success with drug therapy demonstrates the utility of this procedure in providing the basis of a more effective treatment of the duct.

Ductus Arteriosus, Patent↗
PubMed1991

Early screening and treatment of "silent" patent ductus arteriosus in prematures with RDS.

From January 1987 to December 1989, prematures with RDS weighing 1750 g or less admitted to the Neonatal Intensive Care Unite (NICU) were submitted from the third postnatal day to serial two-dimensional and pulsed Doppler (ATL MK 600) echocardiographic evaluation for "silent" patent ductus arteriosus (PDA). PDA was diagnosed in 36/175 prematures with RDS (20.5%). Thirty patients had indomethacin treatment and the PDA closed completely in 27 (90%); five needed a second course of indomethacin, that was effective in two (40%). Four RDS patients (4/36-11%) already weaned from the respirator, needed supplemental oxygen. The three non-responders and six other prematures with counterindications to the drug underwent surgical ligation (25%). As historical control, we retrospectively evaluated the population of preterm infants with RDS weighing less than or equal to 1750 g treated for hemodynamically significant PDA during three previous years before the screening protocol; in this group the echocardiographic and Doppler evaluations were done when congestive heart failure and pulmonary edema were clinically evident. In comparison, we found a reduced incidence of prematures with RDS treated for PDA, 7/120 (5.8%) a higher age at medical treatment (9 +/- 1.4 vs 4.4 - 2.3 days) and a larger prevalence of patients underwent ductal ligation (71.4%). These data show that early screening and treatment of "silent" PDA may result advantageous to improve the efficacy (90%) of indomethacin, in a critical time for the recovery of RDS, and furthermore decreasing the need of surgical ligation.

Birth Weight↗
PubMed1991

[Endoluminal occlusion, using a catheter, of patent ductus arteriosus in an adult].

The risk of surgical closure of the ductus arteriosus in the adult is greater than in children. The ductus arteriosus can now be occluded by venous catheterisation using a Rashkind umbrella. This procedure vas performed in a 63 year old woman. The diagnosis was confirmed and the anatomy of the lesion defined by catheterisation with aortography. The patent ductus was then occluded with a balloon catheter to assess the reversibility of the pulmonary hypertension. A 17 mm Rashkind umbrella was then used to completely occlude the ductus. The advantages of the method over surgical closure are: absence of morbidity related to thoracotomy, to general anaesthesia, to blood transfusion and the reduction of hospital stay to 3 days.

Cardiac Catheterization↗
PubMed1991

Familial patent ductus arteriosus. Report of a family.

Three female patients of two generations in one family each had patent ductus arteriosus (PDA) that was proved by echocardiography and cardiac catheterization. Two of them received surgical ligation of the PDA because of large left to right shunt (Qp/Qs of 3.8 and 2.7, respectively), while the third patient with a Qp/Qs of 1.2 was not operated. Although the exact cause of PDA in this family is unclear, an autosomal recessive inheritance is highly possible.

Child↗
PubMed1991

Clinical profile and management of symptomatic patent ductus arteriosus in premature infants.

Twenty cases of symptomatic patent ductus arteriosus (PDA) in preterm inborn infants were studied retrospectively. The diagnostic criteria were a systolic or a systolodiastolic murmur, tachycardia (greater than 160 per minute), hyperdynamic precordium, collapsing arterial pulses, cardiomegaly or a need for intermittent positive pressure ventilation or continuous distending airway pressure. The incidence was found to be 2.48/1000 live births and 1.5% of SCBU admission. All babies were less than 35 weeks gestation and 18/20 weighed less than 1750 g at birth. Ten babies were treated with indomethacin (0.2 mg/kg) and two of these babies died before the course of treatment was completed. Ten babies were treated with conservative therapy. They could not be administered indomethacin because two died of fulminant sepsis soon after the diagnosis was made; two babies had sepsis and DIC but recovered from it, three had thrombocytopenia, one had azotemia, two babies had hyperbilirubinemia requiring exchange transfusion. The two groups of babies matched in respect to gestational age, sex, age at presentation, birth weight and associated illnesses. Two babies in each group died soon after diagnosis. Of the eight babies in each group, six babies closed the ductus on indomethacin therapy as against two on conservative therapy. This difference was significant (p less than 0.05). The babies who responded to indomethacin were all treated within two weeks of age. None of them showed any complication of drug therapy or recurrence of PDA. We conclude that intragastric indomethacin given early in the management of symptomatic PDA in term infants is a safe and effective modality.

Ductus Arteriosus, Patent↗