Large patent ductus arteriosus: To close or not to close

Tharakan, Jaganmohan A.; Subramanian, Venkateshwaran

doi:10.4103/0974-2069.99615

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Clinical examination, chest X-ray, ECG, arterial saturation, echocardiogram, hemodynamic data from cardiac catheterization, and use of pulmonary vasodilator testing help in the clinical decision-making. 30 The use of pulmonary vasodilator prior to closure may have a favorable role in post-procedure outcomes in borderline cases. 31 However, a small percentage of patients with borderline hemodynamic data may worsen after PDA closure due to progressive and irreversible PAH, and pulmonary vascular disease (PVD), 30 , 32 as seen in one of our patients.…”

Section: Discussionmentioning

confidence: 99%

“… 30 The use of pulmonary vasodilator prior to closure may have a favorable role in post-procedure outcomes in borderline cases. 31 However, a small percentage of patients with borderline hemodynamic data may worsen after PDA closure due to progressive and irreversible PAH, and pulmonary vascular disease (PVD), 30 , 32 as seen in one of our patients. Hence, a close clinical and echocardiographic follow-up of these patients is important.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm)

Kanabar

Bootla

Kaur

et al. 2020

Indian Heart Journal

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Objective Transcatheter closure is the first-choice strategy for the management of appropriate patients with patent ductus arteriosus (PDA). The management of large PDAs is challenging due to the limited available sizes of approved devices and the inherent risks of surgical ligation, especially in adults with calcified PDAs. This study aimed to assess the outcomes of the off-label use of large occluders at a tertiary center. Methods This retrospective review included patients who underwent transcatheter PDA closure with large occluders (≥16 mm) over 16 years. The baseline patient data, procedural details, angiograms, and immediate outcomes were recorded and patients were followed up at 3, 6, 12 months after the intervention and annually thereafter. Results Of the 685 patients who underwent transcatheter PDA closure, 36 patients (mean age 16.6 ± 12.5 years) needed occluders ≥ 16 mm in size. Cocoon duct occluder, Cera duct occluder, Amplatzer atrial septal occluder (ASO), and Cera muscular ventricular septal defect occluders were used for PDA closure. There was no device embolization, one patient in whom ASO was used had residual shunt with intravascular hemolysis requiring surgery, and one patient had mild left pulmonary artery narrowing after the intervention, which was managed conservatively. No patient had residual shunt and one patient had persistent pulmonary hypertension at an intermediate duration of follow-up. Conclusion Transcatheter PDA closure with the use of large devices, which are available in Asia and Europe, is an effective and safe method, especially in adolescents and adults. However, a close follow-up of these patients is mandatory.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm)

Kanabar

Bootla

Kaur

et al. 2020

Indian Heart Journal

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“…The operability of PDA in PA pressure reaching systemic blood pressure is generally not feasible in children and adults. Eisenmenger syndrome remains an absolute contraindication of PDA closure in children and adults (17). The major concerns are post-op pulmonary hypertensive crisis and acute right heart failure because of irreversible pulmonary arterial hypertension (18)(19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern

Yang

Liu

et al. 2020

Front. Pediatr.

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Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA. Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups. Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05). Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary Yang et al. PDA Ligation in Pre-term Infants hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.

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“…Definitive therapy to close a PDA is indicated in all cases, except for duct-dependent congenital heart diseases or PDA with Eisenmenger syndrome. 1,5,6 Transcatheter closure has become the treatment of Figure 1. Angiogram before PDA was closed using the ADO II.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Closure of PDA is indicated in all cases, except for duct-dependent congenital heart diseases or PDA with Eisenmenger syndrome. 1,5,6 In small asymptomatic PDAs, closure is indicated to prevent the risk of complications, such as endarteritis, endocarditis, aneurysm of ductus arteriosus, or congestive heart failure. 1,2,7 In recent years, interventional cardiology has become a gold standard therapy for the majority of PDA cases beyond neonatal age.…”

mentioning

confidence: 99%

Transcatheter closure of tubular type patent ductus arteriosus using Amplatzer® ductal occluder II: a case report

Djer

Idris

Angelina

2016

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Patent ductus arteriosus (PDA) is a common congenital heart disease, accounting for 5-10% of all congenital heart diseases. The incidence of PDA is even higher in preterm neonates, ranging from 20-60%.1-4 Closure of PDA is indicated in all cases, except for duct-dependent congenital heart diseases or PDA with Eisenmenger syndrome.1,5,6 In small asymptomatic PDAs, closure is indicated to prevent the risk of complications, such as endarteritis, endocarditis, aneurysm of ductus arteriosus, or congestive heart failure.1,2,7In recent years, interventional cardiology has become a gold standard therapy for the majority of PDA cases beyond neonatal age. Since its introduction in 1967, many devices and methods have been developed to allow transcatheter closure of virtually all PDAs, regardless of size or configuration. Nevertheless, the tubular shape (type C) PDA, which has the highest residual shunt rate, still poses a great challenge for the interventionist.8-10 The second generation of Amplatzer® device occluders (ADO II), released in 2007, has been suggested to be effective in closing tubular PDAs.10 The purpose of this study was to report the initial clinical experience using ADO II to close a tubular type PDA in Indonesia.

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Large patent ductus arteriosus: To close or not to close

Cited by 8 publications

References 16 publications

Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm)

Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm)

Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern

Transcatheter closure of tubular type patent ductus arteriosus using Amplatzer® ductal occluder II: a case report

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