scholarly journals Effects of Patent Ductus Arteriosus on the Hemodynamics of Modified Blalock–Taussig Shunt Based on Patient-Specific Simulation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiwen Xiong ◽  
Qi Sun ◽  
Yi Qian ◽  
Liwei Hu ◽  
Zhirong Tong ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Computer Aided Design ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Patient Specific ◽  
Physiological Data ◽  
Shunt Flow ◽  
Relative Residence Time ◽  
Blalock Taussig Shunt ◽  
Patent Ductus

The question of preserving the patent ductus arteriosus (PDA) during the modified Blalock–Taussig shunt (MBTS) procedure remains controversial. The goal of this study was to investigate the effects of the PDA on the flow features of the MBTS to help with preoperative surgery design and postoperative prediction. In this study, a patient with pulmonary atresia and PDA was included. A patient-specific three-dimensional model was reconstructed, and virtual surgeries of shunt insertion and ductus ligation were performed using computer-aided design. Computational fluid dynamics was utilized to analyze the hemodynamic parameters of varied models based on the patient-specific anatomy and physiological data. The preservation of the PDA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided, causing significant and complicated turbulence in the pulmonary artery where low wall shear stress, high oscillatory shear index, and high relative residence time were distributed. The highest energy loss was found when the PDA was preserved. The preservation of PDA is not recommended during MBTS procedures because it negatively influences hemodynamics. This may lead to pulmonary overperfusion, inadequate systemic perfusion, and a heavier cardiac burden, thus increasing the risk of heart failure. Also, it seems to bring no benefit in terms of reducing the risk for thrombosis.

Bronchial compression by a patent ductus arteriosus associated with pulmonary atresia

1985 ◽  
Vol 144 (3) ◽  
pp. 535-540 ◽  
Author(s):  
RI Markowitz ◽  
JT Fahey ◽  
WE Hellenbrand ◽  
GS Kopf ◽  
P Rothstein
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Bronchial Compression ◽  
Patent Ductus

Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions

2012 ◽  
Vol 23 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Mazeni Alwi ◽  
Rahmat R. Budi ◽  
Marhisham Che Mood ◽  
Ming C. Leong ◽  
Hasri Samion
Keyword(s):  
Patent Ductus Arteriosus ◽  
Balloon Dilatation ◽  
Pulmonary Valve ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Total Occlusion ◽  
Patent Ductus

AbstractObjectiveTo determine the feasibility and safety of the Conquest Pro wire as an alternative to radiofrequency wire for perforation of atretic pulmonary valve and subsequent balloon dilatation and patent ductus arteriosus stenting in patients with pulmonary atresia with intact ventricular septum.BackgroundRadiofrequency valvotomy and balloon dilatation has become the standard of care for pulmonary atresia with intact ventricular septum in many institutions today.MethodsWe report eight consecutive patients in whom we used the Conquest Pro coronary guidewire, a stiff wire normally reserved for revascularisation of coronary lesions with chronic total occlusion, for perforation of atretic pulmonary valve and subsequent balloon dilatation, and stenting of the patent ductus arteriosus.ResultsPerforation of atretic pulmonary valve was successful in seven out of eight cases. Radiofrequency valvotomy was employed after failure of perforation by the Conquest Pro wire in one case where the right ventricular outflow tract was broad based and tapered towards the pulmonary valve, and was heavily trabeculated. Failure of the Conquest Pro wire to perforate the pulmonary valve plate was mainly attributed by the failure to engage the wire at the correct position.ConclusionThe Conquest Pro wire for perforation and subsequent interventions in the more straightforward cases of pulmonary atresia with intact ventricular septum is effective and safe, simplifying the entire procedure. However, the radiofrequency generator and wires remain essential tools in the paediatric interventional catheter laboratory.

scholarly journals Patent Ductus Arteriosus Stenting for All Ductal-Dependent Cyanotic Infants

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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