Acquired aortic regurgitation following occlusion of the persistent arterial duct: an echocardiographic assessment.

Abstract

Objective-To document the development of aortic regurgitation following occlusion of a patent arterial duct. Design-Case series involving nine children referred for surgical ligation of an isolated patent arterial duct. Setting-Academic referral centre. Methods-A preoperative transthoracic and transoesophageal echocardiogram was performed in theatre to look for aortic regurgitation. Thereafter, aortic flow was monitored throughout the operation by colour flow mapping with the transoesophageal probe in situ. Onset of aortic regurgitation was documented. An inumediate postoperative transthoracic echocardiogram was performed on all patients and then daily until discharge on day 5. A follow up clinical and echocardiographic assessment was performed six weeks postoperatively. Results-With ligation ofthe patent arterial duct, transoesophageal echocardiography showed immediate regurgitation in seven of the nine patients, seen as a small central jet on colour flow mapping. Six of the seven patients continued to have aortic regurgitation on transthoracic echocardiography before leaving theatre. In none was aortic regurgitation audible clinically. At discharge, five patients still had evidence of aortic regurgitation; of four seen at follow up six weeks later, only one had residual regurgitation.Conclusions-Ligation of the patent arterial duct results in the acute termination of the "run off" in a volume overloaded situation. This, together with a rise in the peripheral vascular resistance and the persistence of increased proximal vascular capacitance, is considered to be the underlying aetiology of the acquired aortic regurgitation.

Aortic valve regurgitation following percutaneous closure of patent ductus arteriosus

“…Harrisberg et al [7] ascribed AR following surgical PDA ligation to the dramatic rise of systemic vascular resistance resulting in an acute elevation of systemic arterial blood pressure. In addition, they suggested that retrograde diastolic blood flow in the aorta due to the increased systemic vascular capacitance proximal to the PDA contribute to AR after surgical PDA ligation [12].…”

“…Aortic valve regurgitation (AR) was reported after surgical ligation and coil occlusion of PDA [7,8]. However, only a small number of children were evaluated and their follow-up was short, incomplete.…”

Case Report: Aortic Regurgitation of Postocclusion and Long-Term Outcome Following PDA Correction in an Adult Dog

“…According to previous studies (19,22), a sudden rise of systemic arterial blood pressure by an acute elevation of systemic vascular resistance and increased vascular capacitance of proximal aorta were suggested as the mechanism of postocclusion AR. In addition, deformation of the aortic root structure by sudden hemodynamic change after PDA closure was also proposed as a cause of persistent AR (9).…”

“…However, further studies on a larger number of cases are required to evaluate this. In humans, AR is reported to be one of the possible complications following PDA occlusion (9,10,19,20). Although the exact incidence remains unknown, postocclusion AR is known to occur rarely in human patients with PDA (20).…”