Giant aneurysm following coil occlusion of patent ductus arteriosus

Marasini, Maurizio; Alessandro, Riccardo; Zannini, L.; Pongiglione, Giacomo

doi:10.1002/(sici)1522-726x(200006)50:2<186::aid-ccd8>3.0.co;2-d

Cited by 14 publications

(15 citation statements)

References 9 publications

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“…50 Ductal aneurysm most commonly presents in infancy 49 -51 but has also been reported in adults 52 and may develop after infective endarteritis, surgical closure, or transcatheter coil occlusion. [53][54][55] In approximately one fourth of patients, an underlying disorder such as trisomy 21, trisomy 13, Smith-LemliOpitz syndrome, type IV Ehlers-Danlos syndrome, or Marfan's syndrome is present. 51 Rarely, the ductus arteriosus aneurysm may present with symptoms of a thoracic mass, including hoarseness due to left vocal chord paralysis from recurrent left laryngeal nerve impingement 56 and left bronchial obstruction.…”

Section: Aneurysm Of Ductus Arteriosusmentioning

confidence: 99%

Patent Ductus Arteriosus

2006

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T he patent ductus arteriosus (PDA) is a vascular structure that connects the proximal descending aorta to the roof of the main pulmonary artery near the origin of the left branch pulmonary artery. This essential fetal structure normally closes spontaneously after birth. After the first few weeks of life, persistence of ductal patency is abnormal. The physiological impact and clinical significance of the PDA depend largely on its size and the underlying cardiovascular status of the patient. The PDA may be "silent" (not evident clinically but diagnosed incidentally by echocardiography done for a different reason), small, moderate, or large. Regardless of the size, complications may arise, and it is important for both pediatric and adult cardiologists to have an understanding of the pathophysiology, clinical implications, and management of PDA. EmbryologyThe ductus arteriosus is a normal and essential fetal structure that becomes abnormal if it remains patent after the neonatal period. In normal cardiovascular development, the proximal portions of the sixth pair of embryonic aortic arches persist as the proximal branch pulmonary arteries, and the distal portion of the left sixth arch persists as the ductus arteriosus, connecting the left pulmonary artery with the left dorsal aorta (Figure 1). Normally, the distal right sixth aortic arch loses its connection to the dorsal aorta and degenerates. This transformation is complete by 8 weeks of fetal life. Normal Physiology Fetal CirculationWhereas Ϸ65% of the fetal cardiac output is from the right ventricle, only 5% to 10% passes through the lungs. 1,2 The preponderance of right ventricular output passes through the ductus arteriosus into the descending aorta. The fetal ductus arteriosus is thus an important structure that is essential for normal fetal development, permitting right ventricular output to be diverted away from the high-resistance pulmonary circulation. Premature constriction or closure may lead to right heart failure, resulting in fetal hydrops. 3 Histology and Mechanisms of Normal ClosureGrossly, the constitution of the fetal ductus arteriosus appears to be similar to the contiguous main pulmonary artery and descending aorta; there are important histological differences, however. 4 -9 Whereas the mediae of surrounding aorta and pulmonary artery are composed mainly of circumferentially arranged layers of elastic fibers, the media of the ductus arteriosus is composed of longitudinally and spirally arranged layers of smooth muscle fibers within loose, concentric layers of elastic tissue. The intima of the ductus arteriosus is thickened and irregular, with abundant mucoid material, sometimes referred to as intimal cushions.Fetal patency of the ductus arteriosus is controlled by many factors, the most important of which are relatively low fetal oxygen tension 10 and cyclooxygenase-mediated products of arachidonic acid metabolism (primarily prostaglandin [PGE 2 ] and prostacyclin [PGI 2 ]). 11 Locally produced and circulating PGE 2 and PGI 2 in the fetus cau...

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Section: Aneurysm Of Ductus Arteriosusmentioning

confidence: 99%

Patent Ductus Arteriosus

2006

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“…Although complications are infrequent, transient ischemic events and coil migration have been reported in the early and late periods after embolization, respectively [3][4][5]. In some situations, as in endovascular treatment of cerebral aneurysms, coil deployment may lead to vessel wall injury and bleeding [6]. To our knowledge, the case of esophageal stenosis described in this report is unique in the English literature.…”

Section: Discussionmentioning

confidence: 77%

Esophageal stenosis after coil embolization of an aortopulmonary collateral artery: report of a very unusual cause

Arda

Güney

Çoşkun

et al. 2005

Journal of Pediatric Surgery

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“…On the other hand, the report of Marasini et al of aneurysm formation after PDA closure using two coils (pfm 6 ¥ 5 and Cook 5 ¥ 3) needs special attention. 2 Evidence in the literature on successful PDA surgery or device closure in Marfan patients is very limited. 12,13 In our series, we report on uncomplicated PDA device closure in nine patients.…”

Section: Discussionmentioning

confidence: 99%

“…The patient subsequently developed a large ductal aneurysm that required surgical correction. 2 However, there is little evidence in the medical literature for uncomplicated PDA device closure in these patients. We reported on nine Marfan patients whose ducts were closed by transcatheter techniques.…”

Section: Introductionmentioning

confidence: 99%