Ductal closure with radiofrequency energy: the first in-human report

2014 ◽  
Vol 25 (5) ◽  
pp. 999-1001 ◽  
Author(s):  
Mohammad Dalili
Keyword(s):  
Patent Ductus Arteriosus ◽  
Complete Heart Block ◽  
Ductus Arteriosus ◽  
Radiofrequency Energy ◽  
Small Vessels ◽  
Novel Technique ◽  
Congenital Complete Heart Block ◽  
Ductal Closure ◽  
Vascular Obstruction ◽  
Patent Ductus

AbstractBackgroundVascular obstruction is one of the complications of radiofrequency ablation. Following our previous report on the use of radiofrequency energy for vascular closure in an animal model in this journal, we herein present the first ever in-human report.Patient and methodThe patient was a 3-year-old boy, who received a permanent endocardial pacemaker for congenital complete heart block. He also had a conical patent ductus arteriosus. The ductus was occluded with radiofrequency energy on the arterial side with no complications.ConclusionClosure of patent ductus arteriosus and probably other problematic small vessels could be achieved with radiofrequency energy. Further experience will elucidate the future scope of this novel technique.

scholarly journals A High Ductal Flow Velocity Is Associated with Successful Pharmacological Closure of Patent Ductus Arteriosus in Infants 22–27 Weeks Gestational Age

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Karl Wilhelm Olsson ◽  
Anders Jonzon ◽  
Richard Sindelar
Keyword(s):  
Patent Ductus Arteriosus ◽  
Flow Velocity ◽  
Gestational Age ◽  
Pharmacological Treatment ◽  
Ductus Arteriosus ◽  
Newborn Infants ◽  
Cyclooxygenase Inhibitors ◽  
Antenatal Steroids ◽  
Ductal Closure ◽  
Patent Ductus

Objective. To identify factors affecting closure of patent ductus arteriosus (PDA) in newborn infants born at 22–27 weeks gestational age (GA) during pharmacological treatment with cyclooxygenase inhibitors.Method. Infants born at 22–27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory, and outcome parameters. Echocardiographic examinations during treatment were reviewed.Results. Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25+4weeks versus24+3weeks;P=0.047),and a higher pretreatment left to right maximal ductal flow velocity (1.6 m/s versus 1.1 m/s;P=0.023). Correcting for GA, preeclampsia, antenatal steroids, and age at start of treatment, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04;P=0.049).Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment.

scholarly journals Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jonathan L. Slaughter ◽  
Clifford L. Cua ◽  
Jennifer L. Notestine ◽  
Brian K. Rivera ◽  
Laura Marzec ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Brain Natriuretic Peptide ◽  
Preterm Infants ◽  
Prospective Cohort ◽  
Ductus Arteriosus ◽  
Neurodevelopmental Delay ◽  
Ductal Closure ◽  
Postmenstrual Age ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm. Methods Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort. Discussion The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in “high-risk” infants most likely to receive benefit. Trial registration ClinicalTrials.gov NCT03782610. Registered 20 December 2018.

Age-Dependent Closure of the Patent Ductus Arteriosus by Indomethacin

PEDIATRICS ◽  
1978 ◽  
Vol 62 (5) ◽  
pp. 706-712 ◽  
Author(s):  
Jeane S. McCarthy ◽  
Leonor G. Zies ◽  
Henry Gelband
Keyword(s):  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ventricular Hypertrophy ◽  
Ductus Arteriosus ◽  
Clinical Findings ◽  
Age Related ◽  
Age Dependent ◽  
Ductal Closure ◽  
Age Range ◽  
Patent Ductus

Indomethacin has been shown to be effective in closing a patent ductus arteriosus (PDA) in small premature infants. However, the age range over which this therapy is effective remains undetermined. Eighteen infants ranging in age from 4 to 45 days were studied. All had auscultatory and clinical findings indicative of PDA. Seventeen had roentgenographic evidence of cardiomegly and/or increased pulmonary vascular markings, and eight had ECG evidence of ventricular hypertrophy. Indomethacin was administered to most patients in two doses of 0.1 to 0.3 mg/kg 24 hours apart. In eight of 12 patients, 3 week of age or younger, the PDA closed after indomethacin therapy. Two patients had a decrease in the intensity of murmur and improvement of congestive heart failure after treatment, but the PDA did not close completely. Only patients 33 weeks of age (actual age) or younger responded to indomethacin therapy with complete ductal closure. The condition of patients 34 to 36 weeks of age improved but there was not complete closure; in patients older than 36 weeks there was no response. The data suggest an age-related mechanism for PDA closure and that treatment with indomethacin before 33 weeks of age is probably required. A role for prostaglandin in ductal patency is postulated.

Abnormal Cerebral Hemodynamics in Preterm Infants with Patent Ductus Arteriosus

PEDIATRICS ◽  
1982 ◽  
Vol 69 (6) ◽  
pp. 778-781
Author(s):  
Brian Lipman ◽  
Gerald A. Serwer ◽  
Jane E. Brazy
Keyword(s):  
Blood Flow ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Cerebral Arteries ◽  
Flow Patterns ◽  
Cerebral Hemodynamics ◽  
Ductal Closure ◽  
Blood Flow Patterns ◽  
Patent Ductus

Blood flow patterns in the anterior cerebral arteries were studied in eight preterm infants with patent ductus arteriosus and left-to-right shunts. A noninvasive Doppler technique was used to obtain the blood flow patterns and to calculate a pulsatility index. Advancing diastolic blood flow was decreased in all eight infants, and two demonstrated retrograde anterior cerebral artery flow during diastole. Following ductal closure, the diastolic flow in the anterior cerebral arteries increased significantly, reaching levels seen in normal infants. These observations demonstrate that infants with patent ductus arteriosus and left-to-right shunts may have abnormal cerebral hemodynamics which return to normal following ductal closure.

Ductal Closure With Paracetamol: A Surprising New Approach to Patent Ductus Arteriosus Treatment

PEDIATRICS ◽  
2011 ◽  
Vol 128 (6) ◽  
pp. e1618-e1621 ◽  
Author(s):  
C. Hammerman ◽  
A. Bin-Nun ◽  
E. Markovitch ◽  
M. S. Schimmel ◽  
M. Kaplan ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
New Approach ◽  
Ductal Closure ◽  
Patent Ductus

Using benchmarking to identify inter-centre differences in persistent ductus arteriosus treatment: can we improve outcome?

2017 ◽  
Vol 27 (8) ◽  
pp. 1488-1496 ◽  
Author(s):  
Esther J. S. Jansen ◽  
Koen P. Dijkman ◽  
Richard A. van Lingen ◽  
Willem B. de Vries ◽  
Daniel C. Vijlbrief ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Standard Procedure ◽  
Ductus Arteriosus ◽  
Short Term ◽  
Surgical Ligation ◽  
Persistent Ductus Arteriosus ◽  
Ductal Closure ◽  
Neonatal Icu ◽  
Patent Ductus

AbstractObjectiveThe aim of this study was to identify inter-centre differences in persistent ductus arteriosus treatment and their related outcomes.Materials and methodsWe carried out a retrospective, multicentre study including infants between 24+0 and 27+6 weeks of gestation in the period between 2010 and 2011. In all centres, echocardiography was used as the standard procedure to diagnose a patent ductus arteriosus and to document ductal closure.ResultsIn total, 367 preterm infants were included. All four participating neonatal ICU had a comparable number of preterm infants; however, differences were observed in the incidence of treatment (33–63%), choice and dosing of medication (ibuprofen or indomethacin), number of pharmacological courses (1–4), and the need for surgical ligation after failure of pharmacological treatment (8–52%). Despite the differences in treatment, we found no difference in short-term morbidity between the centres. Adjusted mortality showed independent risk contribution of gestational age, birth weight, ductal ligation, and perinatal centre.ConclusionsUsing benchmarking as a tool identified inter-centre differences. In these four perinatal centres, the factors that explained the differences in patent ductus arteriosus treatment are quite complex. Timing, choice of medication, and dosing are probably important determinants for successful patent ductus arteriosus closure.

Transcatheter closure of perimembranous ventricular septal defects with ductal occluders

2014 ◽  
Vol 25 (5) ◽  
pp. 918-926 ◽  
Author(s):  
Jayaranganath Mahimarangaiah ◽  
Anand Subramanian ◽  
Srinivasa Kikkeri Hemannasetty ◽  
Subhash Chandra ◽  
Satish Karur ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Tricuspid Regurgitation ◽  
Heart Block ◽  
Complete Heart Block ◽  
Ductus Arteriosus ◽  
Amplatzer Duct Occluder ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Patent Ductus ◽  
New Onset

AbstractBackground: To study the feasibility and complications associated with the use of ductal occluders for closure of perimembranous ventricular septal defects. Methods: A total of 126 patients, ranging from 1 to 41 years of age (median – 8 years), underwent closure of ventricular septal defects from August 2010 to April 2013. Small- and moderate-sized defects were closed using first-generation Patent ductus arteriosus occluders or Amplatzer Duct Occluder-II. Patients were followed up for the development of complications such as heart block, aortic regurgitation, and tricuspid regurgitation. Results: Patent ductus arteriosus occluders were used in 81 patients, and the Amplatzer Duct Occluder-II device in 45 patients. The devices were successfully deployed in 99.2% of the cases. One patient had embolisation of an Amplatzer Duct Occluder-II device soon after deployment. There was one case of transient complete heart block (0.8%) needing temporary pacing, and two cases of isoarrhythmic atrioventricular dissociation (1.6%). One patient developed late-onset complete heart block 15 months after the procedure and underwent permanent pacemaker implantation. There were no instances of new-onset aortic regurgitation. New-onset mild tricuspid regurgitation was seen in two patients. Of the patients, three had small residual shunts on follow-up, without haemolysis. Conclusions: Duct occluders can be used to effectively close small- and moderate-sized ventricular septal defects. The incidence of complete heart block and valvular regurgitations are much less than reported with other devices, and they are cost-effective.

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