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1.
Vasc Endovascular Surg ; 54(2): 165-168, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31707973

RESUMO

BACKGROUND: Pseudoaneurysm developing after repair of a patent ductus arteriosus (PDA) is uncommon, with only a handful of cases reported in the literature. While older literature cites infection, recent series suggest that formation of pseudoaneurysm off of a ligated PDA attributed to breakdown in the suture line. Thoracic endovascular aortic repair (TEVAR) for this rare pathology has been demonstrated in selected case reports. METHODS/RESULTS: A 61-year-old woman presented with enlarging left chest mass and shortness of breath. The patient reported a history of a PDA with 2 attempts at closure. At age 6, she had undergone an attempt at endovascular closure of the PDA; this subsequently resulted in right lower extremity limb ischemia with resultant below-knee amputation. At age 12, she underwent open thoracotomy with ligation of the PDA; at this procedure, she had injury to her recurrent laryngeal nerve, resulting in permanent hoarseness of voice. A computed tomography angiogram of the chest was obtained, which demonstrated a saccular 4.5 × 3.8 cm pseudoaneurysm in the region of the PDA with calcific wall changes. Recommendation was made to proceed with operative repair and she agreed. A TEVAR was performed using a commercially available stent graft. During the procedure, intravascular ultrasound was performed; however, the connection between the PDA pseudoaneurysm and the aorta was not visualized. She had an uncomplicated operative and postoperative course. Follow-up imaging showed complete thrombosis of the pseudoaneurysm. CONCLUSIONS: Pseudoaneurysm from previous PDA repair is a rare pathology. We present a unique case in which the patient had undergone attempts at both endovascular and open surgical repair. Open repair for PDA is still advocated; however, TEVAR appears to be a safe treatment in adults with this pathology following failed open closure.


Assuntos
Falso Aneurisma/cirurgia , Implante de Prótese Vascular , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Endovasculares , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Permeabilidade do Canal Arterial/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Ligadura/efeitos adversos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
2.
J Cardiothorac Surg ; 14(1): 168, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533759

RESUMO

OBJECTIVE: To identify the predictor factors of left ventricular (LV) dysfunction following patent ductus arteriosus (PDA) surgical ligation. BACKGROUND: PDA is viewed as a noticeable amongst the most widely recognized congenital heart defects in children and its closure is responsible for many hemodynamic changes that require intervention and care. METHODS: A retrospective study included fifty children with isolated PDA treated by surgical ligation from June 2015 to June 2018. The LV dimensions and systolic function were assessed by two-dimensional echocardiography pre and post PDA ligation. All cases were followed-up on the first-day, 1 month and 6 months post ligation. RESULTS: The mean age of cases was 15.78 ± 7.58 months and 72% were females. The mean duct size was 4.08 ± 1.25 mm. There was a marked decrease in LVEDd, LA/Ao, EF and FS in the first-day post ligation contrasted with pre ligation values. Moreover, an amazing decline in LVEDd and LA/Ao ratio was observed 1 month post ligation contrasted with the early post ligation status with asynchronous improvement of FS and EF at one and 6 months postoperatively. CONCLUSION: PDA ligation is associated with a noteworthy LV systolic dysfunction within the first day post ligation; that in a significant number of patients may require anti-failure measures, prolong the hospital stay and necessitate a regular follow up and monitoring of LV function. PDA size, age, preoperative LVEDd and FS can be considered as predictor factors for suspicion of acute decrease in the LV systolic function early post PDA ligation. TRIAL REGISTRATION: ClinTrial.Gov NCT04018079 .


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Permeabilidade do Canal Arterial/cirurgia , Medição de Risco/métodos , Disfunção Ventricular Esquerda/etiologia , Pré-Escolar , Ecocardiografia , Feminino , Hemodinâmica , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sístole , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
3.
J Cardiothorac Surg ; 14(1): 99, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159878

RESUMO

BACKGROUND: There is great discussion about non-confluent pulmonary artery (PA) reconstruction, and several materials have been used. Autologous pericardium is considered feasible for infectious resistance, autoimmune response, extensibility, and growth potential. CASE PRESENTATION: The patient was born at 39 weeks (body mass = 2550 g). He was diagnosed with tetralogy of Fallot, pulmonary atresia, non-confluent PA, and bilateral patent ductus arteriosus. Right and left Blalock-Taussig shunts with patent ductus arteriosus ligations were placed on day 27 and 3 months, respectively. At 19 months (8.8 kg), definitive repair was performed with tricuspid valved conduit concurrent with PA reconstruction using an autologous pericardium roll conduit. The autologous pericardium was treated with glutaraldehyde (autologous pericardium fixed with 0.4% glutaraldehyde for 7 min and rolled as conduit - 12 mm in diameter and 30 mm in length). Following an incision on the visceral side of the PAs before the 1st branch, the autologous pericardial roll conduit was anastomosed. Follow-up angiographies on postoperative months 9 and 57 demonstrated that the PA, including the autologous pericardium roll conduit, had spontaneously enlarged. CONCLUSION: Particularly for non-confluent PA, the patients require increased pulmonary beds at an early age because of hypoplastic PA. While size mismatch between the graft and native PA develops as the child grows, size-adjustable extensibility of the PA graft should be noted.


Assuntos
Pericárdio/transplante , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Anormalidades Múltiplas/cirurgia , Pré-Escolar , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/cirurgia , Humanos , Lactente , Masculino , Artéria Pulmonar/anormalidades , Atresia Pulmonar/complicações , Atresia Pulmonar/cirurgia , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Transplante Autólogo
4.
Cardiol Young ; 29(6): 842-844, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169093

RESUMO

We describe two cases of spontaneous embolisation and successful retrieval of ceramic-coated patent arterial duct devices. In both, the device embolised to the descending aorta in the absence of pulmonary hypertension and despite optimum placement. We have discussed possible mechanisms for embolisation in these patients and suggested alternative methods for device retrieval. Based on this limited experience, we conclude that for tubular ducts, ceramic-coated devices should be oversized to form a tighter waist or alternate devices may be considered.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Cerâmica , Remoção de Dispositivo/métodos , Embolia/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Aortografia , Materiais Revestidos Biocompatíveis , Permeabilidade do Canal Arterial/cirurgia , Embolia/diagnóstico , Feminino , Humanos , Lactente , Falha de Prótese
5.
Turk Kardiyol Dern Ars ; 47(4): 265-272, 2019 Jun.
Artigo em Turco | MEDLINE | ID: mdl-31219441

RESUMO

OBJECTIVE: Although many articles have been published about transcatheter coil occlusion, few studies have been conducted on the long-term outcomes of patent ductus arteriosus closure with a coil. This study is an examination of the follow-up data of patients who underwent transcatheter patent ductus arteriosus closure with a coil. METHODS: Between May 1996 and May 2018, 243 patients underwent transcatheter patent ductus arteriosus closure with a coil. The patients were divided into 2 groups based on the timing of the use of ductal occluders at the facility. Until the end of 2005, every ductus was closed with a coil. Since initiating the use of ductal occluders in 2006, coils are mostly used to close small, elongated ducts, and occasionally, some complex ducts. RESULTS: The median age of the patient was 4.33 years, the median weight was 15 kg, and the median duct diameter was 2 mm. In this study group, 98 (40%) patients were male and 145 were female (60%). The angiographic features of the ductus were classified as type A in 126 patients, type B in 15, type C in 6, type D in 9, type E in 74, and 13 were recorded as other types. In 238 of the patients, the patent ductus arteriosus was successfully closed with a coil. In 5 (2.2%) cases, the procedure was unsuccessful. Echocardiography follow-up continued for an average of 4.1+-4.1 years (1 day-19 years). A residual shunt was observed in 42 patients, and spontaneous occlusion was seen in 29 of the 42 patients. CONCLUSION: The results of this study indicated that closure of the patent ductus arteriosus with a coil was a safe and effective method.


Assuntos
Permeabilidade do Canal Arterial/cirurgia , Cateterismo Cardíaco , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Instrumentos Cirúrgicos
6.
Anesthesiology ; 131(2): 392-395, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31233407

RESUMO

Randomised Trial of Fentanyl Anesthesia in Preterm Babies Undergoing Surgery: Effects on the Stress Response. By Anand KJ, Sippell WG, and Aynsley-Green A. Lancet 1987; 1:243-8. Reprinted with permission.In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and D-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 µg/kg intravenously) to the anesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the nonfentanyl than in the fentanyl group. The urinary 3-methylhistidine/creatinine ratios were significantly greater in the nonfentanyl group on the second and third postoperative days. Compared with the fentanyl group, the nonfentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anesthesia may be associated with an improved postoperative outcome.


Assuntos
Anestésicos Intravenosos/farmacologia , Permeabilidade do Canal Arterial/cirurgia , Fentanila/farmacologia , Dor/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Estresse Fisiológico/efeitos dos fármacos , Humanos , Recém-Nascido
7.
Echocardiography ; 36(5): 944-947, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31006919

RESUMO

OBJECTIVES: To report the usefulness of harmonic imaging in echocardiography to visualize and direct the implantation of the Medtronic micro vascular plug (MVP). BACKGROUND: Off label use of the MVP was reported for transcatheter occlusion of patent ductus arteriosus (PDA) in premature infants. The device is poorly visible on fluoroscopy and echocardiography. METHODS: In 9 consecutive premature infants, the MVP was used for transcatheter closure of the PDA. In each, the ability of conventional echocardiographic imaging was compared to harmonic imaging, and the device was deployed in the PDA using echocardiography. RESULTS: In each subject, harmonic imaging proved superior to conventional echocardiography to visualize the MVP in premature infants using 12 and 8 MHz probes. Once the delivery, catheter was across the PDA into the descending aorta, and the MVP advanced to the catheter tip, positioning, and deployment of the device was possible without fluoroscopy. All devices were deployed appropriately with immediate occlusion and no obstruction to the left pulmonary artery or aorta. CONCLUSIONS: The MVP can be accurately imaged using harmonic imaging, even in the near field in premature infants. Precise implantation of the MVP in the PDA of premature infants is possible with echocardiographic imaging of the device and vascular structures.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia/métodos , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/cirurgia , Dispositivo para Oclusão Septal , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
8.
Khirurgiia (Mosk) ; (2): 5-12, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-30855584

RESUMO

AIM: 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. MATERIAL AND METHODS: 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. INCLUSION CRITERIA: 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. RESULTS: 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. CONCLUSION: 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.


Assuntos
Permeabilidade do Canal Arterial/cirurgia , Toracoscopia/métodos , Adolescente , Cateterismo Cardíaco , Criança , Pré-Escolar , Humanos , Lactente , Ligadura , Instrumentos Cirúrgicos , Grampeamento Cirúrgico , Toracoscopia/instrumentação , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(10): e14684, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855458

RESUMO

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 ±â€Š6.7 months (range 3-26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ±â€Š4.1 mm (range 8-26 mm). The mean device diameter used was 17.3 ±â€Š5.6 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 ±â€Š8 months (range 3-28 months). The mean PDA minimum diameter was 2.5 ±â€Š0.8 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.


Assuntos
Cateterismo Cardíaco , Permeabilidade do Canal Arterial , Comunicação Interatrial , Complicações Pós-Operatórias , Dispositivo para Oclusão Septal , Adolescente , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/epidemiologia , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Transesofagiana/métodos , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/epidemiologia , Comunicação Interatrial/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Romênia/epidemiologia , Dispositivo para Oclusão Septal/efeitos adversos , Dispositivo para Oclusão Septal/estatística & dados numéricos , Adulto Jovem
10.
Cardiol Young ; 29(3): 422-424, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739622

RESUMO

An isolated left common carotid artery is very rare, and only 13 cases have been reported thus far. All those cases were accompanied by a right aortic arch and aberrant left subclavian artery, and the connecting vessel between the pulmonary artery and left common carotid artery was thought to be ductal tissue. However, there have been no reports that have followed the natural closure of this vessel. We present a case in whom we could observe the closing process of this vessel at the connection between the left common carotid artery and main pulmonary artery in association with a tetralogy of Fallot.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Artéria Carótida Primitiva/anormalidades , Permeabilidade do Canal Arterial/cirurgia , Artéria Pulmonar/anormalidades , Tetralogia de Fallot/cirurgia , Malformações Vasculares/cirurgia , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Tetralogia de Fallot/diagnóstico , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnóstico
11.
Early Hum Dev ; 131: 10-14, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30771741

RESUMO

BACKGROUND: The current treatment approach in patent ductus arteriosus suggests the identification of high-risk infants that may benefit the most from treatment. Small for gestational age infants are a high-risk population in which the treatment approach to the patent ductus arteriosus and outcomes have not been described. AIM: To compare the patent ductus arteriosus treatment approach and outcomes in small for gestational age and appropriate for gestational age infants. STUDY DESIGN: Retrospective analysis of infants born between January 1, 2011 and December 31, 2015 at <33 weeks' GA and admitted to neonatal intensive care units (NICU) part of the Canadian Neonatal Network. RESULTS: 595 of 2507 small for gestational age infants (23.7%) and 4714 of 20,002 appropriate for gestational age infants (23.6%) had a patent ductus arteriosus. The patent ductus arteriosus treatment approach (conservative, medical, surgical) was similar in both groups. Small for gestational age infants with and without a patent ductus arteriosus had increased risk of the composite outcome of death or bronchopulmonary dysplasia (aOR 3.40; 95% CI 2.73, 4.24; and aOR 2.72; 95% CI 2.24, 3.31) respectively. CONCLUSIONS: Patent ductus arteriosus management did not differ between small for gestational age and appropriate for gestational age infants. Small for gestational age infants had increased risk of death or bronchopulmonary dysplasia regardless of their patent ductus arteriosus status.


Assuntos
Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido Pequeno para a Idade Gestacional , Displasia Broncopulmonar/etiologia , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/terapia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Kyobu Geka ; 72(2): 133-135, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-30772879

RESUMO

We report a case of a 75-year-old woman with residual shunt of patent ductus arteriosus after initial surgical repair. She was successfully treated by thoracic aortic stent graft and residual shunt disappeared. Re-surgical repair for residual shunt of patent ductus arteriosus is very invasive and challenging procedure. Also endo-vascular repair using coil or an occluding device can be problematic because of anatomical change due to initial surgical repair. Thoracic aortic stent graft, as a re-intervention procedure for patent ductus arteriosus, is simple, safe, and useful in elderly patients.


Assuntos
Aorta Torácica , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Endovasculares , Stents , Idoso , Feminino , Humanos , Reoperação
13.
World J Pediatr Congenit Heart Surg ; 10(1): 105-108, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30799710

RESUMO

The neonatal management of critical aortic arch obstruction in association with an arterial duct that remains closed or significantly constricted requires urgent surgical repair, with a postoperative focus on resolving the impaired function of compromised organs. Here, we present two neonatal cases illustrating the use of the dual arterial cannulation perfusion method in the complete repair of interrupted aortic arch and critical coarctation of the aorta with nonfunctional ductus arteriosus. We suggest that dual arterial cannulation, which provides total body perfusion (with the exception of cardiac perfusion during cardioplegic arrest of the heart), may be a good alternative to other perfusion strategies in cases of absent ductal blood flow, as this method allowed us to avoid the further development of severe multiple organ failure.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Coartação Aórtica/cirurgia , Cateterismo/métodos , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Aorta Torácica/cirurgia , Coartação Aórtica/diagnóstico , Permeabilidade do Canal Arterial/diagnóstico , Feminino , Humanos , Recém-Nascido , Masculino , Período Pós-Operatório , Tomografia Computadorizada por Raios X
14.
Congenit Heart Dis ; 14(1): 69-73, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811788

RESUMO

OBJECTIVE: The objective of this article is to describe the elements involved with transporting extremely low birth weight (ELBW) infants from referring centers to our center's neonatal intensive care unit (NICU) and then from the NICU to the catheterization lab for transcatheter closure of patent ductus arteriosus (PDA). SETTING: Several referring centers are over 300 miles away. ELBW infants are transferred in to our NICU safely for the procedure and transferred back following the procedure. A multidisciplinary team approach is necessary in order to achieve a safe transport of these fragile patients. PATIENTS: To date, we have over 12 centers referring patients that weigh <1000 g for transcatheter PDA closure (TCPC). Three of these centers are over 300 miles away. Five other centers are between 100 and 300 miles from the hospital in which we perform TCPC. INTERVENTIONS: Fixed-wing aircrafts are necessary for long-distance transfers. Various modes of mechanical ventilators including transport oscillators are built into temperature- and humidity-controlled incubators in which these infants are transported. Ambulances are used to take the patient between the airport and the hospital. Shorter distance transports are accomplished via helicopters or ambulances. Transfer from the NICU to the catheterization lab to perform TCPC is a relatively easier endeavor. OUTCOME MEASURES: Patients' body temperature, fluid balance, and hemodynamics have to be maintained throughout the transport and the procedure for best outcomes. RESULTS: There has been 100% procedural success of performing TCPC in ELBW infants with no hemodynamic compromise during transport. CONCLUSIONS: TCPC has shown promise in improving overall patient outcomes that the potential hazards associated with complex transport measures are worth it. Successful transfer to and from referring centers and to and from the catheterization lab can be accomplished safely with increasing institutional experience.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Unidades de Terapia Intensiva Neonatal , Transporte de Pacientes/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
15.
Congenit Heart Dis ; 14(1): 60-64, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811790

RESUMO

Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a comprehensive review of this emerging procedure.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido Prematuro , Dispositivo para Oclusão Septal , Idade Gestacional , Humanos , Recém-Nascido
16.
Congenit Heart Dis ; 14(1): 90-94, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811791

RESUMO

OBJECTIVES: Patent ductus arteriosus (PDA) is a common finding in preterm infants. A hemodynamically significant PDA may require intervention for closure. This article aims to describe a transcatheter PDA closure (TCPC) program for preterm infants and the components of a comprehensive outpatient follow-up strategy. SETTING: A multidisciplinary team approach including neonatology, cardiology, anesthesiology, medical transport team, pulmonology, cardiac surgery, neurodevelopmental specialist, nutrition, speech therapy, social work, research collaborators, and other health care specialists is integral to the dedicated care and promotion of wellness of extremely low birth weight (ELBW) infants. PATIENTS: To date, we have performed TCPC on 134 ELBW infants weighing <2 kg at the time of the procedure, 54 of whom were <1 kg with the smallest weighing 640 g with a median gestation age of 25 weeks (range 23-27 weeks). INTERVENTIONS: A comprehensive follow-up strategy with the creation of the Memphis PDA Clinic was implemented. OUTCOME MEASURES: Respiratory support, tolerance of enteral feeds, growth, and neurodevelopmental progress are indicators of favorable outcomes. RESULTS: TCPC has benefited ELBW infants with faster weaning off the ventilator, increase in enteral feedings, and somatic growth with the overall shortening of the hospital length of stay. The Memphis PDA Clinic has ensured optimal postdischarge follow-up to improve long-term outcomes. CONCLUSIONS: TCPC is a safe and effective alternative to manage ELBW infants with a hemodynamically significant PDA. Comprehensive follow-up after discharge provided in a multispecialty clinic developed specifically for this unique population has been successful in improving outcomes.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido de Baixo Peso , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas/métodos , Humanos , Recém-Nascido
17.
Congenit Heart Dis ; 14(1): 110-115, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811792

RESUMO

The use of prostaglandin-E1 immediately after birth and subsequent surgical creation of the modified Blalock-Taussig shunt (BTS) shunt have remarkably improved the prognosis and survival of children with congenital heart disease and ductal-dependent pulmonary blood flow (PBF). Despite the advancement in surgical techniques, bypass strategies, and postoperative management, significant morbidity and mortality after BTS still remain. Patent ductus arteriosus stenting has been shown to be as an acceptable alternative to BTS placement in select infants with ductal-dependent PBF. Newer procedural techniques and equipment, along with operator experience have all contributed to procedural refinement associated with improved outcomes over the recent years. In this article, we review the procedural and periprocedural details, with an emphasis on recent advances of this procedure.


Assuntos
Procedimento de Blalock-Taussig/métodos , Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/cirurgia , Canal Arterial/cirurgia , Cuidados Paliativos/métodos , Circulação Pulmonar/fisiologia , Stents , Permeabilidade do Canal Arterial/fisiopatologia , Humanos , Recém-Nascido
18.
Congenit Heart Dis ; 14(1): 79-84, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811793

RESUMO

OBJECTIVE: Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. DESIGN: The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. SETTING: A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous-only approach outlined in this article be followed to achieve optimal results with low risk of complications. PATIENTS: To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure-related complications. INTERVENTIONS: It is important that specific techniques with venous-only approach outlined in this article be followed to achieve optimal results with low risk of complications. OUTCOME MEASURES: This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. RESULTS: There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure-related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. CONCLUSIONS: It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.


Assuntos
Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Dispositivo para Oclusão Septal , Angiografia , Procedimentos Cirúrgicos Cardíacos , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia Doppler em Cores , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Tennessee , Resultado do Tratamento
19.
Congenit Heart Dis ; 14(1): 65-68, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811794

RESUMO

The ductus arteriosus is a lifeline for the developing fetus prior to delivery, allowing the circulation of oxygen-rich blood from the placenta to bypass the lungs and perfuse the body. However, when the ductus fails to close after birth, the pressures can cause blood to shunt from the aorta back into the lungs, causing pulmonary edema. This is called a left-to-right shunt. The patent ductus arteriosus (PDA) can also shunt blood from the pulmonary arteries to the aorta, bypassing the lungs and causing oxygen-poor blood to mix with the oxygen-rich blood circulating to the body. This is called a right-to-left shunt. Too much shunting in either direction can cause significant long-term problems for the neonate. These three case studies compare the outcomes of patients with PDAs closed using different treatment techniques. The first patient's ductus arteriosus closed >2 months after birth following pharmacologic treatment. The second was closed by surgical ligation. The third was closed by transcatheter device closure.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Furosemida/uso terapêutico , Glucocorticoides/uso terapêutico , Indometacina/uso terapêutico , Dispositivo para Oclusão Septal , Inibidores de Ciclo-Oxigenase , Diuréticos/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/tratamento farmacológico , Ecocardiografia , Feminino , Seguimentos , Humanos , Recém-Nascido , Ligadura/métodos , Masculino
20.
Congenit Heart Dis ; 14(1): 95-99, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811795

RESUMO

The optimal treatment method for infants with a patent ductus arteriosus (PDA) necessitating closure remains a subject of controversy and debate. While the risks associated with surgical PDA ligation are well described, the available evidence base for alternative management strategies during infancy, including percutaneous closure or conservative (nonintervention) management, are not well explored. Among infants, the goals of this review are to: (a) use rigorous systematic review methodology to assess the quality and quantity of published reports on percutaneous closure vs surgical ligation; (b) compare outcomes of percutaneous closure vs conservative management; and (c) based on recommendations from the International PDA symposium, to elucidate needs and opportunities for future research and interdisciplinary collaboration. The available evidence base, as well as on broad consensus reached at the International PDA Symposium, suggests that a contemporary, pragmatic clinical trial comparing PDA treatment strategies is warranted. Additionally, quality assurance safeguards are necessary in the implementation of newer PDA closure devices. Finally, to determine best approaches to treatment for infants with PDA, tools for consistent data collection and reporting across centers and disciplines are needed to minimize heterogeneity and permit pooled analysis.


Assuntos
Cateterismo Cardíaco/tendências , Procedimentos Cirúrgicos Cardíacos/tendências , Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido de Baixo Peso , Melhoria de Qualidade , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Recém-Nascido
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