The Current Role of Surgery in Treating Adult Patients with Patent Ductus Arteriosus

Djukanovic, Bosko; Mićović, Slobodan; Stojanović, Ivan; Unic-Stojanovic, Dragana; Birovljev, S; Vuković, Petar

doi:10.1111/chd.12164

Cited by 11 publications

(11 citation statements)

References 12 publications

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“…Before the era of percutaneous treatment, most adult PDAs must have been closed using cardiopulmonary bypass with patching of the main pulmonary artery; thus, any approach by transcatheter closure is likely to be of lower risk [11]. However, surgical treatment in adults remains the method of choice in wide, deformed ducts, especially when associated with concomitant operative heart disease [12].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Patent Ductus Arteriosus in Elderly Patients: Initial and One-Year Follow-Up Results—Do We Have the Proper Device?

Gałeczka

Szkutnik

Białkowski

et al. 2020

Journal of Interventional Cardiology

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Objectives. Patent ductus arteriosus (PDA) in elderly patients is an uncommon anomaly, and the duct itself is often calcified and fragile; therefore, transcatheter closure is more difficult. The aim is to analyse periprocedural and one-year follow-up results of transcatheter closure of PDA in such patients. Methods and results. Retrospective analysis of 33 elective patients aged ≥55 years (median 63; 56–85; 29 women), in whom PDA was closed percutaneously between 2002 and 2018 in two tertiary centres. All but three patients were symptomatic, with most in NYHA II (n = 14) and III (n = 11) class; pulmonary hypertension (n = 22), arterial hypertension (n = 22), duct calcifications (n = 17), atrial fibrillation (n = 15), significant mitral regurgitation (n = 5), and decompensated renal failure (n = 2) were observed. Different devices were applied depending on PDA morphology; nitinol wire mesh occluders with symmetrical articulating discs have been the most used in recent years (n = 11). Follow-up was conducted at an outpatient clinic (28/33 patients). The procedure was successful in all patients. There was one embolisation, followed by implantation of a larger device. No major complications were noted. A small residual shunt was present in echocardiography in one patient after one year. NYHA class improved in all but two patients (with multiple comorbidities). Conclusions. Transcatheter PDA closure in elderly patients is safe and efficient with a high complete closure rate and few complications. Amplatzer duct occluder type II is an attractive device in such patients.

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Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Patent Ductus Arteriosus in Elderly Patients: Initial and One-Year Follow-Up Results—Do We Have the Proper Device?

Gałeczka

Szkutnik

Białkowski

et al. 2020

Journal of Interventional Cardiology

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“…After an incision is made, exposing and suturing are difficult because of the high flow rate. The operation should even be stopped under deep hypothermia [6]. Therefore, open surgery of intracardiac malformations has gradually been replaced by interventional closure therapy for congenital heart disease [7, 8].…”

Section: Discussionmentioning

confidence: 99%

Hybrid procedure for treating adult congenital heart disease with valvular heart disease in two patients

Liu

Zhong

Song

et al. 2019

J Cardiothorac Surg

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BackgroundThe traditional approach for adult congenital heart disease combined with valvular disease is surgical treatment under cardiopulmonary bypass (CPB). This approach has a high incidence of postoperative complications, especially in patients with pulmonary hypertension and old age. We present two patients in whom the hybrid procedure was used to treat congenital malformations, followed by valve formation and replacement surgery.Case presentationA 63-year-old man had a muscular ventricular septal defect complicated by mitral regurgitation and a 57-year-old man had patent ductus arteriosus complicated by aortic stenosis. In both of the patients, the congenital malformation was successfully treated by the hybrid procedure, followed by valve repair or replacement. Both patients had no complications. A post-procedure echocardiogram showed no residual shunt across the duct.ConclusionsOur findings suggest that the hybrid procedure is a useful alternative for treating adult congenital heart disease with valvular heart disease. This procedure reduces the surgical incision and difficulty of surgery, shortens the CPB time, avoids residual leakage after surgery, and reduces recovery and hospitalization times.

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“…Less invasive and more effective percutaneous catheterization technologies are more commonly used for PDA closure, but surgical PDA closure in adults is still the treatment of choice for complicated PDAs unsuitable for endovascular intervention, which carries the risk of concomitant calcification, aneurysms, and cardiovascular or aortic diseases. [7]…”

Section: Discussionmentioning

confidence: 99%

Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient

Kim

Baek

2018

Medicine

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Rationale:Patent ductus arteriosus (PDA) ligation by open surgery is more difficult and dangerous in elderly patients than in infants. Nowadays, simple and safe interventional catheterization technology is used for the closure of uncomplicated isolated PDAs. Therefore, an alternative less invasive therapeutic option must be developed to treat complicated PDA.Patient concerns:A 53-year-old woman presented with gradually exacerbated dyspnea on effort and continuous cardiac murmurs.Diagnosis:Transthoracic echocardiography (TTE) and contrast-enhanced 3D computed tomography (CT) were performed and revealed a conically shaped large PDA with calcification.Interventions:We used a nontouch exclusion technique with thoracic endovascular repair (TEVAR) for the treatment of this rare complicated PDA. The patient had an adequate proximal landing zone, and a tapered stent graft (S&G, Bio 34–30 mm × 110 mm, Korea) was used.Outcomes:Aortography after stent graft implantation revealed complete occlusion of PDA and no endoleaks. The procedure was successful, and the patient showed no vascular or other complications during follow-up.Lessons:TEVAR is a less invasive solution for pathologies of the thoracic aorta, such as aortic dissection or aneurysm. TEVAR is an established, simple, and safe method for repairing the thoracic aorta and can be a new alternative to other transcatheter techniques for complicated PDAs in elderly patients.

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The Current Role of Surgery in Treating Adult Patients with Patent Ductus Arteriosus

Abstract: Surgical PDA closure in adults remains the treatment of choice in wide, deformed PDAs unsuitable for percutaneous closure and PDAs associated with surgical aortic or heart disease.

Cited by 11 publications

References 12 publications

Transcatheter Closure of Patent Ductus Arteriosus in Elderly Patients: Initial and One-Year Follow-Up Results—Do We Have the Proper Device?

Transcatheter Closure of Patent Ductus Arteriosus in Elderly Patients: Initial and One-Year Follow-Up Results—Do We Have the Proper Device?

Hybrid procedure for treating adult congenital heart disease with valvular heart disease in two patients

Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient

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