Patent Ductus Arteriosus with Persistent Pulmonary Artery Hypertension after Transcatheter Closure

Transcatheter closure has become the leading approach for closure of most instances of patent ductus arteriosus. However, there are some complications associated with this procedure. We report a case involving the embolization of a device in the right pulmonary artery during placement. A 20-year-old woman was referred to our hospital for percutaneous transcatheter closure of patent ductus arteriosus. During the deployment of an Amplatzer duct occluder device, it was disconnected from the connector and became embolized in the lower branch of the right pulmonary artery. We could not grasp the device with a gooseneck snare. After various attempts, the device was captured and removed by a BiPal bioptome endomyocardial biopsy forceps. Based on our findings, we recommend that endomyocardial biopsy forceps should be considered as an alternative when such complications occur.

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Safety and Outcomes of Transcatheter Closure of Patent Ductus Arteriosus in Children With Pulmonary Artery Hypertension

Texas Heart Institute Journal ◽

10.14503/thij-19-6982 ◽

2020 ◽

Vol 47 (4) ◽

pp. 250-257

Author(s):

Arash Salavitabar ◽

Usha S. Krishnan ◽

Mariel E. Turner ◽

Julie A. Vincent ◽

Alejandro J. Torres ◽

...

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Resistance Index ◽

Pulmonary Artery Hypertension ◽

Adverse Outcomes ◽

Closure Device ◽

Vasodilator Therapy ◽

Pulmonary Vasodilator ◽

Patent Ductus

To investigate whether transcatheter device closure of patent ductus arteriosus (PDA) is safe in children with pulmonary artery hypertension, we retrospectively analyzed our experience with 33 patients who underwent the procedure from January 2000 through August 2015. Pulmonary artery hypertension was defined as a pulmonary vascular resistance index (PVRI) >3 WU · m2. All 33 children (median age, 14.5 mo; median weight, 8.1 kg) underwent successful closure device implantation and were followed up for a median of 17.2 months (interquartile range [IQR], 1.0–63.4 mo). During catheterization, the median PVRI was 4.1 WU · m2 (IQR, 3.6–5.3 WU · m2), and the median mean pulmonary artery pressure was 38.0 mmHg (IQR, 25.5–46.0 mmHg). Premature birth was associated with pulmonary vasodilator therapy at time of PDA closure ( P=0.001) but not with baseline PVRI (P=0.986). Three patients (9.1%) had device-related complications (one immediate embolization and 2 malpositions). Two of these complications involved embolization coils. Baseline pulmonary vasodilator therapy before closure was significantly associated with intensive care unit admission after closure (10/12 [83.3%] with baseline therapy vs 3/21 [14.3%] without; P <0.001). Of 11 patients receiving pulmonary vasodilators before closure and having a device in place long-term, 8 (72.7%) were weaned after closure (median, 24.0 mo [IQR, 11.0–25.0 mo]). We conclude that transcatheter PDA closure can be performed safely in many children with pulmonary artery hypertension and improve symptoms, particularly in patients born prematurely. Risk factors for adverse outcomes are multifactorial, including coil use and disease severity. Multicenter studies in larger patient populations are warranted.

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Expectant management of prolonged hemolysis following complete transcatheter coil closure of a patent ductus arteriosus after previous pulmonary artery banding: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02365-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mao-Sheng Hwang ◽

Ching-Chia Kuo ◽

Hung-Tao Chung ◽

Hsin-Mao Hsu ◽

Jaw-Ji Chu ◽

...

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Expectant Management ◽

Pulmonary Artery Banding ◽

Refractory Anemia ◽

Serum Lactate Dehydrogenase ◽

Serum Total Bilirubin ◽

Patent Ductus

Abstract Background Transcatheter coil occlusion has been the treatment of choice for closure of small patent ductus arteriosus (PDA). In spite of its safety, complications such as hemolysis still occasionally occur. And the hemolysis almost always occurs following partial transcatheter closure of PDA; hence, it occurs extremely rarely following complete transcatheter closure of PDA without residual ductal flow. Case presentation Here, we describe a male newborn who developed prolonged hemolysis following complete transcatheter coil closure of his PDA after previous palliative pulmonary artery banding. Over the following days, we corrected his refractory anemia by repeated blood transfusion with packed red blood cells and frequently monitored his hemoglobin, serum total bilirubin, and serum lactate dehydrogenase. We speculated that the high-velocity pulmonary blood flow jet coming into contact with the extruded part of the coil led to red blood cell mechanical injury, thereby resulting in the hemolysis. We adopted expectant management in expectation of the endothelialization of the coil with a resultant reduction in the hemolysis. The hemolysis, as expected, was reduced gradually until it spontaneously resolved 81 days after coil implantation. Conclusions This case reminds us that hemolysis can still potentially occur following complete transcatheter coil closure of PDA. It also highlights the importance of preventing coils from extruding into the pulmonary artery in patients after previous pulmonary artery banding.

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Operable patent ductus arteriosus even with differential cyanosis: a case of patent ductus arteriosus and mitral stenosis

Cardiology in the Young ◽

10.1017/s1047951117001275 ◽

2017 ◽

Vol 27 (9) ◽

pp. 1845-1848 ◽

Cited By ~ 1

Author(s):

Anunay Gupta ◽

Shyam S. Kothari

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Mitral Stenosis ◽

Ductus Arteriosus ◽

Pulmonary Artery Hypertension ◽

Early Age ◽

Eisenmenger Syndrome ◽

Corrective Surgery ◽

Patent Ductus

AbstractPatients with patent ductus arteriosus and significant left-to-right shunt develop Eisenmenger syndrome at an early age and are not operable after development of irreversible pulmonary artery hypertension. Patients with mitral stenosis, however, are treatable even with suprasystemic pulmonary artery pressures. A combination of these two lesions is rare. We document a patient with differential cyanosis who improved after corrective surgery of both the lesions. The importance of post-capillary pulmonary artery hypertension in shunt lesions needs to be better appreciated.

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Hospital Outcomes of Surgical Closure of Patent Ductus Arteriosus: 19 Years Experience at Shahid Gangalal National Heart Center

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i2.33222 ◽

2020 ◽

Vol 18 (2) ◽

pp. 30-35

Author(s):

R. Koirala ◽

N. Panthee ◽

S. Pradhan ◽

N. Rajbhandari ◽

D.K. Shrestha ◽

...

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Main Pulmonary Artery ◽

Pulmonary Artery Hypertension ◽

Hospital Outcomes ◽

Descending Aorta ◽

Surgical Closure ◽

First Case ◽

Patent Ductus

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension. Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

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Patent Ductus Arteriosus with Persistent Pulmonary Artery Hypertension after Transcatheter Closure