Morphology Of Patent Ductus Arteriosus Research Articles

Off-label use of KONAR-MF™ occluder for transcatheter closure of patent ductus arteriosus in unusual circumstances.

Transcatheter patent ductus arteriosus (PDA) closure with unusual morphology associated with multiple constrictions or unusual circumstances such as interruption of inferior vena cava (IVC) is still challenging. This study evaluates the use of KONAR-MF™ (Lifetech Scientific Co Ltd., Shenzhen) for transcatheter closure of PDA in such situations. Between January 2021 and October 2021, 24 patients from three different tertiary care centers underwent PDA device closure using the KONAR-MF™ device and are included in the study. Patient demographics, echocardiographic assessment, procedural details including the approach, device details, complications, and follow-up data were recorded. The median age and weight of the cohort were 2 years (0.5-41) and 10 kg (5-98), respectively. The indications for using KONAR-MF™ were (a) unusual morphology of PDA in 14, long tubular PDA in 8, and long tubular with multiple constrictions in 6 patients and (b) unusual circumstances such as interrupted IVC in 6 and inability to cross PDA antegradely in 4 due to dilated main pulmonary artery. The procedure was successful in all the patients and no procedure-related complications were noted in this cohort. Median follow-up of 9 months (range: 5-18) showed no residual shunt and only one patient had flow acceleration across the left pulmonary artery (peak Doppler gradient 16 mmHg). KONAR-MF™ device can be used safely and effectively for transcatheter closure of PDA with unusual anatomy or in unusual circumstances.

A review of stent’s failure on patent ductus arteriosus

This paper presents a review of stent’s failure on patent ductus arteriosus (PDA). Ductus arteriosus (DA) is an opening for newborn babies and some patient that experienced cynotic congenital heart disease (CCHD) should maintain the duct opening for survival. To date, there are no specific research on mechanical stent failure study at DA. The challenging of the stent implantation on PDA is the PDA morphology. The failure of stent in term of stent fracture have been reported and reviewed in this paper. Furthermore, the failure prediction of stent is important for further stent design development. The morphology of PDA, stent type and material used in PDA and method for accessing the failure of stent is reviewed.

A Retrospective Study of 1,526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus.

Background:Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices.Methods:One thousand five hundred and twenty-six patients (537 boys, 989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications.Results:Median age and median weight were 4.0 years (range: 0.3–52.0 years old) and 15.3 kg (range: 4.5–91.0 kg), respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 mm, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I (ADO I, 1280, 85.8%), Cook detachable coils (116, 7.8%), ADO II (ADO II, 68, 4.6%), muscular VSD occluder (12, 0.8%), and Amplatzer vascular plug (16, 1.0%).Conclusions:Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.

An unusual morphology of patent ductus arteriosus in a dog

A 12-week old, entire female Border terrier weighing 3·5 kg was presented for investigation of a continuous left heart base murmur. The clinical presentation and preoperative echocardiogram were consistent with a standard morphology of patent ductus arteriosus (PDA) but a discrete ductal vessel was not identified during surgical dissection. Surgery had to be abandoned due to deterioration of the patient's condition under general anaesthesia which led to cardiorespiratory arrest and death despite attempts at resuscitation. Necropsy identified a recess within the wall of the aorta communicating with the pulmonary artery via an ostium at the heart base which determined this structure as an intramural PDA. This morphology of PDA is previously unreported. This report demonstrates that an intramural PDA is not readily identifiable surgically because of the absence of a discrete ductal vessel and it is important to appreciate that unusual morphologies of PDA may occur.

Oclusão percutânea dos canais arteriais com prótese amplatzer

INTRODUÇÃO: Vários dispositivos têm sido utilizados para o fechamento percutâneo dos canais arteriais, com graus variáveis de sucesso. Dentre eles, destaca-se o oclusor ductal Amplatzer (Amplatzer Duct Occluder® - ADO) que, pela sua facilidade de uso, segurança e eficiência, em praticamente todos os tipos de canais, tem sido largamente utilizado. Neste trabalho, apresentamos a experiência do nosso grupo com este dispositivo, discutindo suas características, aspectos técnicos do seu implante, bem como os resultados obtidos com o seu emprego. MÉTODO: De abril de 1999 até dezembro de 2006, 116 pacientes foram encaminhados para oclusão percutânea. Destes, 91 (64F:27M) foram selecionados para fechamento percutâneo utilizando a prótese Amplatzer. O implante foi realizado da maneira tradicional, já descrita em outros trabalhos, na maioria dos casos. Nos PCA de menor diâmetro, foi necessária a dilatação da extremidade pulmonar do canal com cateter-balão para angioplastia coronariana. Os casos foram todos selecionados por meio de ecocardiogramas transtorácicos (ETT) com mapeamento de fluxo a cores. O seguimento foi feito com ETT no dia seguinte ao procedimento e com 1, 3, 6 e 12 meses (m) após. RESULTADOS: As idades variaram de 2 a 600 meses (48,0 ± 116,4 meses) e os pesos de 4 a 88 kg (17,0 ± 19,1 kg). Os menores diâmetros dos canais variaram entre 0,5 e 11 mm (3,0 ± 1,8 mm), sendo 25 menores do que 2 mm. Os tipos morfológicos se distribuíram da seguinte maneira: tipo A= 58 (64%); tipo C= 6 (7%); tipo D= 2 (2%) e tipo E= 25 (27%), de acordo com a classificação de Krichenko. Não houve nenhum canal do tipo B na nossa casuística. Foram usadas ADO em 90 casos, distribuídas segundo os tamanhos, como se segue: 5-4 em 4 casos (4%); 6-4 em 34 casos (37%); 8-6 em 33 (37%); 10-8 em 16 (18%) e 12-10 em 3 (3%). Em uma paciente de 50 anos com canal amplo e hipertensão arterial pulmonar grave, foi utilizada, com sucesso, uma prótese de CIV muscular (Amplatzer Muscular VSD Occluder® -VSD MUSC) de 12 mm. O implante foi possível em 90 casos. No outro, a rosca defeituosa de uma prótese ADO 8-6 causou seu destacamento prematuro na aorta descendente. O paciente foi encaminhado para cirurgia eletiva, onde teve a prótese resgatada e seu canal ligado sem problemas. Em todos os que tiveram o implante, houve fechamento completo, sem fluxo residual dentro do primeiro mês do procedimento, e se mantêm fechados desde então. Não houve complicações significativas relacionadas ao uso da prótese. Não houve óbitos relacionados ao procedimento. CONCLUSÕES: O fechamento dos canais arteriais com a prótese Amplatzer é um procedimento extremamente simples, seguro e com alto índice de sucesso. É nossa opinião que deva ser adotada como primeira opção para a oclusão de todos os canais. O procedimento é possível mesmo nos canais de pequeno diâmetro (< 2 mm), que são indicados para fechamento percutâneo.

Percutaneous angiography of Patent Ductus Arteriosus in dogs: techniques, results and implications for intravascular occlusion

Objectives To evaluate the percutaneous angiography and the morphology of patent ductus arteriosus (PDA) in dogs. Background In contrast to surgical ligation the knowledge of angiographic morphology is necessary for intravascular PDA occlusion. Methods Forty-nine dogs with a left to right shunting PDA were included in a three-year, prospective study. In 43 dogs with a body weight ≥ 3.0 kg a percutaneous approach to brachial artery was tested. In six miniature dogs (< 3.0 kg) placement of angiographic catheter from femoral vein antegrade through the PDA was studied. Angiographic morphology and dimensions of PDA were analyzed. Results Percutaneous approach to brachial artery was performed successfully in 41/43 (95%) dogs, in the remaining 2 dogs this approach was not possible and the femoral artery had to be used. Two dogs did not survive the procedure. Arterial bleeding was not a problem in any of the 39 cases in which percutaneous brachial artery catheterization was performed. Two dogs developed transient radial nerve paralysis that resolved 4 to 6 days later. The transvenous technique was successful in all 6 small dogs. In 39 dogs there was an elongated conical duct (type E). A conical duct (type A) was found in nine dogs and one dog had a PDA with two constrictions (type D). The mean PDA minimal diameter was 3.78 ± 1.55 mm (range 1.5 to 6.9), in 20/49 dogs (41%) the minimal PDA diameter measured more than 4.0 mm. Conclusions Percutaneous catheterization of the brachial artery using a vascular introducer is feasible and entails minimal risk of hemorrhage. Angiographic evaluation of the ductus arteriosus is easily performed with this technique, but coilimplantation is not possible by this approach. The frequency of PDA-types is different in dogs and humans and the PDA minimal diameter is larger in dogs.