Surgical ligation of a residually patent arterial duct following failed occlusion using transcatheter coils

2003 ◽  
Vol 13 (6) ◽  
pp. 574-575 ◽  
Author(s):  
Derek S. Wheeler ◽  
James Matthew Maxwell ◽  
W. Bradley Poss
Keyword(s):  
Heart Disease ◽  
Premature Infants ◽  
Pediatric Cardiology ◽  
Large Diameter ◽  
Structural Heart Disease ◽  
Comparable Efficacy ◽  
Surgical Ligation ◽  
Arterial Duct ◽  
Low Weight ◽  
Patent Arterial Duct

Transcatheter techniques for occlusion of the persistently patent arterial duct using coils have become standard therapy at many centers for pediatric cardiology, and in selected patients have demonstrated comparable efficacy to surgical ligation. Surgical ligation may still be required in many cases, including premature infants or those born with low weight, those with ducts of large diameter, those with associated structural heart disease, and in circumstances of unsuccessful occlusion subsequent to attempted closure using coils. We report on the successful surgical ligation of an arterial duct of moderate size that exhibited residual patency despite two separate attempts at occlusion using coils.

scholarly journals Patent Arterial Duct and Vascular Ring in a Premature Infant

2013 ◽  
Vol 52 (189) ◽  
pp. 275-276 ◽  
Author(s):  
Anil Bhattarai ◽  
Vladimiro Vida ◽  
Silvia Ricato ◽  
Sabrina Salvadori ◽  
Giovanni Stellin
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Premature Infant ◽  
Premature Infants ◽  
Congenital Heart ◽  
Vascular Ring ◽  
Surgical Ligation ◽  
Arterial Duct ◽  
Operative Findings ◽  
Patent Arterial Duct

We report a case of a 750 grams premature female who was scheduled for surgical ligation of a patent arterial duct. Intra-operative findings showed a patent arterial duct in association to a retro-esophageal aortic arch creating a complete vascular ring around the trachea, which was successfully divided. A vascular ring should be ruled-out in premature infants prior to ductal ligation at bidimensional echocardiography. Keywords: congenital heart disease; premature infant; surgery; vascular ring.

scholarly journals Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1138
Author(s):  
Mathilde Méot ◽  
Raymond N. Haddad ◽  
Juliana Patkai ◽  
Ibrahim Abu Zahira ◽  
Anna Di Marzio ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Transcatheter Closure ◽  
Spontaneous Closure ◽  
Device Closure ◽  
Catheterization Laboratory ◽  
Surgical Ligation ◽  
Arterial Duct ◽  
Closure Group ◽  
Patent Arterial Duct

(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.

scholarly journals The Role of Natriuretic Peptides in Management of Premature Infants with Hemodynamically Significant Patent Arterial Duct

2019 ◽  
Vol 18 (1) ◽  
pp. 8-12
Author(s):  
Evgenij G. Furman ◽  
Aleksej N. Biyanov ◽  
Artem Porodikov ◽  
Oksana B. Bahmet’eva ◽  
Vladimir G. Druzhen’kov
Keyword(s):  
Premature Infants ◽  
Natriuretic Peptides ◽  
Prognostic Value ◽  
Neonatal Period ◽  
Management Planning ◽  
Arterial Duct ◽  
Life Threatening ◽  
Complications And Mortality ◽  
Patent Arterial Duct

Hemodynamically significant patent arterial duct in premature infants can be the reason of life-threatening complications. Thus it is topical to define the high risk of such complications and mortality in early neonatal period. We have reviewed researches results covering prognostic value of natriuretic peptides level in premature infants with hemodynamically significant patent arterial duct. The data on management planning of such patients according to the A-type and B-type natriuretic peptides levels is presented.

Surgical management of congenital cardiac defects in neonates and young infants born with extremely low weight

2003 ◽  
Vol 13 (4) ◽  
pp. 328-332 ◽  
Author(s):  
Hiroaki Kawata ◽  
Hidefumi Kishimoto ◽  
Takuya Miura ◽  
Tohru Nakajima ◽  
Hiroyuki Kitajima
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Optimal Timing ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Cardiac Defects ◽  
Young Infants ◽  
Arterial Duct ◽  
Low Weight ◽  
Patent Arterial Duct

Surgical treatment of cardiac defects in infants born with extremely low weight is sometimes required during the neonatal period. Optimal timing of these operations has yet to be clarified. With this in mind, we reviewed our experience of surgical treatment for 29 infants born with extremely low weight between 1994 and 2001. The main surgical procedures were ligation of a patent arterial duct in 26, a Brock procedure in 2, and ligation of an aorto-pulmonary window in 1 infant. The age at operation ranged from 5 to 57 days, with a median of 30 days, and weighed from 506 to 902 g, with a median of 710 g. There were no deaths. For the 2 infants undergoing the Brock procedure, the reduced systemic blood flow also necessitated closure of the arterial duct. For almost all the 26 infants with a patent arterial duct, indomethacin was given as the initial therapy, but the duct had not closed completely. Increased symptomatology just before the operation due to reduced systemic blood flow, such as decreased cerebral blood flow, decreased urine output, and intestinal ischemia, mandated the earlier surgical ligation (r = −0.576, p = 0.004). The youngest infant needed an infusion of catecholamines perioperatively to maintain stable hemodynamic conditions (r = 0.554, p = 0.003). In 4 infants, including the youngest 2, steroids were administered intravenously just after the ligation. Our results suggest that reduced systemic blood flow is the main indication of surgical repair in infants born with extremely low weight. Even for one in whom the supply of pulmonary blood is dependent on the arterial duct, early reconstruction of the pulmonary arterial pathways, using the Brock procedure, followed by ligation of the duct, is required. Acute adrenal insufficiency should not be overlooked just after the surgery, particularly in the youngest patients.

Percutaneous closure of small patent arterial ducts using occluding spring coils and a snare

1996 ◽  
Vol 6 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Benjamin Zeevi ◽  
Michael Berant ◽  
Galit Bar-Mor ◽  
Leonard C. Blieden
Keyword(s):  
Transcatheter Closure ◽  
Color Doppler ◽  
Percutaneous Closure ◽  
Surgical Ligation ◽  
Residual Lesion ◽  
Arterial Duct ◽  
The Mean ◽  
Patent Arterial Duct ◽  
Spring Coil

AbstractIn recent years, the percutaneous closure of small and medium-sized patent arterial ducts has been achieved using occluding spring coils. We describe our experience in 33 patients with this technique using a snare to facilitate the procedure. All patients had a clinically apparent patent arterial duct and underwent an attempt at transcatheter closure at a mean age of 5.6 years. In one patient, the duct was a residual lesion following surgical ligation, and in three was residual following attempted closure with a Rashkind double-umbrella. The mean narrowest diameter of the ducts was 1.9 mm. The coil embolized in two of the first four patients, and subsequent to that experience we used a snare to improve delivery. Of the 33 patients, implantation was successful in 32 (97%) using one [29 patients] or two [two patients] coils and in one by a combination of a double-umbrella device and an occluding spring coil. The mean fluoroscopic screening time for the whole group was 26.5 minutes, this time decreasing to 18.5 minutes in the last 26 patients [p <0.05]. Color-Doppler echocardiogram performed the morning after placement of the coils has shown residual leaks in nine of 32 patients [28%]. At a mean follow-up of 7.6 months, repeated imaging has shown residual leaks in four of these patients [12.5%]. No patient had a residual continuous murmur immediately following occlusion. Based on our results, we conclude that occlusion of small to medium-sized ducts using coils appears to be effective. The use of a snare to hold and manipulate the coil as it is delivered improves both control of the coil and the accuracy of its placement.

Difficulties generated by the small, persistently patent, arterial duct

1999 ◽  
Vol 9 (4) ◽  
pp. 392-395 ◽  
Author(s):  
Brigitte Raaijmaakers ◽  
Aagje Nijveld ◽  
Anton van Oort ◽  
Ronald Tanke ◽  
Otto Daniëls
Keyword(s):  
Heart Surgery ◽  
Transcatheter Closure ◽  
Open Heart Surgery ◽  
Clinical Findings ◽  
Open Heart ◽  
Transcatheter Intervention ◽  
Surgical Ligation ◽  
Arterial Duct ◽  
Catheter Closure ◽  
Patent Arterial Duct

AbstractOver recent years, echo-Doppler cardiography has shown that a small, sometimes silent, arterial duct exists in more patients than previously recognized. To know the incidence of an arterial duct subsequent to therapy, we studied retrospectively our patients undergoing open-heart surgery and surgical or catheter closure. Three groups of patients were studied: those with patency of the duct subsequent to open heart surgery without any sign of patency before or during surgery, those with persistent duct after surgical ligation and those with persistent patency after attempted catheter occlusion with the Rashkind device. In the first group (of 431 children) four (0.9%) had persistence of this duct, of which three were silent. In the second group, patency persisted in four of 100 patients (4%), three being silent. In the last group there were five persisting shunts, three producing no murmur, in 30 patients (17%). We compared our results with those reported in the literature and conclude that echo-Doppler cardiography is needed to detect persistent shunting across a duct after therapy, since most of the residual ducts in this study were silent. This means that clinical findings alone cannot be relied upon, and careful echo-Doppler cardiography is essential. Also, the process of closure of a persistent duct by surgical ligation or transcatheter intervention is no guarantee of success. The risk of infective endocarditis is important in such persistent ducts and, at present, it is unknown either for a small, silent duct or in a persistent duct that remains open after attempted transcatheter closure, but now is in association with a foreign body.

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