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Khajali Z, Firouzi A, Shakerian F, Alemzadeh-Ansari MJ, Ghobadi E, Khalilipur E, Khalili Y, Rezaei L, Hosseini Z. Cardiac Reverse Remodeling After Transcatheter Patent Ductus Arteriosus Closure in Adults. Curr Probl Cardiol 2021; 47:100938. [PMID: 34400002 DOI: 10.1016/j.cpcardiol.2021.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
Whereas most patent ductus arteriosus (PDAs) are identified and treated in the childhood, and the long term outcome studies have approved the outstanding results (positive cardiac reverse remodeling) in these group of patients, the outcome of percutaneous PDA closure in adults is not comprehensible. The aim of this retrospective cohort study which consecutively recruited 121 adult patients (age >16 years) who underwent the transcatheter closure (TCC) of PDAs between 2012 and 2018 is, evaluation at least 1-year follow-up of adult patients after PDA closure and compare the hemodynamic and the cardiac reverse remodeling findings with the previous studies in adults and children.
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Affiliation(s)
- Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Shakerian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ghobadi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Khalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Rezaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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2
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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3
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 798] [Impact Index Per Article: 266.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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4
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Chen PY, Luo DL, Li HZ, Fei HW, Huang T, Huang YG, Chen JM, Zhuang J, He PC, Zhang CJ. Prediction value of pulmonary hypertension in newly identified left ventricular dysfunction among adult patients after patent ductus arteriosus closure. Pulm Circ 2019; 9:2045894019888428. [PMID: 31827770 PMCID: PMC6885525 DOI: 10.1177/2045894019888428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to propose the pulmonary hypertension for predicting left
ventricular dysfunction in adults after patent ductus arteriosus closure. A
total of 183 patients (age ≥18 years) after patent ductus arteriosus occlusion
were retrospectively collected in this study. In brief, pre-, post-procedure and
short-term follow-up transthoracic echocardiography were performed. Simpson’s
method was used to measure the left ventricular ejection fraction (LVEF), and
LVEF less than 50% after procedure was utilized as a criterion to identify left
ventricular dysfunction. As a result, 36 (19.67%) patients developed newly
identified left ventricular dysfunction. The rate of newly identified left
ventricular dysfunction was significantly higher in moderate or severe pulmonary
hypertension groups compared to the groups of mean pulmonary artery pressure
(mPAP) <25 mmHg (P < .001). Logistic regression analysis showed that
elevated mPAP ( ≥25 mmHg) was an independent predictive value for newly
identified left ventricular dysfunction (OR = 3.584, 95%CI: 1.186–10.832,
P = .024) after adjusting confounders. The ROC curve revealed a good
discrimination power for predicting newly identified left ventricular
dysfunction (AUC = 0.924, 95%CI: 0.885–0.963, P < .001). Taken together,
newly identified left ventricular dysfunction after patent ductus arteriosus
closure was prevalent in patients with elevated mPAP. The pre-procedure elevated
mPAP is an independent risk factor for the prediction of the newly identified
left ventricular dysfunction in adult patients undergoing percutaneous patent
ductus arteriosus closure. It is feasible to propose a risk model for predicting
post-procedure left ventricular dysfunction and a heart function monitoring in
pulmonary hypertension patients.
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Affiliation(s)
- Peng-Yuan Chen
- Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, China
| | - Dong-Ling Luo
- Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, China
| | - He-Zhi Li
- Department of Echo Room, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Hong-Wen Fei
- Department of Echo Room, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Tao Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structure Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Yi-Gao Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structure Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ji-Mei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Peng-Cheng He
- Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Cao-Jin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structure Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
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5
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Lee HY, Her SH, Park MW, Choi MS, Cho JS, Kim CJ, Kang HS, Choi YA, Ju IN, Kim SA, Lee JH, Kwon JB, Park K. A case of patent ductus arteriosus with congestive heart failure in a 80-year-old man. Korean Circ J 2013; 42:849-52. [PMID: 23323124 PMCID: PMC3539052 DOI: 10.4070/kcj.2012.42.12.849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/15/2012] [Accepted: 05/29/2012] [Indexed: 11/26/2022] Open
Abstract
Patent ductus arteriosus (PDA) is a rare clinical finding in adult patients. Considering the increase in cases of PDA discovered incidentally on echocardiograms at young ages, and the life-shortening effect of PDA, it is rare to diagnose PDA in old patients. We report a case of an 80-year-old patient who experienced symptoms of congestive heart failure showed findings suggestive of PDA in echocardiogram and confirmed the diagnosis through a cardiac catheterization and a coronary angiography. After percutaneous occlusion of PDA with an Amplatzer duct occlusion device, symptoms related to congestive heart failure improved.
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Affiliation(s)
- Hye Yeon Lee
- Division of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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6
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Ardıç İ, Kaya MG. Indications for Percutaneous Closure in
Adult Congenital Heart Defect. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Recomendações da ESC para o tratamento da cardiopatia congénita no adulto (nova versão de 2010). Rev Port Cardiol 2012. [DOI: 10.1016/j.repc.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Kaleschke G. Katheterinterventionelle Therapie bei Erwachsenen mit Herz- und Gefäßmissbildungen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-011-0885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Sullivan MM, Theleman KP, Choi JW. Percutaneous closure of patent ductus arteriosus in an asymptomatic adult. Proc (Bayl Univ Med Cent) 2011; 21:386-8. [PMID: 18982080 DOI: 10.1080/08998280.2008.11928433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Margaret M Sullivan
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
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10
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Baumgartner H, Bonhoeffer P, De Groot NMS, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJM, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, McDonagh T, Swan L, Andreotti F, Beghetti M, Borggrefe M, Bozio A, Brecker S, Budts W, Hess J, Hirsch R, Jondeau G, Kokkonen J, Kozelj M, Kucukoglu S, Laan M, Lionis C, Metreveli I, Moons P, Pieper PG, Pilossoff V, Popelova J, Price S, Roos-Hesselink J, Uva MS, Tornos P, Trindade PT, Ukkonen H, Walker H, Webb GD, Westby J. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31:2915-57. [PMID: 20801927 DOI: 10.1093/eurheartj/ehq249] [Citation(s) in RCA: 1513] [Impact Index Per Article: 108.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Helmut Baumgartner
- Adult Congenital and Valvular Heart Disease Center (EMAH-Zentrum) Muenster, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany.
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11
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Gamboa R, Rios-Méndez RE, Mollón FP, Arroyo GM, Gutiérrez DF. Percutaneous closure of patent ductus arteriosus in adults using different devices. Rev Esp Cardiol 2010; 63:726-9. [PMID: 20515630 DOI: 10.1016/s1885-5857(10)70147-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical closure of patent ductus arteriosus in adults involves a number of risks because there are associated anatomic and histologic alterations. Between October 1992 and August 2008, 23 patients were referred to our department with isolated patent ductus arteriosus. Their age ranged from 16-75 years (median 25.5 years) and their weight from 52-80 kg (median 57 kg). The pulmonary diameter ranged from 1.8-5.8 mm (mean 3.5 mm), and pulmonary artery pressure, from 9-72 mmHg (mean 15 mmHg). The rate of ductal occlusion achieved with the Rashkind patent ductus arteriosus occluder was 85.7%, and it was 100% with the Amplatzer duct occluder and the Nit-Occlud coil. The average hospitalization time and follow-up duration were 24 hours and 2 years, respectively. The only immediate complication was an inguinal hematoma, and there were no late complications. In adults, closure of patent ductus arteriosus using a number of different devices, especially the latest generation devices, was safe and effective, regardless of morphologic and histologic characteristics.
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Affiliation(s)
- Ricardo Gamboa
- Sección de Cardiología Infantil, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
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12
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Gamboa R, Rios-Méndez RE, Mollón FP, Arroyo GM, Gutiérrez DF. Cierre percutáneo del ductus con diferentes dispositivos en adultos. Rev Esp Cardiol (Engl Ed) 2010. [DOI: 10.1016/s0300-8932(10)70165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: shunt lesions. Can J Cardiol 2010; 26:e70-9. [PMID: 20352137 DOI: 10.1016/s0828-282x(10)70354-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with congenital heart disease, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part I of the guidelines includes recommendations for the care of patients with atrial septal defects, ventricular septal defects, atrioventricular septal defects and patent ductus arteriosus. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk, and follow-up requirements. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 974] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 624] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Russell IA, Rouine-Rapp K, Stratmann G, Miller-Hance WC. Congenital Heart Disease in the Adult: A Review with Internet-Accessible Transesophageal Echocardiographic Images. Anesth Analg 2006; 102:694-723. [PMID: 16492817 DOI: 10.1213/01.ane.0000197871.30775.2a] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Isobel A Russell
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA.
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17
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Kobayashi T, Tomita H, Fuse S, Takamuro M, Hatakeyama K, Horita N, Tsutsumi H. Coil Occlusion for Patent Ductus Arteriosus Larger Than 3 mm. Circ J 2005; 69:1271-4. [PMID: 16195630 DOI: 10.1253/circj.69.1271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coil occlusion of patent ductus arteriosus (PDA) is now widely accepted as the first-line treatment, but there are few reports of age-dependent differences in the complications associated with this technique. METHODS AND RESULTS Sixteen patients (11 adults, 5 children) with a PDA larger than 3 mm, who underwent coil occlusion at Sapporo Medical University Hospital between September 1995 and August 2004, were enrolled. Immediate and intermediate outcomes and complications were analyzed. Procedural success rate was 72.7% (8/11) in the children and 100% (5/5) in the adults. Coil migration occurred in 4 children and 1 adult, and 3 adult patients had hemolysis. CONCLUSION Hemolysis was more frequent in adults than in children even though the residual shunt was trivial.
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Affiliation(s)
- Toshiyuki Kobayashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Japan
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18
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Abstract
The number of patients with congenital cardiac disease reaching adulthood is increasing steadily. Many adults with such disease face both medical and surgical difficulties. Most clinicians know very little about basic cardiac defects, their natural history, complications after surgery, and adequate management of these patients. We aim to provide an overview of the most frequently encountered cardiac lesions and long-term complications and to outline an up-to-date approach to their management. We present a series of hypothetical cases and discuss their management.
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Affiliation(s)
- Judith Therrien
- University of Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, Ontario, Toronto, Canada
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19
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Wang JK, Liau CS, Huang JJ, Hsu KL, Lo PH, Hung JS, Wu MH, Lee YT. Transcatheter closure of patent ductus arteriosus using Gianturco coils in adolescents and adults. Catheter Cardiovasc Interv 2002; 55:513-8. [PMID: 11948902 DOI: 10.1002/ccd.10090] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present the short- and intermediate-term results of transcatheter closure of patent ductus arteriosus with Gianturco coils in adolescents and adults. During a 5-year period, 55 patients (44 females, 11 males) with ages ranging from 14 to 72 years (median, 23) underwent attempted transcatheter closure of patent ductus with the Gianturco coils. The diameter of the narrowest segment of the ductus ranged from 0.8 to 7.6 mm (3.9 +/- 1.3 mm). The 55 patients were divided into three groups. Group I consisted of nine patients with a ductal diameter < or = 3 mm, group II consisted of 27 patients with a ductal diameter > 3 mm but < or = 4 mm, and group III consisted of 19 patients with a ductal diameter > 4 mm. Four- to five-loop Gianturco coils were used, which were deployed via retrograde aortic route. Multiple-coil technique was generally applied in group II patients. Balloon occlusion technique in combination with multiple-coil technique was generally used in group III patients. Deployment of coil was successful in 51 patients (93%) but failed in 4. The success rate of coil deployment in group I, II, and III were 100% (9/9), 96% (26/27), and 84% (16/19), respectively. A mean of 1.9 +/- 0.7 coils was deployed per patient. Of the four patients with unsuccessful coil deployment, three underwent surgery and one received implantation with Amplatzer duct occluder. Distal embolization of 21 coils occurred in 10 patients (3 in group II and 7 in group III), from whom 20 coils were retrieved with a gooseneck snare and 1 coil was removed during surgery. The mean diameter of ductus in the 10 patients with distal embolization was significantly larger than that in those without (5.2 +/- 1.4 vs. 3.7 +/- 1.1 mm; P < 0.01). Among the 51 patients with successful coil deployment, immediate complete closure was achieved in 20 (39%), while trivial to mild leak was present in 31 (61%). No significant complications were encountered. After a follow-up period ranging from 5 to 42 months, four patients had a small residual shunt and three underwent a second intervention with complete occlusion. None had left pulmonary artery stenosis documented with Doppler echocardiography. Transcatheter closure of ductus with the Gianturco coils is safe and feasible in the majority of adolescents and adults. Taking high embolization rate in patients with a ductus diameter > 4 mm into consideration, controlled-release coils, Buttoned device, or Amplatzer duct occluder can be a better choice.
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Affiliation(s)
- Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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20
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Affiliation(s)
- R Arora
- Department of Cardiology, GB Pant Hospital, New Delhi 110001, India
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21
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Abstract
In the absence of irreversible pulmonary hypertension, closure of clinically detectable patent ductus arteriosus (PDA) is usually recommended in adults. Device closure obviates the need for general anesthesia and a surgical incision and eliminates postoperative pain, long convalescence, and lifelong scarring. Over the past 20 years, the efficacy and safety of transcatheter device closure of PDA in adults has been established. Even though the immediate success rate is lower with transcatheter device closure than with surgical closure, transcatheter reintervention for residual clinical shunts is very effective at abolishing residual leaks. The late complete closure rate, as determined by echocardiography, is very similar with surgical closure and with device closure. The clinical significance of silent residual shunts is unknown. In patients with silent residual shunts, the use of prophylactic antibiotics is as of yet recommended. Occlusion devices should be used whenever possible in adults, and surgical closure of patent ducts should be reserved for patients with larger ducts. The method of ductal closure should be selected on the basis of the quality of and experience with available interventional and surgical resources. Emerging minimally invasive surgical treatments seem promising, but further experience and follow-up are needed before widespread application of these techniques can be recommended.
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22
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Amir IM, Maranets I, Barash P. Transesophageal echocardiography of the distal aortic arch. J Cardiothorac Vasc Anesth 1998; 12:599-603. [PMID: 9801987 DOI: 10.1016/s1053-0770(98)90110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- I M Amir
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT
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23
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Ing FF, Mullins CE, Rose M, Shapir Y, Bierman FZ. Transcatheter closure of the patient ductus arteriosus in adults using the Gianturco coil. Clin Cardiol 1996; 19:875-9. [PMID: 8914781 DOI: 10.1002/clc.4960191107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risk. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. METHODS Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occlusion of the PDA using Gianturco coils. RESULTS Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. CONCLUSION Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.
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Affiliation(s)
- F F Ing
- Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston 77030, USA
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