Outcomes among preterm infants with patent ductus arteriosus: Relationship with treatment, gestational age, hemodynamic status and timing of treatment

BACKGROUND: There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined. STUDY DESIGN: This retrospective case-control study including infants < 1250 gm who were categorized into 3 groups: Group 1: without PDA, Group 2: with untreated PDA, and Group 3: treated PDA. Diagnosis and treatment of PDA extracted from the medical records. Demographics, clinical characteristics, and outcomes compared using chi-square and analysis of variance. Logistic regression used to estimate adjusted odds ratios. RESULTS: The study included 734 infants, with 141(19%) in Group 1, 329 (45%) in 2, and 264 (36%) in 3. Group 3 had higher incidence of bronchopulmonary dysplasia (BPD) (aOR, 2.9; 95%CI 1.7–4.8). Infant treated for hemodynamically significant PDA (HSPDA) had higher incidence of BPD (aOR, 1.9; 95%CI 1.0–3.8) and retinopathy of prematurity (ROP) (aOR, 3.4; 95%CI 1.6–6.9). There were no differences in outcome associated with treatment among≤26 weeks gestation and the age when treated. CONCLUSION: Infants with PDA who were treated had higher incidence of BPD. Among those who were treated, those with HSPDA had a higher incidence of BPD and ROP.

Download Full-text

A beneficial technique for preventing the device protrusion to the aorta during percutaneous patent ductus arteriosus closure: “Balloon-assisted device releasing technique”

Cardiology in the Young ◽

10.1017/s1047951119002269 ◽

2019 ◽

Vol 29 (11) ◽

pp. 1380-1386 ◽

Cited By ~ 1

Author(s):

Serdar Epçaçan ◽

Mustafa Orhan Bulut ◽

İlker Kemal Yücel ◽

Ahmet Çelebi

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Safe Procedure ◽

Disc Protrusion ◽

Surgical Interventions ◽

Significant Difference ◽

Patent Ductus Arteriosus Closure ◽

Group 2 ◽

Patent Ductus ◽

Group 1

AbstractBackground:Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion.Methods:One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation.Results:There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1.Conclusion:The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.

Download Full-text

Transcatheter device closure of patent ductus arteriosus by exclusive venous access under echocardiographic guidance without angiography

Cardiology in the Young ◽

10.1017/s104795112100158x ◽

2021 ◽

pp. 1-5

Author(s):

Salem Deraz ◽

Mohamed Tawfik ◽

Susy Kotit ◽

Abdelrahman Elafifi

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Vascular Complications ◽

Venous Access ◽

Device Closure ◽

Arterial Access ◽

Surgical Closure ◽

Group 2 ◽

Patent Ductus ◽

Group 1

Abstract Introduction: The standard transcatheter technique to profile the patent ductus arteriosus requires arterial access through the femoral artery and is associated with arterial complications, longer fluoroscopic time, contrast volume, and longer hospital stay. Aim of the study: To compare exclusive transvenous access with the standard procedures for patent ductus arteriosus closure and evaluate whether exclusive venous approach is a safe and effective alternative. Methods: A total of 320 patients were included. A detailed echocardiographic evaluation of the duct morphology was performed. Patients were classified into group 1 included patients who underwent exclusive femoral venous access, without any injections of contrast media and group 2 included patients who underwent arterial and venous access. Results: Arterial access was achieved in 210 (65.6%). Successful closure of patent ductus arteriosus was achieved in 109 (99.1%) patients in group 1 and in 203 (96.7%) patients in group 2. The patent ductus arteriosus was large and was referred for surgical closure in one patient from group 1 and 7 patients from group 2. Residual patent ductus arteriosus was seen in 6 cases from group 1 (5.4%) and 12 patients from group 2 (5.7%). None of the cases in group 1 had vascular complications, while vascular complications were seen in 20 cases, all of them in group 2 (9.5%). Nonvascular complications were seen in one patient from group 1 (0.9%) and 15 patients in group 2 (7.1%). The procedure time and fluoroscopy times were less in patients with exclusive transvenous access. Conclusion: Patent ductus arteriosus device closure without arterial access can be accomplished safely and effectively.

Download Full-text

Surgical Closure of Patent Ductus Arteriosus in Infants Weighing Less than 2.5kg

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300104 ◽

1995 ◽

Vol 3 (1) ◽

pp. 13-15

Author(s):

Somboon Boonkasem ◽

Boonchob Pongpanich ◽

Anant Tejavei

Keyword(s):

Heart Failure ◽

Birth Weight ◽

Renal Insufficiency ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Low Birth Weight Infants ◽

Surgical Closure ◽

Group 2 ◽

Patent Ductus ◽

Group 1

Persistent heart failure is a major problem in low birth weight infants with patent ductus arteriosus (PDA). There is a considerable incidence of renal insufficiency and reopening of the ductus after pharmacologic closure. Surgical closure of symptomatic PDA should therefore be indicated to avoid morbidity or mortality from heart failure and renal failure. Between March 1990 and December 1993 there were 33 low birth weight infants who underwent surgical closure of PDA, ranging in age from 5 to 90 days (mean = 25) with 15 males and 18 females (M:F = 1:1.2). The patients were classified into 3 groups: group 1 (< 1000gm) 11 cases, group 2 (1000-1499gm) 10 cases, group 3 (1500-2499gm) 12 cases. The indications for surgical closure of PDA included: persistent heart failure in 28, renal insufficiency in 20, reopening of the ductus after pharmacologic closure in 16 and growth failure in 1. The early mortality was 6% (2/33). Both of them were in group 1: one from necrotizing enterocolitis (NEC), and one from cytomegalovirus (CMV) infection on the 6th and 20th postoperative day respectively. Late death occurred twice: the first case in group 1 from sepsis 35 days postoperatively, and the second in group 2 from pneumonia 3 months after surgery. The causes of late mortality in both cases were not related to surgery. The 29 survivors are doing reasonably well during follow-up period.

Download Full-text

Indomethacin and patent ductus arteriosus: effects on renal function in preterm lambs

AJP Renal Physiology ◽

10.1152/ajprenal.1988.254.1.f38 ◽

1988 ◽

Vol 254 (1) ◽

pp. F38-F44

Author(s):

C. A. Gleason ◽

R. I. Clyman ◽

M. A. Heymann ◽

F. Mauray ◽

R. Leake ◽

...

Keyword(s):

Renal Function ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Urine Volume ◽

Preterm Newborn ◽

Apparent Lack ◽

Group 3 ◽

Group 2 ◽

Patent Ductus ◽

Indomethacin Treatment

To examine the independent effects of a patent ductus arteriosus and of indomethacin therapy on the renal function of the preterm newborn, we created a preterm lamb model in which ductus diameter could be regulated. We studied 24 preterm newborn lambs. Eight lambs (group 1) had their ductus closed at delivery and received no indomethacin. Eight lambs (group 2) had their ductus closed and then received indomethacin (0.3 mg/kg) at 5.5 h; eight lambs (group 3) had their ductus kept open and then received indomethacin at 5.5 h. Hemodynamic and renal function measurements were made at 5 h (pretreatment) and at 12.5 h. In group 2 lambs there was a significant reduction in inulin clearance (GFR) and osmolal clearance after indomethacin. In contrast, lambs with an open ductus (group 3), when compared with lambs with a closed ductus (groups 1 and 2) at 5 h, already had significantly decreased blood pressure, GFR, urine volume, and osmolal clearance. Following indomethacin treatment, group 3 lambs showed no further decrease in renal function. We suggest that in preterm lambs with patent ductus, the apparent lack of renal dysfunction following indomethacin treatment reflects underlying diminished renal function.

Download Full-text