Patent Ductus Arteriosus Banding for Circular Shunting After Pulmonary Valvuloplasty

We report two cases of newborns with critical pulmonary stenosis having intact ventricular septum, who underwent pulmonary valve balloon valvuloplasty followed by banding of a patent ductus arteriosus. Transcatheter pulmonary valvuloplasty was performed one week after delivery. Following the procedure, both developed “circular shunting” as a consequence of left-to-right ductal flow and pulmonary regurgitation. This in turn caused increased blood flow into a dysfunctional right ventricle and low systemic cardiac output syndrome. The PDA banding was performed urgently as a rescue measure in order to restore systemic flow while still maintaining some duct-dependent pulmonary blood flow. This approach resolved the circular shunting. Outcome was favorable in both the patients.

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Response by Glatz et al to Letter Regarding Article, “Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative”

Circulation ◽

10.1161/circulationaha.118.035223 ◽

2018 ◽

Vol 138 (4) ◽

pp. 436-437 ◽

Cited By ~ 2

Author(s):

Andrew C. Glatz ◽

Christopher J. Petit ◽

Bryan H. Goldstein ◽

Athar M. Qureshi

Keyword(s):

Blood Flow ◽

Patent Ductus Arteriosus ◽

Pulmonary Blood Flow ◽

Ductus Arteriosus ◽

Blalock Taussig Shunt ◽

Patent Ductus

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PROBLEM OF DIFFERENTIAL DIAGNOSIS IN INFANTS WITH LARGE HEARTS AND INCREASED BLOOD FLOW TO THE LUNGS

PEDIATRICS ◽

10.1542/peds.13.1.30 ◽

1954 ◽

Vol 13 (1) ◽

pp. 30-40

Author(s):

CHARLOTTE FERENCZ ◽

ARNOLD L. JOHNSON ◽

ALTON GOLDBLOOM

Keyword(s):

Blood Flow ◽

Differential Diagnosis ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Pulmonary Veins ◽

Heart Catheterization ◽

Radiologic Findings ◽

The Right ◽

Increased Blood Flow ◽

Patent Ductus

This paper deals with the differential diagnosis of the cardiac lesion in infants who have enlargement of the heart associated with increased blood flow to the lungs, and in whom cyanosis is not a prominent feature. Some patients in this group have a patent ductus arteriosus in the absence of a typical continuous murmur, and these infants may urgently require the benefits of surgical therapy. Since the diagnosis can be established by aortography or heart catheterization, some criteria are required for the better selection of infants from this group in whom these investigations should be performed. Twenty-five infants form the subject of this study. In 19 the diagnosis was confirmed at autopsy. Eight patients had a patent ductus, either as an isolated lesion or in association with other defects; 10 had ventricular septal defects with or without overriding of the aorta; 5 had anomalous pulmonary vein drainage; one had an ostium atrioventricular communis and in one there was a functional single ventricle. Clinical, electrocardiographic and radiologic findings were analyzed. Important features which appear to favour the diagnosis of patent ductus arteriosus are full or collapsing pulses and a normal ECG or one showing evidence of combined ventricular hypertrophy. Suggestive, but of lesser importance, is the finding of an apical diastolic rumble and enlargement of the left atrium. All these findings may, however, be present in patients with other malformations, especially defects involving the ventricular septum. Evidence of marked hypertrophy of the right atrium and right ventricle by electrocardiography and fluoroscopy renders the presence of patent ductus unlikely and is consistent with the diagnosis of anomalous drainage of pulmonary veins.

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Patent Ductus Arteriosus Stenting for All Ductal-Dependent Cyanotic Infants

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009520 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Kanishka Ratnayaka ◽

Stephen J. Nageotte ◽

John W. Moore ◽

Peter W. Guyon ◽

Krishna Bhandari ◽

...

Keyword(s):

Blood Flow ◽

Length Of Stay ◽

Patent Ductus Arteriosus ◽

Pulmonary Blood Flow ◽

Ductus Arteriosus ◽

Pulmonary Arteries ◽

Practice Change ◽

Almost All ◽

Blalock Taussig Shunt ◽

Patent Ductus

Background: Ductal-dependent cyanotic newborns require a secure source of pulmonary blood flow. There has been a recent migration to selective ductal (patent ductus arteriosus [PDA]) stenting for some of these children. Universal (nonselective) ductal stenting for all infants with ductal-dependent pulmonary blood flow is controversial. We examine outcomes from a single center with this practice change. Methods: We compare outcomes of all ductal-dependent pulmonary blood flow infants (2013–2020 [January–June]) in the following treatment eras: Era 1 (selective PDA stenting; 2013–2017) or Era 2 (universal PDA stenting; 2018–2020 [January–June]). Results: Eighty-eight patients (Blalock-Taussig shunt, n=41; PDA stent, n=47) met inclusion criteria. In Era 1, most received Blalock-Taussig shunt (62% [41/66]). In Era 2, all received PDA stents (100% [22/22]). There were more females in Era 2, but otherwise no demographic differences between eras. There were no differences in mortality, treatment failures, complications, or reinterventions between eras. Postprocedure length of stay was shorter in Era 2 (8 versus 22 days, P =0.02). There were less surgical revisions for PDA stent patients (2% versus 20%, P =0.02). Postprocedure recovery surrogate end points favored Era 2 and PDA stenting. Additional analysis revealed PDA stent (compared with Blalock-Taussig shunt) patients had shorter post-procedure (10 versus 29 days, P ≤0.001) length of stay and more symmetrical branch pulmonary arteries (0.9 versus 0.7, P =0.001) at subsequent surgery. Conclusions: PDA stenting for almost all ductal dependent cyanotic newborns can be safe and effective and may have lower morbidity than selective PDA stenting.

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Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.28125 ◽

2019 ◽

Vol 93 (5) ◽

pp. 933-943 ◽

Cited By ~ 12

Author(s):

Athar M. Qureshi ◽

Bryan H. Goldstein ◽

Andrew C. Glatz ◽

Hitesh Agrawal ◽

Varun Aggarwal ◽

...

Keyword(s):

Blood Flow ◽

Patent Ductus Arteriosus ◽

Pulmonary Blood Flow ◽

Classification Scheme ◽

Ductus Arteriosus ◽

Patent Ductus

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EFFECT OF THE PATENT DUCTUS ARTERIOSUS ON THE PULMONARY BLOOD FLOW, BLOOD VOLUME, HEART RATE, BLOOD PRESSURE, ARTERIAL BLOOD GASES AND pH

PEDIATRICS ◽

10.1542/peds.6.4.557 ◽

1950 ◽

Vol 6 (4) ◽

pp. 557-572

Author(s):

DONALD E. CASSELS ◽

MINERVA MORSE ◽

W. E. ADAMS

Keyword(s):

Heart Rate ◽

Blood Flow ◽

Patent Ductus Arteriosus ◽

Blood Volume ◽

Pulmonary Blood Flow ◽

Ductus Arteriosus ◽

Blood Gases ◽

Arterial Blood Gases ◽

Arterial Blood ◽

Patent Ductus

The effect of the patent ductus arteriosus on the circulation and on the arterial blood gases and pHs has been studied. The pulmonary blood flow diminished 19.6 to 61.8% following ligation in 12 cases examined. The blood volume diminished following closure of the ductus in most cases. Likewise, the heart rate lessened and the pulse pressure was lower after surgery. Arterial oxygen saturation was low preoperatively in some cases and in most instances postoperatively, and this low value sometimes persisted. Some aspects of the data presented have been discussed in detail.

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