The Use of Transesophageal Echocardiography to Evaluate the Effectiveness of Patent Ductus Arteriosus Ligation

Abstract

The ligation of patent ductus arteriosus (PDA) is a comparatively easy operation, but some complications are possible. The most common complication is incomplete ligation of the PDA; others include inadvertent ligation of the descending aorta or left pulmonary artery, transient rise in systemic blood pressure and increased left ventricular afterload, and acute right heart failure due to pulmonary hypertension. The completeness of the PDA ligation is usually determined only by the operating physician's experience, including the use of an esophageal stethoscope or a finger on the lesion to feel for vibration. These methods sometimes fail to detect an incomplete ligation. With transesophageal echocardiography (TEE), we have monitored the entire course of the PDA ligation directly without interrupting the surgical procedure, and precisely determined the completeness of the ligation. We also expect that TEE will enable us to avoid other complications as well.

Echocardiography for Patent Ductus Arteriosus Including Closure in Adults

“…44 Contrast Echocardiography: Peripheral intravenous contrast echocardiography has been used to noninvasively identify an otherwise undetectable PDA that manifests as central right-to-left shunt at the ductal level in cyanotic patients with Eisenmenger's physiology. 49 PDA Closure with Catheter-Based Interventions: Indications for Intervention: The indications for PDA closure are to reduce the risk of developing pulmonary hypertension due to pulmonary overcirculation, as well as to reduce the risk of endocarditis. "Bubbles" can be seen opacifying the right heart and then appearing in the descending thoracic/ abdominal aorta.…”

“…In addition, in an older population, the contribution of ischemic posterior papillary muscle to the severity of mitral regurgitation should also be considered. 49 PDA Closure with Catheter-Based Interventions: Indications for Intervention: The indications for PDA closure are to reduce the risk of developing pulmonary hypertension due to pulmonary overcirculation, as well as to reduce the risk of endocarditis. 14 The absolute contraindications for device closure in adults are irreversible pulmonary vascular disease/severe pulmonary hypertension or active endocarditis.…”

Esophageal stethoscope: an old tool with a new role, detection of residual flow during video-assisted thoracoscopic patent ductus arteriosus closure

“…Thus intraoperative TTE imaging may be of lesser quality than in the preoperative evaluation. With good technique, intraoperative transesophageal echocardiography (TEE) monitoring can be a useful and valuable diagnostic tool during VATS procedure in detection of residual patency and provides high resolution for direct evaluation of the entire course of PDA clipping [19,22,23]. Missed residual patency during PDA VATS closure by TEE monitoring is reported to be 3% to 10% [13,22].…”

Clinical profile of post-operative ductal aneurysm and usefulness of sternotomy and circulatory arrest for its repair

“…Residual left to right shunt and infection are the important factors in its etiology; therefore, every effort should be made to prevent them. The measures may include meticulous surgical technique, prompt detection [11] and treatment of the residual left to right shunt, division and suturing of ductus, and antibiotic prophylaxis for infective endocarditis. It is rare after division and suturing (incidence 0.4%) and is usually a true aneurysm arising from the aortic diverticula [1].…”