Retrospective evaluation of occlusion of patent ductus arteriosus with hemoclips in 20 dogs

2000 ◽  
Vol 36 (6) ◽  
pp. 548-555 ◽  
Author(s):  
LB Corti ◽  
D Merkley ◽  
OL Nelson ◽  
WA Ware
Keyword(s):  
Clinical Outcome ◽  
Patent Ductus Arteriosus ◽  
Left Atrial ◽  
Ductus Arteriosus ◽  
Retrospective Evaluation ◽  
Good Clinical Outcome ◽  
Heart Size ◽  
Fractional Shortening ◽  
Patent Ductus

Twenty dogs with patent ductus arteriosus occluded with Hemoclips were evaluated with a mean follow-up time of 799.4 days (range, 83 to 3,580 days). Significant decreases were found between pre- and postsurgical means for vertebral heart size and for echocardiographic left atrial/aortic-root ratios and percent fractional shortening (%FS). Despite a good clinical outcome, six of 20 dogs had persistent cardiomyopathy of overload with diminished %FS (28% or less) at follow-up. One dog had residual ductal flow identified five days postoperatively. Subsequent evaluations in this case at 60, 144, 226, 344, and 560 days postoperatively demonstrated gradually diminishing ductal flow. The remaining 19 dogs did not recanalize.

scholarly journals Heart size, heart function, and plasma B-type natriuretic peptide levels after transcatheter closure of patent ductus arteriosus

2013 ◽  
Vol 53 (3) ◽  
pp. 181
Author(s):  
Mulyadi M. Djer ◽  
Sudigdo Sastroasmoro ◽  
Bambang Madiyono
Keyword(s):  
Heart Failure ◽  
Patent Ductus Arteriosus ◽  
Diastolic Function ◽  
Transcatheter Closure ◽  
Heart Function ◽  
Ductus Arteriosus ◽  
Class Iii ◽  
Heart Size ◽  
Patent Ductus

Background Patent ductus arteriosus (PDA) is a commoncongenital heart disease causing some blood in the aorta to flowinto the pulmonary artery (PA), resulting in dilatation of the leftatrium (IA) and left ventricle (LY), increased B-type natriureticpeptide (BNP) level, and the development of h eart failure.Objectives To evaluate the clinical course, changes in heart sizeand function, and BNP level after transcatheter closure of PDAusing the Amplatzer® duct occluder (ADO).Methods This quasi-experimental study used a one-group, pretestposttestdesign, and was done on PDA patients who underwenttranscatheter closure using ADO. The outcomes measurementswere performed four times, namely, before the procedure andat one, three, and six months after the procedure. Results werecompared using a serial time analysis. Outcomes measured wereheart failure scores, chest x-ray (CXR) and echocardiographyfindings, and plasma BNP level.Results There were 23 PDA patients enrolled, of which 12 werefemales. Subjects' median bodyweight was 11 (range 6.6 to 55) kg.Prior to PDA closure, 12 subjects had mild heart fa ilure (class II)and 7 had moderate heart failure (class III). On follow-up at onemonth after the procedure, all subjects had improved heart failurescores (P<0.0001), and no heart failure was found on furtherfollow up. Likewise, there was a decreased mean cardiothoracicratio (CTR) from 58 to 55% at 1-month (P = 0.001), and alsofrom 55 to 52% at3-month follow up (P<0.0001), but no furtherdecrease was found afterwards (P = 0.798). The left atrium/aorta(LA/Ao) ratio measured by echocardiography also showed astatistically significant decrease from 1.6 prior to the procedureto 1.3 (P<0.0001) in the first month, but it remained stableafterwards. Diastolic function, represented by peak E and A wavesalso significantly decreased from 127 and 91 cm/sec, before theprocedure, to 90 and 68 cm/sec, respectively, at 1 month follow-up(P <0.0001 and P < 0.0001, respectively) . However, there were nostatistically significant changes in E/ A ratio, ejection fract ion andfractional shortening. Plasma BNP level significantly decreasedfrom 58 pg/mL before the procedure to 28 pg/mL at 1 monthfollow-up (P= 0 .001), but no further significant decrease wasobserved afterwards.Conclusion After PDA closure with ADO, we observe significantimprovements in heart failure scores, heart size, diastolic function,and BNP level of our subjects especially in the first month afterthe procedure.

scholarly journals Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

2020 ◽  
Vol 68 (1) ◽  
Author(s):  
Reem M. Soliman ◽  
Fatma Alzahraah Mostafa ◽  
Antoine Abdelmassih ◽  
Elham Sultan ◽  
Dalia Mosallam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

scholarly journals Role of Sequential Functional Echocardiography in Predicting Clinically Apparent Patent Ductus Arteriosus in Preterm Very Low Birth Weight Newborns-An Observational Study

2020 ◽  
Author(s):  
Anchala Bhardwaj ◽  
ARVIND SAILI ◽  
Dinesh Kumar Yadav ◽  
Ajay Kumar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Left Atrial ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Predictive Utility ◽  
Patent Ductus

Abstract Background The management of patent ductus arteriosus in preterm neonates continues to be a topic of discussion and controversy. Prolonged ductal patency in preterm neonates has been associated with significant short and long term morbidities and with increased mortality however, policy of routine treatment of all during neonatal period has failed to show significant improvement in long term outcome. Echocardiography has emerged as a promising modality to screen the newborns at risk of adverse effects of ductal shunting. This helps in identifying PDAs that require treatment to ultimately prevent unnecessary therapy or delay of necessary therapy. There are multitude of studies that have evaluated large number of echocardiographic markers for their predictive utility but only few have included all ductal markers together in a single study. The reported sensitivity (26-100%) and specificity (6-100%) of echocardiographic markers vary over a wide range. Thus, this study was planned with an aim to assess the predictive utility of all available ductal markers and their added advantage of having all over few ones in clinically apparent PDA in preterm VLBW newborns.Methods It was an observational prospective study conducted in tertiary care NICU at Lady Hardinge Medical College, Delhi. Fifty preterm very low birth weight (VLBW) newborns underwent four sequential Echo scans within first 72 hrs; first scan within 12 hours then at 24 hrs ,48 hrs and 72 hrs of age and were monitored clinically for the signs of PDA up to two weeks of life or discharge whichever comes later.Results The Ductal diameter, pulsatile ductal flow pattern, Left pulmonary artery (LPA) velocity, Left atrial to aortic width (La/Ao) ratio, Left atrial volume index (LAVI), Left ventricle to aortic width (Lv/Ao) ratio, E/A ratio and Left ventricular output/superior vena caval (LVO/SVC) flow ratio predicted clinically apparent PDA during first 72 hours of life.Conclusion This study provides insights into the predictive utility of other ductal echo markers along with the routinely measured conventional ones during first 72 hours of life in preterm VLBW newborns.

scholarly journals Resolution of neonatal posthemorrhagic ventricular dilation coincident with patent ductus arteriosus ligation: case report

2020 ◽  
Vol 26 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Erik B. Vanstrum ◽  
Matthew T. Borzage ◽  
Jason K. Chu ◽  
Shuo Wang ◽  
Nolan Rea ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Intraventricular Hemorrhage ◽  
Ductus Arteriosus ◽  
Medical Intervention ◽  
Cranial Ultrasound ◽  
Ventricular Dilation ◽  
Venous Flow ◽  
Systemic Hemodynamic ◽  
Patent Ductus

Preterm infants commonly present with a hemodynamically significant patent ductus arteriosus (hsPDA). The authors describe the case of a preterm infant with posthemorrhagic ventricular dilation, which resolved in a temporally coincident fashion to repair of hsPDA. The presence of a PDA with left-to-right shunting was confirmed at birth on echocardiogram and was unresponsive to repeated medical intervention. Initial cranial ultrasound revealed periventricular-intraventricular hemorrhage. Follow-up serial ultrasound showed resolving intraventricular hemorrhage and progressive bilateral hydrocephalus. At 5 weeks, the ductus was ligated with the goal of improving hemodynamic stability prior to CSF diversion. However, neurosurgical intervention was not required due to improvement of ventriculomegaly occurring immediately after PDA ligation. No further ventricular dilation was observed at the 6-month follow-up.Systemic venous flow disruption and abnormal patterns of cerebral blood circulation have been previously associated with hsPDA. Systemic hemodynamic change has been reported to follow hsPDA ligation, although association with ventricular normalization has not. This case suggests that the unstable hemodynamic environment due to left-to-right shunting may also impede CSF outflow and contribute to ventriculomegaly. The authors review the literature surrounding pressure transmission between a PDA and the cerebral vessels and present a mechanism by which PDA may contribute to posthemorrhagic ventricular dilation.

scholarly journals INFANT FOLLOW-UP AFTER INDOMETHACIN (IND) CLOSURE OF THE PATENT DUCTUS ARTERIOSUS (PDA)

1977 ◽  
Vol 11 (4) ◽  
pp. 395-395 ◽  
Author(s):  
T Allen Merritt ◽  
Charlotte L White ◽  
Michael J Hirschklau ◽  
William F Friedman ◽  
Louis Gluck
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Patent Ductus

Abstract 15358: Cardiac Remodeling in Adults Following Percutaneous Patent Ductus Arteriosus Closure: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah Blissett ◽  
Harsh Agrawal ◽  
Ahmed Kheiwa ◽  
Hope Caughron ◽  
Ian Harris ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Cardiac Remodeling ◽  
Meta Analysis ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Weighted Mean ◽  
Post Procedure ◽  
Patent Ductus

Introduction: Patent ductus arteriosus (PDA) is often recognized and treated with percutaneous closure in adults. However, the impact on cardiac reverse remodeling following PDA closure in adults is not clear. We performed a meta-analysis to characterize the extent of cardiac remodeling following percutaneous PDA closure in adults. Methods: MEDLINE and EMBASE were systematically searched for original studies that reported echocardiographic variables at baseline, immediately post-procedure (within 24 hours), and at follow-up (>1 month) in adults undergoing percutaneous PDA closure. Additionally, we included echocardiographic data from a cohort of patients >18 years of age that underwent percutaneous PDA closure between 01/2015 and 12/2019 at our centre. For parameters with sufficient data for pooling, weighted averages were calculated, and pooled differences were presented as weighted mean differences. Heterogeneity was assessed using the I 2 statistic. Results: After screening 278 abstracts, 5 studies were identified. When combined with our own cohort of 13 patients, our meta-analysis encompassed 244 patients. The weighted mean age of all patients was 33 years with all studies predominantly comprised of female patients and the median follow-up was 12 months (ranging from 1 month- 5 years across the studies). When compared to baseline, left ventricular ejection fraction (LVEF) decreased significantly immediately post-procedure and all parameters significantly decreased at follow-up (Table 1). Conclusions: As demonstrated by the decreases in the left ventricular and left atrial sizes, reverse remodeling was observed in adults who underwent percutaneous PDA closure. The significantly lower LVEF immediately post-procedure could reflect withdrawal of chronic volume overload or increased afterload. The clinical significance of the statistically significant lower LVEF on follow-up testing is unclear and requires further evaluation.

Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement

2021 ◽  
Author(s):  
Georgios Kourelis ◽  
Meletios Kanakis ◽  
Constantinos Loukas ◽  
Felicia Kakava ◽  
Konstantinos Kyriakoulis ◽  
...  
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Chest Tube ◽  
Ductus Arteriosus ◽  
Extremely Low Birth Weight ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Surgical Ligation ◽  
Patent Ductus

AbstractPatent ductus arteriosus (PDA) has been associated with increased morbidity and mortality in preterm infants. Surgical ligation (SL) is generally performed in symptomatic infants when medical management is contraindicated or has failed. We retrospectively reviewed our institution's experience in surgical management of PDA for extremely low birth weight (ELBW) infants without chest tube placement assessing its efficiency and safety. We evaluated 17 consecutive ELBW infants undergoing SL for symptomatic PDA (January 2012–January 2018) with subsequent follow-up for 6 months postdischarge. Patients consisted of 9 (53%) females and 8 (47%) males. Mean gestational age (GA) at birth was 27.9 ± 2.1 weeks. Median values for surgical age (SA) from birth to operation was 10 days (interquartile range [IQR]: 8–12); PDA diameter 3.4 mm (IQR: 3.2–3.5); surgical weight (SW) 750 g (IQR: 680–850); and days of mechanical ventilation (DMV) as estimated by Kaplan–Meier curve 22 days (95% confidence interval: 14.2–29.8). We observed a statistically significant negative association between DMV and GA at birth (rho = − 0.587, p = 0.017), SA (rho = − 0.629, p = 0.009) and SW (rho = − 0.737, p = 0.001). One patient experienced left laryngeal nerve palsy confirmed by laryngoscopy. Otherwise, there were no adverse events to include surgical-related mortality, recurrence of PDA, or need for chest tube placement during follow-up. SL of PDA in ELBW infants without chest tube placement is both efficient and safe. Universal consensus recommendations for the management of PDA in ELBW neonates are needed. Further study is required regarding the use of the less invasive option of percutaneous PDA closure in ELBW infants.

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