Difficulties generated by the small, persistently patent, arterial duct

Division or Occlusion of Patent Ductus Arteriosus?

The traditional and most effective form of treatment of persistent ductus arteriosus is surgical ductal division. New therapeutic techniques such as intraluminal ductal occlusion are currently recommended to replace the traditional treatment procedure. The purpose of this paper is to analyze the state of the art of these new therapeutic modalities. From reports in the medical literature, the authors analyzed the indications, results, and complications of the intraluminal ductal occlusion procedures. They applied the Student's t test for independent samples to evaluate the results of intraluminal patent ductus arteriosus occlusion by means of umbrellas, buttons, coils, and Gianturco-Grifka and Amplatzer occluders, respectively, in 2,691 patients collected from the medical literature. According to their analysis the results of intraluminal ductal occlusion with coils were as follows: success 83.7 ±12.2%, failure 3.9 ±2.8%, incom plete ductal occlusion 17.5 ±15.3%, need for surgery 2.8 ±3.8%, need for a second intraluminal procedure 5.8 ±9.9%, and device embolization 6.2 ±7.2%. The use of the Gianturco-Grifka device showed the following results: success 96.0 ±5.6%, failure 4.0 ±5.6%, incomplete ductal occlusion 4.0 ±5.6%, need for surgery 0%, need for a second intraluminal procedure 4.0 ±5.6%, and device embolization 4.0 ±5.6%. The Amplatzer occluder showed the following results: success 92.8 ±6.1%, failure 7.2 ±6.1%, incomplete ductal occlusion 2.0 ±4.3%, need for surgery 0%, need for a second intraluminal procedure 0.8 ±1.7%, and device embolization 0.5 ±1.3%. According to the state of the art, intraluminal ductal occlusion with Gianturco-Grifka device and Amplatzer occluder reduces the proportion of incomplete obstructions and need for surgery. Additionally, the use of the Amplatzer occluder reduces need for a second procedure and the embolization rate. Although the results obtained with the new procedures are better than those obtained previously, they are still not totally satisfactory.

Infective Endocarditis in Adults with Congenital Heart Disease

Although modern medicine has improved survival in congenital heart disease dramatically, the long-term course carries a risk of late complications. The incidence of infective endocarditis in adults with congenital heart disease is more than 10 times higher than that of the normal population. Identification of the high-risk groups, a high diagnostic alert, and no random prescription of antibiotics to these patients are important issues to health care providers. There is also a need for a structured education of patients on preventive measures and symptoms of infective endocarditis.