Age at Surgical Ligation of Patent Ductus Arteriosus Affects Prognosis in Extremely Premature Infants

Background: This study aimed to evaluate outcomes, prognosis, and safety associated with the timing of surgical ligation for patent ductus arteriosus (PDA) in extremely premature infants (EPI). Methods: We reviewed the clinical data of 44 EPI (gestational age at birth 26.8 ± 0.67 weeks; birth weight 997 ± 152 g) who received surgical ligation for hemodynamically significant PDA (hsPDA) in the Neonatal Intensive Care Unit (NICU) of Bayi Children’s Hospital in China between January 2021 and December 2014. We compared the general characteristics, underlying diseases, postoperative surgical complications, and prognoses in two groups of patients who received early ligation (≤ 14 days after birth) and late ligation (> 14 days after birth). Results: The gender, gestational age at birth, birth weight, Apgar score, postoperative surgical complications, rates of bronchopulmonary dysplasia (BPD), retinopathy of prematurity, necrotic enterocolitis, periventricular leukomalacia, total hospitalization, and medical costs of both groups were compared. According to the results, the late ligation group had a higher rate of severe BPD (66.3% cf. 35%) and required significantly longer time to reach total enteral feeding and weaning of respiratory support compared with the early ligation group. Conclusions: In EPI with hsPDA, for whom medical treatment failed or is contraindicated, early surgical closure of the ductus arteriosus can promote earlier total enteral feeding, shorten the duration of mechanical ventilation, and reduce the rates of severe BPD.

Does Early Neonatal Thrombocytopenia Affect Ductal Therapeutic Respose to Acetaminophen in Preterm Neonates?

Perinatal thrombocytopenia has been shown to affect responsiveness to therapeutic ductal closure with cyclo-oxygenase inhibitors. This has not been studied in responsiveness to acetaminophen, which has less effect on platelet function. Objective: To evaluate whether thrombocytopenia affects ductal responsiveness to acetaminophen. Study Design: Retrospective review of preterm neonates <1500 gm. Echocardiograms were performed within the first week of life; if ductal status was found to be hemodynamically significant, infants were treated with acetaminophen. Results: We studied 254 infants. Fifty seven of these (22%) had a hemodynamically significant PDA (hsPDA) and were treated with acetaminophen. Forty (70%) of those treated responded with ductal closure after 1-2 courses of acetaminophen. Seventeen infants were considered non-responsive, requiring the addition of ibuprofen and/or surgical ligation. Sixty-seven of the 254 infants (26%) developed moderate thrombocytopenia [platelets <100,000] within the first ten days of life, more within the hsPDA group (54% vs. 18% p<0.001); however, no differences in platelet related parameters were observed when comparing infants with hsPDA who did or did not respond to acetaminophen treatment. Twenty-six of the 67 thrombocytopenic were already thrombocytopenic prior to acetaminophen treatment; and 19 of these 26 (73%) with pre-treatment thrombocytopenia responded to acetaminophen treatment – similar to the overall response rate of 70% . Conclusions: This study is the first to document that, in contrast to the cyclo-oxygenase inhibitors, there is no association between early neonatal thrombocytopenia and ductal therapeutic responsiveness to acetaminophen.

Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants

(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.

Complex, Isolated Pulmonary Arteriovenous Malformation in Two Children With Severe Cyanosis.

We present two cases of Isolated complex pulmonary arteriovenous malformations in two children presenting with cyanosis and exercise intolerance. We present the anatomical features and the management of each case. One patient was treated with surgical ligation of the draining vein, and one patient was treated percutaneously by closure of the feeding segmental artery.

EPICARDIAL CLIP CLOSURE OF THE LEFT ATRIAL APPENDAGE: REPLY

Epicardial surgical clip is showed to be a safe and effective tool in order to achieve a complete left atrial appendage (LAA) exclusion thus reducing the risk of stroke in patients with atrial fibrillation. Historically, other methods as surgical ligation, internal oversewing or external stapling showed to be largely uneffective with an incidence of LAA residual flow ranging from 25% to 35% thus, increasing per se 5- to 10-fold the risk of stroke. Epicardial LAA exclusion by means of external clip could be potentially released under transesophageal echocardiographic guidance thus increasing the procedural success rate of complete closure with no residual stump left.

Percutaneous transhepatic access for catheter ablation of A patient with heterotaxy syndrome complicated with atrial fibrillation ：a case report

Atrial fibrillation (AF) is one of the most common arrhythmia, and radiofrequence catheter ablation has become the most effective treatment method.The inferior vena cava(IVC)is a common approach for radiofrequency ablation of atrial fibrillation. In some cases, this approach cannot be used, such as chronic venous occlusions, surgical ligation of the IVC and heterotaxy syndrome. In patients without femoral vein access, use of the hepatic vein for PVI is a viable alternative for invasive EP procedures.