Coarctation of Aorta Associated with Large Patent Ductus Arteriosus and Severe Pulmonary Artery Hypertension

To investigate whether transcatheter device closure of patent ductus arteriosus (PDA) is safe in children with pulmonary artery hypertension, we retrospectively analyzed our experience with 33 patients who underwent the procedure from January 2000 through August 2015. Pulmonary artery hypertension was defined as a pulmonary vascular resistance index (PVRI) >3 WU · m2. All 33 children (median age, 14.5 mo; median weight, 8.1 kg) underwent successful closure device implantation and were followed up for a median of 17.2 months (interquartile range [IQR], 1.0–63.4 mo). During catheterization, the median PVRI was 4.1 WU · m2 (IQR, 3.6–5.3 WU · m2), and the median mean pulmonary artery pressure was 38.0 mmHg (IQR, 25.5–46.0 mmHg). Premature birth was associated with pulmonary vasodilator therapy at time of PDA closure ( P=0.001) but not with baseline PVRI (P=0.986). Three patients (9.1%) had device-related complications (one immediate embolization and 2 malpositions). Two of these complications involved embolization coils. Baseline pulmonary vasodilator therapy before closure was significantly associated with intensive care unit admission after closure (10/12 [83.3%] with baseline therapy vs 3/21 [14.3%] without; P <0.001). Of 11 patients receiving pulmonary vasodilators before closure and having a device in place long-term, 8 (72.7%) were weaned after closure (median, 24.0 mo [IQR, 11.0–25.0 mo]). We conclude that transcatheter PDA closure can be performed safely in many children with pulmonary artery hypertension and improve symptoms, particularly in patients born prematurely. Risk factors for adverse outcomes are multifactorial, including coil use and disease severity. Multicenter studies in larger patient populations are warranted.

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Operable patent ductus arteriosus even with differential cyanosis: a case of patent ductus arteriosus and mitral stenosis

Cardiology in the Young ◽

10.1017/s1047951117001275 ◽

2017 ◽

Vol 27 (9) ◽

pp. 1845-1848 ◽

Cited By ~ 1

Author(s):

Anunay Gupta ◽

Shyam S. Kothari

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Mitral Stenosis ◽

Ductus Arteriosus ◽

Pulmonary Artery Hypertension ◽

Early Age ◽

Eisenmenger Syndrome ◽

Corrective Surgery ◽

Patent Ductus

AbstractPatients with patent ductus arteriosus and significant left-to-right shunt develop Eisenmenger syndrome at an early age and are not operable after development of irreversible pulmonary artery hypertension. Patients with mitral stenosis, however, are treatable even with suprasystemic pulmonary artery pressures. A combination of these two lesions is rare. We document a patient with differential cyanosis who improved after corrective surgery of both the lesions. The importance of post-capillary pulmonary artery hypertension in shunt lesions needs to be better appreciated.

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Hospital Outcomes of Surgical Closure of Patent Ductus Arteriosus: 19 Years Experience at Shahid Gangalal National Heart Center

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i2.33222 ◽

2020 ◽

Vol 18 (2) ◽

pp. 30-35

Author(s):

R. Koirala ◽

N. Panthee ◽

S. Pradhan ◽

N. Rajbhandari ◽

D.K. Shrestha ◽

...

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Main Pulmonary Artery ◽

Pulmonary Artery Hypertension ◽

Hospital Outcomes ◽

Descending Aorta ◽

Surgical Closure ◽

First Case ◽

Patent Ductus

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension. Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

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Patent ductus arteriosus with persistent pulmonary artery hypertension after transcatheter closure

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s112400 ◽

2016 ◽

Vol Volume 12 ◽

pp. 1609-1613 ◽

Cited By ~ 4

Author(s):

Jianqi Feng ◽

Xiangqing Kong ◽

Yanhui Sheng ◽

Rong Yang

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Pulmonary Artery Hypertension ◽

Patent Ductus

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Ligation of left pulmonary artery instead of patent ductus arteriosus

Cardiology in the Young ◽

10.1017/s1047951120002784 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1943-1945

Author(s):

Semih Murat Yucel ◽

Irfan Oguz Sahin

Keyword(s):

Surgical Treatment ◽

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Surgical Complication ◽

Ductus Arteriosus ◽

Left Pulmonary Artery ◽

Artery Ligation ◽

Surgical Closure ◽

Post Operative Period ◽

Patent Ductus

AbstractDuctus arteriosus is an essential component of fetal circulation. Due to occurring changes in the cardiopulmonary system physiology after birth, ductus arteriosus closes. Patent ductus arteriosus can be closed by medical or invasive (percutaneous or surgical) treatment methods. Percutaneous or surgical closure of patent ductus arteriosus can be performed for the cases that medical closure failed. Surgical treatment is often preferred method for closure of patent ductus arteriosus in the neonatal period. The most common surgical complications are pneumothorax, recurrent laryngeal nerve injury, bleeding, and recanalisation. A very rare surgical complication is left pulmonary artery ligation that has been presented in a few cases in the literature. Echocardiography control should be performed in the early post-operative period, especially in patients with clinical suspicion. If reoperation is required, it should never be delayed. We report a newborn patient whose left pulmonary artery ligated accidentally during patent ductus arteriosus closure surgery and surgical correction of this complication at the early post-operative period.

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