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1.
Medicine (Baltimore) ; 100(35): e27099, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477146

RESUMO

ABSTRACT: Transcatheter occlusion and surgical ligation are the treatments of choice for most patent ductus arteriosus (PDA) in children. Fifty-five children who had PDA completed a pulmonary function test and a symptom-limited treadmill exercise test from 2016 to 2018 at 1 medical center in southern Taiwan. The study group was divided into surgical ligation and catheterization groups, which were compared to a healthy control group matched for age, sex, and body mass index. Data about the performance on the exercise test, including metabolic equivalent at anaerobic threshold and peak, were analyzed. No differences in the pulmonary function and ventilatory parameters were observed between the surgery, catheterization, and control groups. Heart rate at peak and at anaerobic threshold significantly differed in the investigated groups. The post hoc analysis showed that the surgery group had a lower heart rate at peak and threshold compared to the catheterization and control groups (P = .02, P < .001, respectively). No significant difference was found between the catheterization group and the control group. A larger and younger group of patients were recruited, allowing for newer data about the cardiopulmonary function to be obtained. The findings suggest that patients with PDA could undergo physical training after intervention. The imposition of restrictions to limit sports activities should be avoided.


Assuntos
Débito Cardíaco/fisiologia , Permeabilidade do Canal Arterial/complicações , Testes de Função Cardíaca/estatística & dados numéricos , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estatística & dados numéricos , Criança , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Testes de Função Cardíaca/métodos , Humanos , Masculino , Pediatria/métodos , Resultado do Tratamento
2.
Arch Cardiovasc Dis ; 114(6-7): 482-489, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34312100

RESUMO

BACKGROUND: Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature infants at Hôpital Necker Enfants Malades, we have changed our technique several times to advance the guidewire through the right heart to avoid tricuspid valve damage. AIM: To describe the technique we have been using since May 2019, to report our results with a particular focus on tricuspid leaks and to analyse the potential mechanisms of tricuspid lesion development with previous methods. METHODS: All premature infants weighing<2kg who underwent transcatheter PAD closure with this new technique were included. Demographic data, procedural data, outcome and procedural complications were reviewed, with particular attention to the occurrence of tricuspid regurgitation. RESULTS: Between May 2019 and May 2020, 33 patients were included. Median gestational age was 25 weeks. Median birth weight and procedural weight were 690g (range 490-1065g; interquartile range [IQR] 620-785g) and 1160g (range 900-1900g; IQR 1030-1300g), respectively. Median age at procedure was 35 (IQR 30-46) days. PAD anatomy was evaluated on transthoracic echocardiography only. The median duct diameter was 3 (IQR 2.5-3.2) mm at the pulmonary end. Success rate was 100% (defined as successful closure without residual shunt). One patient had a renal vein thrombosis, which fully resolved with low-molecular-weight heparin anticoagulation. No tricuspid regurgitation or stenosis of the left pulmonary artery or the aorta was seen. One patient died of a superior caval vein obstruction with bilateral chylothorax related to a central catheter thrombosis 56 days after the procedure, unrelated to the catheter procedure. CONCLUSION: In this prospective study, we describe a new technique to avoid tricuspid valve damage and facilitate delivery of the PAD device.


Assuntos
Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Dispositivo para Oclusão Septal , Valva Tricúspide/fisiopatologia , Peso ao Nascer , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/fisiopatologia , Idade Gestacional , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Paris , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/lesões , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/fisiopatologia
3.
Comput Math Methods Med ; 2021: 6675613, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33986825

RESUMO

A central shunt (CS) was an important surgery of systemic-to-pulmonary shunt (SPS) for the treatment of complex congenital heart diseases with decreased pulmonary blood flow (CCHDs-DPBF). There was no clear conclusion on how to deal with unclosed patent ductus arteriosus (PDA) during CS surgery. This study expanded the knowledge base on PDA by exploring the influence of the closing process of the PDA on the hemodynamic parameters for the CS model. The initial three-dimensional (3D) geometry was reconstructed based on the patient's computed tomography (CT) data. Then, a CS configuration with three typical pulmonary artery (PA) dysplasia structures and different sizes of PDA was established. The three-element windkessel (3WK) multiscale coupling model was used to define boundary conditions for transient simulation through computational fluid dynamics (CFD). The results showed that the larger size of PDA led to a greater systemic-to-pulmonary shunt ratio (Q S/A), and the flow ratio of the left pulmonary artery (LPA) to right pulmonary artery (RPA) (Q L/R) was more close to 1, while both the proportion of high wall shear stress (WSS) areas and power loss decreased. The case of PDA nonclosure demonstrates that the aortic oxygen saturation (Sao2) increased, while the systemic oxygen delivery (Do2) decreased. In general, for the CS model with three typical PA dysplasia, the changing trends of hemodynamic parameters during the spontaneous closing process of PDA were roughly identical, and nonclosure of PDA had a series of hemodynamic advantages, but a larger PDA may cause excessive PA perfusion and was not conducive to reducing cyanosis symptoms.


Assuntos
Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/cirurgia , Velocidade do Fluxo Sanguíneo , Biologia Computacional , Simulação por Computador , Permeabilidade do Canal Arterial/diagnóstico por imagem , Hemodinâmica , Humanos , Imageamento Tridimensional , Recém-Nascido , Modelos Anatômicos , Modelos Cardiovasculares , Oxigênio/sangue , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Atresia Pulmonar/diagnóstico por imagem , Atresia Pulmonar/fisiopatologia , Atresia Pulmonar/cirurgia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/métodos
4.
Pediatr Cardiol ; 42(6): 1410-1415, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33914123

RESUMO

For patients with single ventricle physiology, being able to initially establish systemic blood flow and control pulmonary blood flow is critical to their long-term health. Recently, there have been descriptions in achieving this by a purely transcatheter approach with stenting of the ductus arteriosus and implanting pulmonary flow restrictors, a very appealing prospect. We review a case series of 6 patients who underwent a percutaneous modified stage 1 approach using modified Microvascular plugs (MVP) at our center between September 2019 and December 2019. The initial procedure was technically successful in all patients with single-stage ductal stenting and placement of bilateral modified MVP via femoral access. Four patients underwent repeat cardiac catheterization prior to subsequent surgery that demonstrated elevated Qp:Qs (> 2:1) in 3 of the 4 patients with an elevated mean distal PA pressure > 20 mmHg in all patients. In some patients, the device migrated into the distal right pulmonary artery. One patient after Glenn shunt was found to have significant LPA stenosis requiring stenting. While the percutaneous modified stage 1 approach is a promising approach, we offer a word of caution against widespread adoption of this technique with the currently available devices.


Assuntos
Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/cirurgia , Canal Arterial/cirurgia , Hemodinâmica/fisiologia , Artéria Pulmonar/cirurgia , Stents , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Circulação Pulmonar , Fatores de Tempo , Resultado do Tratamento
5.
J Cardiothorac Surg ; 16(1): 89, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858447

RESUMO

BACKGROUND: Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries. CASE PRESENTATION L: We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years. CONCLUSIONS: The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up.


Assuntos
Implante de Prótese Vascular/métodos , Veias Braquiocefálicas/transplante , Artéria Pulmonar/cirurgia , Atresia Pulmonar/cirurgia , Veias Braquiocefálicas/diagnóstico por imagem , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Seguimentos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Atresia Pulmonar/complicações , Atresia Pulmonar/diagnóstico por imagem , Reoperação , Transplante Autólogo
6.
Pediatr Surg Int ; 37(2): 197-203, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33388956

RESUMO

PURPOSE: The optimal timing of surgery for congenital diaphragmatic hernia (CDH) is controversial. We aimed to validate our protocol for the timing of CDH repair using the quantified patent ductus arteriosus (PDA) flow pattern. METHODS: This retrospective comparative study analyzed patients with a prenatal diagnosis of isolated CDH between 2007 and 2020. We defined the "LR ratio" as the percentage of velocity-time integral (VTI) of the left-to-right flow of PDA against overall VTI on echocardiography. Since 2010, we followed the decision criterion of performing surgery when LR ratio of > 50% has been achieved in the patients (protocol group). The protocol group (2010-2020) was compared with the historical control group (2007-2009). RESULTS: The average age at surgery was 104.1 ± 175.9 and 37.3 ± 30.6 h in the control and protocol groups, respectively (p = 0.11). Survival rate (88.9% vs. 95.0%, p = 0.53) and the rate of worsening of pulmonary hypertension within 24 h after surgery (22.2% vs. 10.0%, p = 0.57) were not different between the groups. The protocol group had a significantly shorter duration of tracheal intubation (26.9 ± 21.1 vs. 13.3 ± 9.5 days, p = 0.03). CONCLUSION: Our decision criterion might have the advantage of facilitating early and safe surgery for patients with CDH.


Assuntos
Anormalidades Múltiplas , Velocidade do Fluxo Sanguíneo/fisiologia , Permeabilidade do Canal Arterial/fisiopatologia , Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/métodos , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Duração da Cirurgia , Estudos Retrospectivos
7.
BMC Cardiovasc Disord ; 21(1): 9, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407150

RESUMO

BACKGROUND: Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches. METHODS: The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs). RESULTS: In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, - 4.83; 95% CI - 7.92 to - 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28-0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30-0.81; p < 0.05) and ICU stay (MD, - 4.00; 95% CI - 5.96 to - 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68-0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07-1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups. CONCLUSION: Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt. TRIAL REGISTRATION: CRD42019147672.


Assuntos
Procedimento de Blalock-Taussig , Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Cardiopatias Congênitas/terapia , Hemodinâmica , Artéria Pulmonar/cirurgia , Circulação Pulmonar , Stents , Procedimento de Blalock-Taussig/efeitos adversos , Procedimento de Blalock-Taussig/mortalidade , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Cuidados Paliativos , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/crescimento & desenvolvimento , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
8.
BMC Cardiovasc Disord ; 21(1): 56, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509091

RESUMO

INTRODUCTION: The absence of a pulmonary artery is a rare congenital anomaly that occurs isolated or with other congenital cardiac disorders, particularly tetralogy of Fallot (TOF); meanwhile, a hidden pulmonary artery might exist and originate from a closed ductus arteriosus (DA), which can be stented to reach the artery. MATERIAL AND METHODS: This prospective study describes cardiac catheterization of nine TOF patients diagnosed with the absence of the left pulmonary artery before the operation. The patients were stratified into three groups: group one, whose closed DA was found and connected to the hidden pulmonary artery with a stent; group two, whose hidden pulmonary arteries were found via the pulmonary vein angiography; and group three, for whom we could not find the remnant of the DA, or our attempt to stent the DA to the hidden pulmonary artery was not successful. We also evaluated outcomes of six other surgically-corrected TOF patients who were operated with the absent left pulmonary artery. RESULTS: The first group included the patients aged 1, 24, and 30 months, whose CT angiography 6-9 months after stenting showed acceptable left pulmonary artery diameter for surgical correction, and the pulmonary vein angiography of the second group showed a hidden left pulmonary artery with a suitable diameter for surgical correction. However, we were unable to find or stent the DA of group three patients, aged 12, 38, 60, and 63 months. Earlier Angiography might have increased the chance of access to the hidden vessel. Apart from these three groups, follow-ups of six other patients previously corrected with only the right pulmonary artery revealed pulmonary artery hypertension in all patients. CONCLUSION: The concealed pulmonary artery might be found, and stenting of the closed DA to it might be performed to improve the diameter of the diminutive pulmonary artery. This procedure may allow TOF total surgical correction with two pulmonary arteries. Besides, pulmonary vein angiography can reveal the hidden pulmonary artery.


Assuntos
Pressão Arterial , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Permeabilidade do Canal Arterial/terapia , Artéria Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/fisiopatologia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Stents , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Pediatr Neonatol ; 62(1): 36-40, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32830076

RESUMO

BACKGROUND: Patent Ductus Arteriosus (PDA) is a common condition, affecting nearly half of infants born before 28 weeks' of gestation, and it has been associated with poor growth. It is not known if different treatment modalities are associated with more profound growth impairment. Our aim was to compare differences in weight gain at 36 weeks' corrected gestational age (CGA) in premature infants that received medical, surgical or conservative management for PDA. METHODS: We retrospectively reviewed notes of 208 infants born under 30 weeks' gestation with a diagnosis of PDA. Gestational age (GA) at birth, birth weight z-score, CGA and weight z-score at 36 weeks' CGA were collected. In our cohort, surgical closure was performed in infants who remained symptomatic after medical or conservative management. RESULTS: Ninety-four infants had medical, 56 surgical and 58 conservative management. Surgically managed infants had a lower median (IQR) GA [24.4 (24.0-26.1) weeks'] than medically [25.4 (24.6-26.5) weeks'] or conservatively managed [26.4 (25.4-28.1) weeks', p < 0.001] infants. There was no difference in birth weight z-scores across the groups. Surgically managed infants demonstrated a greater decrease in weight z-score [-2.24 (-2.89 to -1.53)] compared to medically [-1.79 (-2.45 to -1.35)] and conservatively [-1.57 (-1.99 to -1.28), p < 0.001] managed infants between birth and 36 weeks' CGA. After adjusting for GA at birth, definitive treatment modality was significantly related to change in weight z-score from birth to 36 weeks' CGA (adjusted p = 0.022). CONCLUSION: Premature infants with PDA who were managed surgically had a greater degree of faltering growth compared to those who were treated medically or conservatively.


Assuntos
Permeabilidade do Canal Arterial/terapia , Transtornos do Crescimento/etiologia , Doenças do Prematuro/terapia , Procedimentos Cirúrgicos Cardíacos , Tratamento Conservador , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Idade Gestacional , Transtornos do Crescimento/diagnóstico , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/fisiopatologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Ganho de Peso
10.
BMC Cardiovasc Disord ; 20(1): 505, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261574

RESUMO

BACKGROUND: Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidences of benefit from targeted therapies, ES patients once thought to be inoperable may have increasing options for management. This study aims to explore whether PDA in patients with ES can be treated with transcatheter closure (TCC). METHODS: Between August 2014 and July 2016, four of fifteen PDA-ES patients whose Qp/Qs improved significantly and Qp/Qs > 1.5 after acute vasodilator testing with 100% oxygen were selected to receive TCC and pulmonary vasodilator therapy. PAH-targeted drugs were prescribed before and after occlusion for all. Trial occlusion was performed before permanent closure. RESULTS: The first TCC failed after initiation of PAH-targeted drugs for 6 months in four patients. After the medication was adjusted and extended to 12 months, TCC was performed for all without hemodynamic intolerances during perioperative period. Pulmonary artery systolic pressure (PASP) was significantly decreased (≥ 40%) immediately after TCC. During a mean follow-up of 48 ± 14.70 months, there were a further decrease of PASPs in two patients, the other two showed improved pulmonary vascular resistance, WHO functional class and six-minute walking distance despite deteriorated PASP. CONCLUSION: Some selected PDA-ES patients might benefit from TCC and combined PAH-targeted drugs play a crucial role.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Cateterismo Cardíaco , Permeabilidade do Canal Arterial/terapia , Complexo de Eisenmenger/terapia , Artéria Pulmonar/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Adulto , Anti-Hipertensivos/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Terapia Combinada , Quimioterapia Combinada , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Complexo de Eisenmenger/diagnóstico por imagem , Complexo de Eisenmenger/fisiopatologia , Feminino , Humanos , Masculino , Artéria Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/efeitos adversos , Adulto Jovem
11.
Pediatr Neonatol ; 61(5): 513-521, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32620378

RESUMO

BACKGROUND: Patent ductus arteriosus (PDA) remains a critical issue in prematurity care. To predict the PDA closure early, we aimed to clarify the association of PDA closure with the initial postnatal 24-hour clinical characteristics and maternal and gestational histories of preterm neonates. METHODS: A retrospective cohort study was conducted in a pediatric-neonatal-intensive-care-unit from 2008 to 2013. Data relating to birth histories, maternal histories, and clinical data from the first 24 h of life were analyzed according to three types of PDA closure-non-treated, medically-responsive, and surgically-ligated PDA and birth body weights (BBWs). Univariate analysis was performed using non-parametric analysis and Chi-square test or Fisher's exact test. Multivariate analysis was performed using multinomial logistic regression to determine the independent risk factors for the PDA closure. RESULTS: This study involved 682 preterm infants with median gestational age of 31 (interquartile, IQR: 28-34) weeks and BBW of 1360 (IQR: 1085-1861) g. Inclusively, 16.7% of (P)DAs underwent medical and/or surgical treatment. For very low birth body weight (VLBW) neonates, surfactant use not only predicted the requirement of PDA treatment, but together with dopamine use and the larger amount of first 24-hour intravenous fluid (IVF) per kilogram of BBW, it also predicted the possibility of surgical ligation. Meanwhile, the cut-off values of the IVF amount (87 and 89.5 ml/kg/day, respectively) might predict the PDA treatment necessity and surgical ligation. For neonates with BBW ≥1500 g, placenta previa and lower BBW and systolic blood pressure (SBP) predicted the risk of treatment for PDA and its treatment response. CONCLUSIONS: Neonatal care for PDA in prematurity should be meticulously personalized. Surfactant use, dopamine administration and the first 24-hour IVF management may be critical for PDA closure in VLBW neonates. Antepartum history of placenta previa, BBW and SBP control may be important for BBW≥1500 g.


Assuntos
Peso ao Nascer , Permeabilidade do Canal Arterial/terapia , Recém-Nascido Prematuro/fisiologia , Adulto , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Ligadura , Modelos Logísticos , Masculino , Gravidez , Estudos Retrospectivos
12.
Heart Vessels ; 35(11): 1605-1613, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32494943

RESUMO

The data comparing the characteristics and effect of transcatheter patent ductus arteriosus (PDA) closure between children and adults is scarce. We analyzed 54 consecutive patients who underwent transcatheter PDA closures. We divided the patients into 2 groups of < 18 years and ≥ 18 years and compared the hemodynamic changes before and after the PDA closure. Adults had a higher incidence of heart failure on admission, diagnoses by heart failure and incidental echocardiography, PDA calcifications, and procedural complications than children (all P < 0.05). The left ventricular end-diastolic volume index (LVEDVI), left atrial diameter index (LADI), and LV mass index (LVMI) decreased after the PDA closure in children but not in adults. The LV ejection fraction (LVEF) significantly decreased 1 day after the PDA closure in both groups but remained low at 6 months after the procedure in only adults. The percent change in the LVEDVI, LADI, LVMI, and LVEF from baseline to 6 months after the procedure was significantly lesser in adults than children (LVEDVI: - 5.2 ± 29.1% vs. - 34.9 ± 18.9%, LADI: - 7.0 ± 13.2% vs. - 22.1 ± 18.9%, LVMI: - 11.0 ± 16.5% vs. - 34.1 ± 15.7%, LVEF: - 5.9 ± 7.6% vs. 6.1 ± 9.1%, all P < 0.05). Transcatheter PDA closure was not associated with a reduction in the LV and LA volume as well as an improvement in the LV hypertrophy and LV function in adults as compared to children. We suggested that an early diagnosis and transcatheter PDA closure during childhood might provide clinical benefit before progressive LV remodeling and heart failure.


Assuntos
Cateterismo Cardíaco , Permeabilidade do Canal Arterial/terapia , Fatores Etários , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Pré-Escolar , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Remodelação Ventricular
13.
Pediatr Cardiol ; 41(7): 1386-1390, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32524206

RESUMO

We evaluated the effectiveness of a whole-body bioimpedance device (NICaS®, NI Medical, Petach Tikva, Israel) to predict the presence of a hemodynamically significant patent ductus arteriosus (PDA) in premature infants. A total of 36 infants less than 35 week's gestation age and birth weights of less than 1750 g were included in the study. Using the NICaS® device, we obtained whole-body bioimpedance measurements of stroke volume index (SI), cardiac output index (CI) and total peripheral resistance index. A total of 61 measurements were taken together with echocardiograph imaging. The study population was divided into three groups according to the echocardiograph results: group 1-small PDA, group 2-moderate PDA, and group 3-large PDA. Both SI and CI significantly increased from a median value of 22.6 ml/m2 and 3.4 l/min/m2 to 23.8 and 3.7, to 39.8 and 5.4 between groups 1, 2 and 3 respectively. The difference was statistically significant between groups 1 and 3 (P = 0.005 for SI and P = 0.002 for CI) and between groups 2 and 3 (P = 0.037 for SI and P = 0.05 for CI). We found statistically significant differences in SI and CI between infants with large PDAs and infants with no or small and medium PDAs. We suggest that these differences can be used in real time, in addition to echocardiography, in assessing the presence of significant PDAs.


Assuntos
Débito Cardíaco , Permeabilidade do Canal Arterial/fisiopatologia , Impedância Elétrica , Doenças do Prematuro/fisiopatologia , Peso ao Nascer , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Masculino , Volume Sistólico , Resistência Vascular
14.
Semin Fetal Neonatal Med ; 25(5): 101120, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32513596

RESUMO

Patent ductus arteriosus is associated with multiple comorbidities in premature infants, however a causal link or strategy to decrease these morbidities has not been found. The association between the patent ductus arteriosus and morbidities has biologic plausibility as, like any cardiac mixing lesion, a significant systemic to pulmonic shunt may lead to pulmonary over-circulation and systemic hypoperfusion. Understanding the underlying pathophysiology of associated morbidities in the setting of a patent ductus arteriosus may aid in risk stratifying infants and offer a patient targeted approach to infants with a pathological ductal shunt. While the deleterious impact of increased pulmonary blood flow maybe easier to identify, the impact on end-organ perfusion is more challenging. In this review, we will discuss the pathophysiology of a hemodynamically significant patent ductus arteriosus in premature infants, impact on end-organ perfusion and associated morbidities, and novel modalities to assess shunt volume and effect on end-organ perfusion.


Assuntos
Permeabilidade do Canal Arterial/fisiopatologia , Microbioma Gastrointestinal , Recém-Nascido Prematuro , Permeabilidade do Canal Arterial/diagnóstico por imagem , Hemodinâmica/fisiologia , Humanos , Recém-Nascido , Doenças do Prematuro/fisiopatologia
15.
Pediatr Radiol ; 50(8): 1107-1114, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32556575

RESUMO

BACKGROUND: Very-low-birth-weight (VLBW) preterm neonates are vulnerable to patent ductus arteriosus (PDA), which might be related to high-resistance flow in the superior mesenteric artery (SMA), with decreased diastolic flow in situations of marked intestinal hypoperfusion. No previous studies have evaluated the portal vein and superior mesenteric vein (SMV) parameters to assess the PDA hemodynamic repercussions. OBJECTIVE: To assess mesenteric and portal flow in VLBW preterm neonates with or without PDA using serial Doppler ultrasonography (US). MATERIALS AND METHODS: We conducted a prospective longitudinal study on 61 VLBW preterm neonates submitted to 161 Doppler US exams, from 2 days to 20 days of age. RESULTS: All infants exhibited a progressive daily increase in the mean of the SMA diameter and systolic velocity, the portal vein diameter, the peak velocity, the mean velocity and the flow volume and of SMV diameter (P<0.05). The incidence of PDA was 37.7% (n=23) and infants with the disease revealed a smaller diameter, greater systolic velocity, lower diastolic velocity, and higher resistivity and pulsatility indices on SMA compared to those without PDA (P<0.05). Additionally, 47.8% (n=11) of infants with PDA exhibited absent or reversed end-diastolic flow in the SMA, and its resolution was seen among 54.5% (n=6) of these. Infants with PDA also exhibited lower values of portal vein diameter and flow volume and of SMV diameter (P<0.01). CONCLUSION: Doppler US enhances the understanding of mesenteric and portal flow, including the effects of PDA. The study of SMV and portal vein flow is proposed as a new parameter in PDA evaluation.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/fisiopatologia , Artéria Mesentérica Superior/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Ultrassonografia Doppler , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Estudos Longitudinais , Masculino , Estudos Prospectivos
16.
Can J Cardiol ; 36(6): 837-843, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32536374

RESUMO

BACKGROUND: There is little published data regarding percutaneous patent ductus arteriosus (PDA) closure in adults. We aim to describe the outcomes of adult patients undergoing PDA closure at a single tertiary referral centre. METHODS: All adults who underwent device PDA closure at our centre from 2001 to 2017 were identified and enrolled in the study. Available clinical data and imaging data were reviewed. RESULTS: At total of 141 patients were identified, with a mean age of 43 ± 15 years. Left ventricular dilation was present in 27% and pulmonary hypertension in 36% of the patients. Most ducts (74%) were of type A morphology. Mean ductal diameter at the pulmonary artery end was 4.1 ± 1.9 mm and mean length was 10.0 ± 4.7 mm. Wire passage from the pulmonary artery was achieved in 79%. Procedural success rate was 100%, and an Amplatzer duct occluder was deployed in all successful cases (ADO1 device in 97%). There was a small residual shunt in 6% at the time of closure, and only 2 patients had a residual leak on echocardiography at a median 3 months' follow-up. No major complications occurred. CONCLUSIONS: Transcatheter PDA closure with the use of an Amplatzer duct occluder is very effective in adults across all duct morphologies and associated with a very low complication rate.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Permeabilidade do Canal Arterial , Ventrículos do Coração , Hipertensão Pulmonar , Complicações Pós-Operatórias , Implantação de Prótese , Dispositivo para Oclusão Septal , Adulto , Canadá , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/epidemiologia , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Masculino , Tamanho do Órgão , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Estudos Retrospectivos , Resultado do Tratamento
17.
Med Sci Monit ; 26: e921671, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32538377

RESUMO

BACKGROUND Patent ductus arteriosus (PDA) is a common congenital cardiac abnormality in premature infants. In low-birth-weight infants weighing less than 2500 g, if the PDA continues to open, abnormal circulation hemodynamics and pulmonary edema may occur. This study aimed to investigate the role of lung ultrasound score in the assessment of pulmonary edema in low-weight neonates with PDA. MATERIAL AND METHODS Two hundred and twenty-one neonates with low birth weight were selected as the subjects, children with PDA as the observation group, and children with closed ductus arteriosus as the control group. On the fourth postnatal day, lung ultrasound examination and 6-segment lung ultrasound scoring were performed. RESULTS All 221 infants (94 in the observation group, 127 controls) underwent ultrasound examinations of the lungs. Intergroup differences in gestational age, birth weight, length of hospital stay, and left ventricular ejection fraction were not statistically significant. There was a significant difference in lung ultrasound score (t=0.005, P=0.000) and aortic root ratio to left atrial (t=0.085, P=0.000), which was negatively correlated with gestational age (r=-0.235, P=0.000) and positively correlated with PDA diameter (r=0.261, P=0.011). CONCLUSIONS Low-birth-weight children often have PDA. Its continued opening changes the circulation hemodynamics in children. Lung ultrasound score can semi-quantitatively evaluate the extravascular lung water content, identifying the need to intervene and follow up the hemodynamic significance of PDA over time.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Água Extravascular Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Estudos de Casos e Controles , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Pulmão/fisiopatologia , Masculino , Prognóstico , Ultrassonografia
18.
Can J Cardiol ; 36(6): 967.e5-967.e7, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32416064

RESUMO

Neonates with pulmonary atresia survive only if duct patency is maintained before staged surgical repair. Ductal stenting is an effective alternative to conventional shunt surgery, as it avoids thoracotomy. With today's generation of coronary stents having better profile, flexibility, and trackability, it may be achieved safely, with less difficulty than previously described. The strategy during patent ductus arteriosus (PDA) stenting with trifurcation narrowing is a real challenge. We present an underweight newborn with ventricular septal defect pulmonary atresia, restrictive PDA, and bilateral branch stenosis at the ostia. We performed a successful PDA stenting as well as addressed the ostia of branch pulmonary arteries.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Permeabilidade do Canal Arterial , Comunicação Interventricular , Atresia Pulmonar , Stents , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia/métodos , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Atresia Pulmonar/diagnóstico , Atresia Pulmonar/fisiopatologia , Atresia Pulmonar/cirurgia , Resultado do Tratamento
19.
Cardiol Young ; 30(6): 769-773, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32340633

RESUMO

BACKGROUND: Thrombocytopenia is a risk factor for patent ductus arteriosus. Immature and mature platelets exhibit distinct haemostatic properties; however, whether platelet maturity plays a role in postnatal, ductus arteriosus closure is unknown. METHODS: In this observational study, counts of immature and mature platelets (=total platelet count - immature platelet count) were assessed on days 1, 3, and 7 of life in very low birth weight infants (<1500 g birth weight). We performed echocardiographic screening for haemodynamically significant patent ductus arteriosus on day 7. RESULTS: Counts of mature platelets did not differ on day 1 in infants with (n = 24) and without (n = 45) haemodynamically significant patent ductus arteriosus, while infants with significant patent ductus arteriosus exhibited lower counts of mature platelet on postnatal days 3 and 7. Relative counts of immature platelets (fraction, in %) were higher in infants with patent ductus arteriosus on day 7 but not on days 1 and 3. Receiver operating characteristic curve analysis unraveled associations between both lower mature platelet counts and higher immature platelet fraction (percentage) values on days 3 and 7, with haemodynamically significant ductus arteriosus. Logistic regression analysis revealed that mature platelet counts, but not immature platelet fraction values, were independent predictors of haemodynamically significant patent ductus arteriosus. CONCLUSION: During the first week of postnatal life, lower counts of mature platelets and higher immature platelet fraction values are associated with haemodynamically significant patent ductus arteriosus. Lower counts of mature platelet were found to be independent predictors of haemodynamically significant patent ductus arteriosus.


Assuntos
Plaquetas/patologia , Permeabilidade do Canal Arterial/diagnóstico , Doenças do Prematuro/diagnóstico , Recém-Nascido de muito Baixo Peso/sangue , Contagem de Plaquetas , Permeabilidade do Canal Arterial/sangue , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia , Feminino , Idade Gestacional , Hemodinâmica , Humanos , Incidência , Recém-Nascido , Doenças do Prematuro/sangue , Doenças do Prematuro/fisiopatologia , Modelos Logísticos , Masculino , Curva ROC
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