Mean Patent Ductus Arteriosus Research Articles

Transcatheter Patent Ductus Arteriosus Closure in Children With Different Devices and Long-Term Results.

With the development of transcatheter interventional techniques and the introduction of next-generation duct occluder devices, transcatheter closure has become the first treatment option for patent ductus arteriosus (PDA) in pediatric patients. In this study, we compared the effectiveness and safety of different devices for transcatheter PDA closure in pediatric patients, focusing on long-term outcomes. A total of 235 patients aged 0-18 years who underwent transcatheter PDA closure at a tertiary care center between January 2005 and February 2020 were included. The medical records of the cases were retrospectively evaluated. The median age of the patients was 2.3 years (range: 3.5 months to 17 years), with a mean weight of 12.8 kg (range: 5.7-43.2 kg). The mean PDA diameter at its narrowest point was 2.9 mm (range: 2.2-5.1 mm). Ductal anatomy was as follows: Type A in 98 (41.7%) patients, Type E in 36 (15.6%) patients, Type C in 32 (13.5%) patients, Type F in 27 (11.4%) patients, Type D in 23 (9.7%) patients, and Type B in 19 (8.1%) patients. Arterial access was used in 138 (57.1%) patients, venous + arterial access in 58 (24.6%) patients, and venous access only in 39 (16.5%) patients. Closure was performed with Amplatzer Duct Occluder (ADO; AGA Medical Corp., Golden Valley, MN, USA) II in 151 (64.2%) cases, ADO I in 43 (18.2%) cases, and coils in 41 (17.4%) cases. The mean fluoroscopy time and mean procedural time were 10.3 ± 4.2 minutes and 41 ± 7.2 minutes, respectively. The mean radiation dose was 1364 ± 497 cGy/min. The early closure rate after the procedure was 92%, while residual shunting on the first day post-procedure was observed in 1.8% of cases, decreasing to 0.1% at the one-month follow-up. The overall procedural success rate for all cases was 96.0%. The mean follow-up duration was 9.7 years (range: 2.9-13.8 years). For percutaneous PDA closure, ADO I devices are preferred for larger defects, whereas ADO II devices are prioritized for small- to medium-sized defects instead of coils.

Role of angiography procedure for assessment the type of patent ductus arteriosus in children under 18 years.

Objective: To determine the role of angiography for the assessment the type of patent ductus arteriosus in children under 18 years. Study Design: Observational Retrospective study. Setting: Children’s Hospital Lahore. Period: October 2021 to February 2022. Material & Methods: The sample size calculated was 245 but, at the end of the period of four months only 120 patients fulfilled the criteria and were included in this study convenient sampling technique was used to collect the data. Patients with patent ductus arteriosus were included in this study. Patients with other congenital heart diseases were excluded. Essential measurements included Types of Patent Ductus Arteriosus (PDA), (PDA) Size, Ampulla Size, Aortic and Pulmonary systolic and diastolic pressures. Results: In this study 120 patients with PDA were included. Out of 120, 38 (31.7%) patients were male and 82 (68.3%) patients were female. The age range of the patients was 8 months to 18 years (mean;5.44 ± 3.972 years). The weight range of the patients was 5.3 to 41 Kg (mean;16.05 ± 8.38Kg). The mean PDA size was 4.01 ± 1.80. The mean Ampulla size was 9.92 ± 3.13. The types of PDA detected by angiography were Type A 59(49%), Type B 15(12.5%), Type C 20(16.7%), Type D 20(16.7%), Type E 5(4%), Type F 1(0.8%). The mean Aortic systolic pressure was 105.5±18.99 and diastolic pressure was 57.2 ±14.4. The mean Pulmonary Artery systolic pressure was 47.4 ± 23.3 and diastolic pressure was 27.7 ±14.2. Conclusion: Angiography was found more accurate for the assessment of all the anatomical types of PDA especially TYPE B, C, D and F. More precise measurements of the ampulla and PDA sizes were obtained using angiography. We may conclude that Angiography is a much better and good modality than other modalities for the assessment of the types of PDA.

Correlation of Ductal size with Left Ventricular Systolic Function Changes by Echocardiography in Children after Transcatheter Closure of Patent Ductus Arteriosus in a Tertiary Care Hospital

Background: Transcatheter closure of Patent Ductus Arteriosus (PDA) is considered an excellent treatment option for children requiring PDA closure due to its low morbidity and mortality rates. Theoretically, after PDA closure, there should be a gradual improvement in left ventricular volume overload and remodeling. However, numerous studies have shown that there is a temporary decline in left ventricular function immediately following PDA closure. Objectives: To see the correlation of ductal size with changes in left ventricular systolic function by echocardiography in children undergoing transcatheter closure of PDA. Materials and methods: It was a cross sectional study. All pediatric inpatients ≥6 months of age, diagnosed as a case of PDA and planned for device closure were enrolled in the study. M-Mode, 2D, Color Doppler and 2D speckle tracking echocardiography was done by GE Echo machine Model VividS70N using probes 5MHz (5s) and 6MHz(6s). Electrocardiogram (ECG ) gated echo was done at base line (prior to closure of PDA), after 24 hour post closure and after 1 month post closure, in order to evaluate the immediate and short term changes in left ventricular systolic function from the baseline, using the following parameters: Left Ventricular Ejection Fraction (LVEF) and Left Ventricular Fractional Shortening (LVFS). The total sample size was 35. Data were collected on a pre-tested questionnaire. Data analysis was carried out by using the SPSS version 22.0 windows software. Continuous data were expressed as mean ±SD and analyzed by paired t-test. Categorical data were expressed as frequency and percentages. Correlation was seen using Pearson’s correlation. P-value < 0.05 was considered statistically significant. Results: The mean age of the study subjects was 46.69 ± 41.8 months with mean body surface area of 0.56 ±0.25m² (0.32-1.3). Females were predominant with 74.3% and males were 25.7%. The mean PDA size was 3.35 ± 0.77mm and the LA: Aorta ratio was 1.45 ± 0.24. The LVEF, LVFS were reduced from 70.11±3.81 to 57.34±5.0, 39.28±3.14 to 32.0±4.54 respectively 24hours after device closure. This reduction of LVEF, LVFS were statistically significant (p<0.01). At 1 month post device follow up all the parameters returned to near baseline level. PDA size was found to be negatively correlated with early changes in left ventricular functions i.e. larger the PDA size, greater is the reduction in LV function post PDA device. Conclusions: Transcatheter closure of PDA can lead to transient reduction in left ventricular systolic function which improves gradually after a month; however, close monitoring is required. Larger the PDA size, greater is the reduction in LV function. As such moderate to large PDAs should be followed up more cautiously and immediate timely intervention is needed, if severe deterioration is found.

Detailed radiological study of the patent ductus arteriosus: a computed tomography study in the Polish population.

The aim of the study was to perform qualitative and quantitative computed tomography (CT) angiography-based evaluation of patent ductus arteriosus (PDA) morphology and its influence on morphology of the great vessels. Two-thousand twenty-two patients underwent 64-slice or dual-source CT and were retrospectively screened for the presence of PDA. Those who had presence of PDA underwent evaluation of its anatomy and morphology. Thirty-two adult patients with PDA were evaluated (mean age 41.4 ± 17.4 years). Subjects with PDA had a higher value of aortic isthmus (p = 0.0148), main pulmonary artery (p < 0.0001), right (p =0.0007) and left (p = 0.0074) pulmonary arteries diameters than individuals from control group (16 adults, median age 43.3 ± 12.4 years). Types A, B, C, D, and E of PDA morphology occurred in 16 (50%), 3 (9%), 9 (28%), 2 (6%), and 2 (6%) patients, respectively. Subjects with the type A configuration of PDA tended to have a larger diameter at the aortic orifice (10.2 ± 5.2 mm vs. 6.4 ± 4.9 mm, p = 0.09) and a larger maximal diameter (10.3 ± 5.3 mm vs. 7.1 ± 4.7 mm, p = 0.14) compared to subjects with the type C configuration. The values of minimal, mean, and maximal diameters of PDA were 4.7 ± 1.9 mm, 7.0 ± 3.2 mm, and 9.4 ± 5.0 mm, respectively. The Spearman correlation coefficient between the main pulmonary artery and PDA diameters demonstrated a good correlation for minimal (r = 0.70, p < 0.001), mean (r = 0.62, p = 001), and maximal (r = 0.60, p = 0.0003) PDA diameters. Computed tomography enables quantitative and qualitative evaluation of PDA, including its type of morphology, length, and diameters. In the evaluated adult population with PDA, the majority of patients had dilation of the aortic isthmus and pulmonary arteries. PDA diameters correlate with diameters of the pulmonary arteries and this correlation is strongest between PDA diameter at the narrowest site and main pulmonary artery.

Transcatheter closure of patent ductus arteriosus, evaluating the outcome: Single center experience in Mansoura, Egypt

Device closure is considered the treatment of choice for patent ductus arteriosus (PDA). The study presents our experience in transcatheter occlusion of PDA using three different devices between January 2008 and December 2016. The immediate and short-term outcome of 213 pediatric patients with PDA underwent PDA occlusion were analyzed. Aortic angiography was done to evaluate the size, position, and shape of the duct for proper device selection. A second aortic angiography was performed 10 min after device deployment. Echocardiography was repeated at intervals of 24 h, then at one, three, six and 12 months after the procedure to assess the presence of any complications. The mean age of patients was 9.2 ± 5.2 months and their mean weight was 7.6 ± 1.8 kg. Mean PDA diameter at its narrowest point measured by angiography was 2.81 ± 0.51 mm. Nit-Occlud pfm Coil occlusion was performed in 107 (50.2%) patients, Amplatzer ductal occluder was performed in 84 (39.4%) and Nit-Occlud PDA-R was performed in 22 (10.3%). Complete closure was observed in 95.7% of patients prior to discharge and this rate has reached 98.5% after three months of follow up and increased to 100% at 6 and 12-months visits. There was no significant difference regarding the outcome for each of the three devices prior to discharge and at 3 months follow up (p = 0.9974 and 0.9729, respectively). Limited complications were reported (e.g. aortic protrusion, mild LPA obstruction, significant blood loss) which were related mainly to the use of large devices (e.g. ADO-1) deployed over large diameter sheaths in young children with small body weight. In conclusion, percutaneous transcatheter closure of PDA technique using Nit-Occlud pfm coils, Amplatzer ductal occluder and Nit-Occlud PDA-R is proved to be safe and effective, with limited complications and non-significant hemodynamic consequences.

Cocoon devices for transcatheter closure of atrial septal defect and patent ductus arteriosus in children: Single center experience.

Closure of the atrial septal defect (ASD) and patent ductus arteriosus (PDA) are among the most frequent cardiac interventional procedures. This was a prospective study, which started together with the implementation of a national program of pediatric interventional cardiology in Romania. We used Cocoon devices in 83 consecutive cases from 92 implantations for ASD and PDA. 27 cases were ASD closure and 56 cases PDA closure. Regarding the ASD closure, the median age was 8.5 years (range 3–25 years) and median weight 25 kg (range 11.5–63 kg). The mean follow-up was 17.4 ± 6.7 months (range 3–26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ± 4.1 mm (range 8–26 mm). The mean device diameter used was 17.3 ± 5.6 mm (range 8–32 mm). Regarding the PDA closure, the median age was 36 months (range 4–192 months) and median weight 14 kg (range 5–58 kg). The mean follow-up was 15 ± 8 months (range 3–28 months). The mean PDA minimum diameter was 2.5 ± 0.8 mm. The success implantation rate for both groups was 97.6% (2 cases of withdrawn for ASD and PDA), while the complication rate was 2.3% (including 2 ASD device embolization). In the first 24 hours, the closure rates were 96.3% for ASD, 98.2% for PDA, and 100% at 1-month follow-up for both procedures. On short and intermediate follow-up (3–28 months), no device-related complications were noted.The Cocoon devices are safe for transcatheter closure of both ASD and PDA, and the initial experience with their use in our emerging center is encouraging.

Percutaneous Device Closure of Patent Ductus Arteriosus in Adult Patients with 10-Year Follow-up.

Objectives:We report our 10-year experience with transcatheter closure of patent ductus arteriosus (PDA) in adult using different closure devices.Background:Transcatheter closure of PDA in adults can be challenging because of frequently associated comorbidities. Reports on immediate and intermediate-term results of PDA closure are excellent. This study aimed to provide the outcomes of PDA closure using different devices on long and very long term follow-up in adults.Materials and Methods:Between September 2009 and December 2018, data were retrospectively reviewed from 27 patients who underwent transcatheter closure of PDA. Outcome parameters were procedural success, procedure-related complications, evidence of residual shunt, and improvement in the signs/symptoms for which the procedure was performed. The mean follow-up interval was 72 months.Results:A device was successfully implanted in 27 of 27 patients (15 females). Median age and weight were 24 years (range: 18–57 years) and 69 kg (range: 53–102 kg), respectively. The mean PDA diameter was 4.1 ± 2.1 mm. Devices used were Amplatzer Duct Occluder (19/27), Occlutech Duct Occluder (6/27), and PFM Nit-Occlud (2/27). Doppler transthoracic echocardiography (TTE) demonstrated 92.6% of full occlusion at day 1, rising to 96.3% at 1 month. Three procedure-related complications occurred with no death. Among symptomatic 26 patients (96.3%), there was marked improvement in symptoms. Among 22 patients (81.5%) for whom the procedure was performed to address left ventricular (LV) enlargement, there was reduction or stabilization in LV size on serial TTEs.Conclusions:Transcatheter closure of PDA in the adult patient appears to be safe and effective.

Thoracoscopic clipping of patent ductus arteriosus: position of surgery in the era of transcatheter procedures

To describe single-center evolution of the procedure and to evaluate the results of thoracoscopic clipping of patent ductus arteriosus (PDA) with diameter over 3,0 mm in term infants weighting over 4,0 kg. Thoracoscopic clipping of PDA has been performed in 140 patients for the period from March 2012 to March 2018 in Meshalkin National Medical Research Center. Mean age was 4.0 years (range 3 months - 13 years), mean body mass index - 15.4±2.2 kg/m2. PDA size 3.5-10 mm, Qp/Qs >1,3/1,0, weight 4.0-40 kg. Mean PDA size was 4.6±0.9 mm (range 3.5-8.0 mm), mean pulmonary artery pressure - 34.3±5.8 mm Hg, mean systemic/pulmonary flow Qp/Qs - 1.6±0.3. All patients underwent successful PDA closure through four-port technique under endotracheal general anesthesia and no need for pleural drainage. Mean procedure time was 24.5±15.5 min. In 29 (20,7%) cases we used titanium clips, in 11 (79.3%) - polymer locking ligating clips. There was 1 conversion to mini-thoracotomy. There were no deaths, bleeding or any other life-threatening complications. 94 (67.1%) patients were weaned from ventilator within operating theatre, in other 46 (32.9%) patients mean ventilation time in ICU was 1.3±1.0 hours. In-hospital postoperative complications: pneumothorax - 2 (1.4%) cases, recurrent laryngeal nerve dysfunction - 1 (0.7%), false croup - 1 (0.7%). There were 2 residual leakages in 2 (1.4%) patients in 10 and 6 months after titanium clip deployment. Both of them underwent transcatheter closure using the coil. Considering these cases all following patients underwent PDA closure by polymer locking ligating clips with no cases of residual leakage. Thoracoscopic PDA closure by polymer locking ligating clip is safe and effective technique for surgical management of PDA with diameter over 3.0 mm in term infants weighting over 4.0 kg.

Descripción anatómica, clínica y sobrevida de los pacientes con atresia pulmonar que han sido llevados a angioplastia con stent en el ductus arterioso persistente en el periodo 2009-2014

Objectivethe aim of this study is to describe the anatomical characteristics, the clinical progression, and survival of patients with pulmonary atresia subjected to angioplasty with a stent in patent ductus arteriosus (PDA), and to determine if there are significant difference in the saturation at the beginning and the end of the procedure, and at 6, 12, and 24hours after the procedure. Materials and methodsAn analytical and descriptive cohort study was conducted on a population taken from the database of a Paediatric Cardiology Department of a specialised institution in the city of Bogota, Colombia. Patients with pulmonary atresia subjected to angioplasty were included, and those with previous cardiovascular were excluded. The statistical analysis was performed using STATA® 12.0, by means of descriptive statistics, Kaplan-Meier curves and repeated measurements ANOVA. ResultsA total of 237 patients with pulmonary atresia were identified. Of the 30 that were selected, 5 were excluded, leaving a total of 25 patients that were subjected to angioplasty. Interventricular communication was observed in 52%. The mean age was 12.2 days, with a mean weight of 2.698g, a mean PDA diameter of 3.8mm (SD=1.1), and a mean McGoon index of 1.35. Although the stent implant was successful in all patients, two died in the procedures room, and another one during the following 6hours. The most common complications were, cardiorespiratory arrest in 2 patients, thrombosis of the stent in 2, and bacteraemia in two patients. The mortality at 30 days was 28% (7), and 36% (9) during the total time. Using ANOVA, no significant differences were found in the saturation means at the five times of interest. ConclusionsPulmonary atresia is a complicated condition that requires invasive intervention in order to maintain the circulatory capacity of the patients. This study shows that, despite an effective intervention, the 30-day mortality is elevated. No differences were, found in the saturation times, which suggest that saturation is maintained in the patients in a way not unlike that with prostaglandin E (PGE1), but ensures the patency of the ductus.

Abstract 17145: Outcomes of Transcatheter Occlusion of Patent Ductus Ateriouses in Infants ≤ 6 Mouths

Objectives: We sought to analyze the outcomes of transcatheter patent ductus arteriosus (PDA) occlusion using a variety of devices in infants ≤ 6 mouths and discuss the transcatheter occlusion indication of PDA in early infants. Methods and Results: A total of 72 patients underwent successful transcatheter device closure. The mean age at catheterization was 4.9±1.8months (1-6 months) with a mean weight at catheterization of 5.1±1.9kg (1.9-6.7kg), the mean PDA diameter of 3.9±0.8mm (1.8-5.3mm),the mean systolic pulmonary arteriosus pressure of 55.7±8.9 mmHg (46-79mmHg). Among these suffered infants, companied with 72cases of growth retardation, 48 cases of recurrent lower respiratory tract infection, 35 cases associated with congestive heart failure, and 5 cases of respirator-oxygen-dependent. 4/6-8/10 PDA occluder was selected for transcatheter device closure, and intraoperative blood transfusion were performed in 46 cases. All subjects resulted with occluder position in good shape, no residual shunt; whileas 16 cases with aortic blood flow velocity increased slightly, 12 cases with left pulmonary artery blood flow velocity increased slightly just postoperation. And in follow-ups the increased velocity of and pulmonary blood flow gradually returned to normal. Follow-up data showed, all subjects resulted good outcomes with growth significantly improved, congestive heart failure cured and repeated lower respiratory tract infection significantly reduced postoperative. Conclusions: In experienced heart center, percutaneous closure of PDA should be considered even in infants ≤ 6 mouths. The indications include PDA infants with respirator-oxygen-dependent, congestive heart failure, and recurrent lower respiratory tract infection and growth retardation. Children underwent PDA occlusion would result with improved growth and development, recovered heart function and less lower respiratory tract infection.

Transcatheter closure of patent ductus arteriosus, evaluating the outcome; single center experience in Mansoura, Egypt

Introduction Device closure is the treatment of choice for patent ductus arteriosus (PDA). Different types of occlusion devices have been developed. We tried to evaluate the outcome in a single tertiary center country through analyzing the immediate and short-term outcomes of transcatheter occlusion in patients with PDA using three different devices. Methodology Between January 2008 and December 2015, 213 pediatric patients with PDA underwent PDA occlusion. Aortic angiography was done to evaluate the size, position, and shape of the duct for proper device selection. A second aortic angiography was performed ten minutes after device deployment. Echocardiography was repeated at intervals of 24 h, then at one, three, six and 12 months after the procedure to assess the presence of any complications. Results The results were assessed by angiography and echocardiography. The mean age was 9.2 ± 5.2 months and their mean weight was 7.6 ± 1.8 kg. Mean PDA diameter at its narrowest point measured by angiography was 2.81 ± 0.51 mm. Nit-Occlud pfm Coil occlusion was performed in 107 patients, ADO-I was performed in 39.4% and Nit-Occlud PDA-R was performed in 10.3%. Complete closure was observed in 95.7% of the patients prior to discharge and this rate has reached 98.5% after 3 months period of follow up and increased to 100% at 6 and 12 months visits. Conclusion Transcatheter closure of PDA technique using Nit-Occlud pfm coils, Nit-Occlud PDA-R and Amplatzer ductal occluder proved to be safe and effective. The residual leak was minimal in our series.

Transcatheter occlusion of the patent ductus arteriosus in premature infants weighing less than 1200 g

ObjectivesOver the last few decades different strategies have been proposed to treat persistent ductal patency in premature infants. The advent of the Amplatzer Duct Occluder II Additional Size (ADOIIAS) provided...

Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS.

The advent of Amplatzer Duct Occluder II additional Size (ADOIIAS) provided the potential to close hemodynamic significant patent ductus arteriosus (HSPDA) and to analyze the feasibility, safety and efficacy of the device. Treatment of a patent ductus arteriosus (PDA) in very premature neonates is still a dilemma for the neonatalogist who has to consider its significance and has to choose among different treatment options. Because surgical ligation and medical therapy both have their drawbacks, interventional catheterization might provide an alternative means of closing HSPDA. Between September 2013 and June 2015, 32 premature infants with complications related to HSPDA defined by ultrasound (US) underwent transcatheter closure. The procedure was performed in the catheterization laboratory by venous cannulation without angiography. The position of the occluder was directed by X-ray and US. In particular we looked at procedural details, device size selection, complications, and short and mid-term outcomes. Thirty two premature infants, all of whom had clinical complications related to HSPDA, born at gestational ages ranging between 23.6 and 36 weeks (mean ± standard deviation 28 ± 3 weeks) underwent attempted transcatheter PDA closure using the ADOIIAS. Their mean age and weight at the time of procedure was 25 days (range 8-70 days) and 1373 g (range 680-2480 g), respectively. Ten infants weighed ≤1,000g. All ducts were tubular. The mean PDA and device waist diameters were 3.2 ± 0.6mm (range 2.2-4) and 4.4 ± 0.6 mm, respectively, and the mean PDA and device lengths 5.2 ± 2.0 mm (range 2-10) and 3.4 ± 1.3 mm. Median fluoroscopy and procedural times were 11 min (range 3-24) and 28 min (range 10-90), respectively. Complete closure was achieved in all but one patient. There was no device migration. A left pulmonary artery (LPA) obstruction developed in one patient. Five infants died. Four deaths were related to complications of prematurity and one death in a 680 g infant was related to the procedure. It is feasible to close HSPDA in relative safety in premature infants who have severe and complex disease. Success requires perfect selection of the occluder and exact positioning by US. © 2017 Wiley Periodicals, Inc.

Construction of Ductal Diameter Centiles in the First 24 h of Life and Their Relation to Cerebral Blood Flow in Neonates Weighing Less Than 1250 g in the First 24 h of Life.

To evaluate the ductal diameter centiles in the first 24 h of life and their relation to cerebral blood flow in neonates weighing <1250 g in the first 24 h of life. This prospective observational cohort study enrolled 44 infants with birth weight <1250 g. Two-dimensional echocardiography and color Doppler were performed within the first 12 h of life and were repeated again in the next 12 h of life to assess the ductal size and middle cerebral artery (MCA) flows [peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI)]. The mean patent ductus arteriosus (PDA) size (mm) within 0-6 h was 1.88 ± 1.12, within 7-12 h was 2.02 ± 0.973, within 13-18 h was 1.47 ± 1.00 and within 19-24 h was 1.42 ± 0.705. There was a significant increase in the PSV and MV of the MCA in infants with open PDA compared with those with closed PDA (p < 0.05) when measured between 13 and 24 h of life. There was no correlation between the PDA size and simultaneous PSV, EDV, MV and PI of MCA within 12 h of life. The PDA size within 13-24 h showed correlation with only the PSV of the MCA (p = 0.05) and not with the EDV, MV and PI. There was no significant difference in the PSV, EDV, MV and PI among the infants depending on the size of the PDA. There is a progressive decrease in the PDA size in the first 24 h of life. The PSV and MV of the MCA are increased in infants with closed PDA, but among those with open PDA, size does not relate to MCA flows in the first 24 h of life.

Could the Size of Ductus Arteriosus be an Independent Predictor for the changes in Left Ventricular Function Post Percutaneous closure! Evaluation by Tissue Doppler and Speckle-derived Strain Rate Echocardiography

Aim: Evaluate the changes of left ventricular (LV) systolic and diastolic function in children after percutaneous closure of patent ductus arteriosus (PDA) and to correlate these changes in relation to the size of the ductus. Methods: 30 children provisional diagnosed with PDA and planned for percutaneous trans-catheter PDA closure. Conventional 2D, Doppler and tissue Doppler imaging (TDI) and speckled-derived strain rate echocardiography were obtained pre-closure, early (I day), and late (1 month) post-PDA closure. Results: Mean age was 26.0 ± 32.17 months (9 male and 21female). The mean PDA diameter was 3.11 ± 1.09 mm. Ejection fraction (EF) and fractional shortening (FS)significant reduced in the day after PDA closure compared with pre closure status (P<0.05), then improved significantly after one month compared with early post- closure measures(p<0.05),but no significant change when compared with pre-closure measure, (P>0.05). There is a negative correlation between the PDA size and changes in left ventricular diastolic dimensions, EF and FS early after PDA closure. Significant reduction in both early and late mitral diastolic flow velocities (EM and AM) after PDA closure (both one day and one month) ,early tissue Doppler velocity of lateral mitral annulus (E`lateral) significant decrease early after PDA closure(P<0.05), but one month after closure E` lateral significantly increased.(P=0.03), EM/E` lateral had a significant reduction in one month after closure compared with pre-closure and early post–closure (P=0.001). There was a significant decrease in global and regional longitudinal strain at early after PDA closure (P=0.001), although there was a significant improvement in all measures in the subsequent one month after closure. Conclusion: Size of PDA considered as an independent predictor for the acute decrease in left ventricular function early after PDA closure which recovers completely within one month.

Catheter Closure Through a Venous Approach of Patent Ductus Arteriosus in Small Pediatric Patients Using Combined Angiographic and Echocardiographic Guidance

The standard technique of catheter closure of patent ductus arteriosus (PDA) may be associated with arterial complications particularly in small pediatric patients. The aim of this study was to evaluate whether catheter closure of PDA in small children using an exclusive venous approach is a safe and effective alternative to closure with the standard technique. One hundred-twelve patients, aged 2 to 24months, were randomly assigned in a 1:1 ratio to catheter closure of PDA using the standard technique (group 1) and an exclusive venous approach (group 2), respectively. In group 2, the procedure was guided using hand injections of contrast media through the delivery sheath and 2-dimensional and color Doppler echocardiography. Group 1: the PDA diameter ranged from 2 to 5.5mm and the device diameter ranged from 4 to 8mm. The PDA occluders were permanently implanted in all patients. Five losses of the arterial pulses that were restored with intravenous infusion of heparin and recombinant tissue plasminogen activator (rtPA), and 4 groin hematomas were the main complications of the procedure. Group 2: the mean PDA diameter ranged from 2.5 to 6mm and the device diameter ranged from 3 to 8mm. The PDA occluders were permanently implanted in all but 2 patients. There were no complications. Complete echocardiographic closure of PDA at 1-month follow-up was observed in all 110 patients. Exclusive transvenous PDA occlusion is an effective and safe technique that prevents the arterial complications of the standard approach in small children.

Interventional Transcatheter Closure Ameliorates the Leukocyte Rho Kinase Activities among Patients with Patent Ductus Arteriosus.

Patent ductus arteriosus (PDA) causes increased pulmonary blood flow, which can lead to pulmonary arterial hypertension (PAH). Rho-associated coiled-coil containing protein kinase (ROCK) may play an important pathophysiological role in PAH. We hypothesized that the increased pulmonary artery (PA) flow from PDA could activate ROCK. Patients who received a PDA transcatheter closure in our hospital were consecutively enrolled in this study. Basic demographics and clinical hemodynamic data of the study participants were recorded. Then, ROCK activity was measured before and after the PDA occlusion procedure. ROCK activity was defined as the phosphorylation ratio of myosin-binding subunit by Western blot measurement. We also sub-divided patients into the coil group and occluder group based on the occlusion device used in each patient's procedure. From January 2009 to December 2011, 25 patients with a median age of 2.3 years, ranging from 10 months to 72 years were enrolled. The mean PDA size was 0.31 ± 0.14 cm, the mean Qp/Qs shunt was 1.54 ± 0.41, and the mean systolic pulmonary artery pressure was 26.9 ± 10.3 mmHg. There were 10 patients (one boy and nine girls) in the coil group and 15 patients (four boys and eleven girls) in the occluder group. Following the closure of the PDA, ROCK activity significantly decreased (1.78 ± 2.25 vs. 0.77 ± 0.69, p < 0.01). There was a strong correlation between the leukocyte ROCK activity with the systolic PA pressure (y = 5.4608x + 22.54, R2 = 0.5539, p < 0.05), but not the Qp/Qs value. Both subgroups showed significant changes of ROCK activity after the procedure. Interestingly, when comparing the coil group with the occluder group, the decrease in ROCK activity was more apparent in the occluder group. The findings of this study indicated that ROCK activity is higher in patients with PDA and correlates with PA pressure. The decrease in ROCK activity following the device closure suggests that ROCK may be an important biomarker for PDA patency. Patent ductus arteriosus (PDA); Pulmonary arterial pressure; Rho kinase; Transcatheter closure.

O-031 Comparison Of Bnp And Nt-pro-bnp For Assessment Of The Patent Ductus Arteriosus In Very Preterm Infants

Background and aims B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NTproBNP) have been shown to correlate with the size of patent ductus arteriosus (PDA) in preterm infants. We investigated whether BNP or NTproBNP is more accurate for assessment of a PDA. Methods Prospective observational study. Preterm infants born. Results 60 infants were recruited, 58 had complete datasets. The cohort’s mean (SD) gestational age was 27 3 (2 2 ) weeks and had a mean (SD) birth weight of 1032 (315) grams. 46 (79.3%) infants had a PDA with a mean (SD) PDA diameter of 3.2 (0.9) mm. Median (IQR) BNP levels: 486.5 (219–1316) pg/ml for infants with PDA, 190 (95.5–514.5) pg/ml for infants without PDA. Median (IQR) NTproBNP levels: 10858.5 (6319–42108) pg/ml for infants with PDA, and 7488 (3363–14227.5) pg/ml for infants without PDA. Both BNP and NTproBNP showed a significant correlation with PDA size in this cohort: BNP R=0.35 (p = 0.0066); NTproBNP R = 0.31 (p = 0.018). Conclusion BNP and NTproBNP were closely correlated to PDA size. Both markers were useful for assessment of PDA size in this cohort of very preterm infants.

GW24-e2156 Transcatheter closure of patent ductus arteriosus in children with body weight less than or equal 8Kg

ObjectivesTo explore the interventional experience of transcatheter closure of patent ductus arteriosus (PDA) in children with body weight ≤ 8Kg.MethodsFrom May 2001 to October 2012, 81 children with body weight...

ASSA13-15-6 Transcatheter Closure of Patent Ductus Arteriosus with Severe Pulmonary Hypertension Using Domestic Occluder in Adults

<h3>Background</h3> To evaluate the clinical efficacy of transcatheter closure of patent ductus arteriosus (PDA) with severe pulmonary hypertention using domestic occluder in adults. <h3>Methods</h3> From July 2000 to July 2011.82 adult patients (13 male, 69 females) were treated by transcatheter closure with domestic occluder. Patients mean age was 36.6years (ranging 18 to 60 years) and the mean PDA diameter at its narrowsest segment was (9.6 ± 2.6) (ranging 6.0 to 16.0) mm. 6 patients of them were treated with sildenafil and/or bosentan before PDA closure. All patients accepted contrast examination of aorta arch-descendens before transcatheter treatment. Patients were classified according to Krichenko grouping method, type A consisted of 35 patients, type B consisted of 4, type C 40 cases, and type E 3 cases. Duct occluder was used in 58, atrial septal defect closure device in 3 and muscular ventricular septal defect closure device in 5. The achievement of permanent transcatheter closure was decided according to the change of the pulmonary arterial pressure, aortic pressure and oxygen saturation. <h3>Results</h3> The devices were successfully placed in all patients except three patients owing to the resistance of pulmonary hypertention. The systolic pulmonary pressure decreased from (97.3 ± 20.4) (range 70 to 140) mmHg to (51.2 ± 19.4) (33 to 109)mmHg, and the mean pulmonary pressure decreased from (71.2 ± 13.5) (51 to 105) mmHg to (36.4 ± 15.1)(22 to 71)mmHg. Complete angiographic closure was seen 10 minutes after the device deployment in 52 out of 82 patients (63.4%), while trivial to small leak was present in 30 (36.6%). During the occlusion, the average X-ray exposure duration was 16.9 +/- 10.3 minutes, occlusion time was 83.5 +/- 39.2 minutes. 15 of them with systolic pulmonary artery pressure &gt; 70 mmHg after PDA closure were treated with sildenafil or/and bosentan. Complete echocardiographic closure was demonstrated in 77 out of 79 patients (97.5%) at 1 month, and 100% at 6-month follow-up in all patients. Among successful patients, the dimensions of the left atrium, left ventricle and pulmonary artery attenuated considerably in follow-up except for two patients. There were no PDA recanalization and migration of devices after the complete occlusion during following up. <h3>Conclusions</h3> Transcatheter closure of patent ductus arteriosus with severe pulmonary hypertention using domestic occluder is a safe and effective interventional method in adults.