MyMedR

Surgical management of patent ductus arteriosus with endocarditis

Kareem BA, Kamarulzaman H, Koh GT

Ann Thorac Surg, 2010 Nov;90(5):1703-5.

PMID: 20971300 DOI: 10.1016/j.athoracsur.2010.04.105

A 9-year-old boy with patent ductus arteriosus complicated by infective endocarditis had not responded to antibiotic therapy and was referred to our institution. He had persistent fever and a chest roentgenogram demonstrated the presence of left lung pneumonic consolidation. An echocardiogram showed the presence of large vegetation in the pulmonary artery at the ductal opening. We successfully performed an open ductal ligation with the aid of cardiopulmonary bypass through a sternotomy and proceeded to resect the vegetation. We completed the procedure with reconstruction of the pulmonary artery. The postoperative course was uneventful. The patient was discharged after a week.

Matched MeSH terms: Ductus Arteriosus, Patent/surgery*

Fulltext Surgery for the persistent ductus arteriosus: a review of 625 cases

Tan CTT

Med J Malaysia, 1987 Jun;42(2):104-9.

PMID: 3503182

Surgery for the persistent ductus arteriosus (PDA) is almost 50-years-old. It started with Robert Gross in 1938 who successfully ligated the PDA in a seven-year-old girl.! Incomplete obliteration, ligatures cutting through the ductus and recanalisation of the ductus remained troublesome possibilities with this method of dealing with the PDA. Dividing the ductus and suturing each divided end separately would eliminate these possibilities. Gross was quick to recognise this and advocated division in all cases to remove any doubt of incomplete obliteration. 2 Jones supported this concept but also stressed that division and suture of the PDA was not to be taken lightly for the fatal consequence that could arise from inexperience.f There were those who continued to have satisfactory results with ligation of the PDA and persisted with this method (Blalock." Clagett, Kirklin, Ellis and Coolev.' Panagopoulos, Tatooles, Aberdeen, Waterston and Bonham Carter"}, The debate continues between ligation on one hand, and division and suture on the other and it appears currently to favour the latter. This paper reviews our experience with surgery for the PDA over the past five years.

Matched MeSH terms: Ductus Arteriosus, Patent/surgery*

Closure of the patent ductus arteriosus with a Ligaclip through a minithoracotomy

Majid AA

Chest, 1993 May;103(5):1512-4.

PMID: 8486035 DOI: 10.1378/chest.103.5.1512

This article describes a technique which allows the patent ductus arteriosus (PDA) to be closed through a minithoracotomy. It combines a simple method of inducing atelectasis with Ligaclip closure of the PDA through a subaxillary incision. It was used successfully in 11 children and adolescents.

Matched MeSH terms: Ductus Arteriosus, Patent/surgery*

Stenting the complex patent ductus arteriosus in tetralogy of Fallot with pulmonary atresia: challenges and outcomes

Rehman R, Marhisham MC, Alwi M

Future Cardiol, 2018 01;14(1):55-73.

PMID: 29199861 DOI: 10.2217/fca-2017-0053

Patent ductus arteriosus (PDA) stenting has gained acceptance for palliation in cyanotic congenital heart disease. The PDA in tetralogy of Fallot with pulmonary atresia (ToF-PA) arises, in the left aortic arch, from underneath the arch and connects to the proximal left pulmonary artery, often resulting in stenosis. The PDA is usually elongated and tortuous, making stent implantation challenging. Shorter duration of palliation, aggravation of branch pulmonary artery stenosis resulting in poor growth and difficulty at surgery makes ductal stenting controversial. Access via the carotid and axillary artery reduces complexity of the procedure and improves success, with recent data demonstrating good pulmonary artery growth. Advances in bioresorbable stents offer future promise and will likely resolve some controversies surrounding PDA stenting in ToF-PA.

Matched MeSH terms: Ductus Arteriosus, Patent/surgery*

Fulltext The new Occlutech® PDA occluder: Initial human experience

Abdelbasit MA, Alwi M, Kandavello G, Che Mood M, Samion H, Hijazi ZM

Catheter Cardiovasc Interv, 2015 Jul;86(1):94-9.

PMID: 25675888 DOI: 10.1002/ccd.25878

OBJECTIVES: To evaluate the feasibility, safety, and efficacy of the Occlutech® PDA occluder for closure of patent ductus arteriosus (PDA).

BACKGROUND: The Occlutech® PDA occluder is novel, self-shaping Nitinol wire device with PET (polyethylene terephthalate) patches integrated into the shank of the device to assure a better obturation of the ductus. The Occlutech® PDA occluder has undergone two design modifications.

METHODS: A prospective, non-randomized pilot study was started in November 2011. Thirty-three patients were included until April 2013. Patients weighing <6 kg or those with associated cardiac anomalies that required surgery were excluded. All patients were followed up by transthoracic echocardiography at 24 hr, 30 days, 90 days, 180 days, and 360 days after implantation. Residual shunt, left pulmonary artery (LPA) and descending aortic velocities were among the parameters assessed. All occluders were delivered via 6-8 F long sheaths and PDA closures were performed following standard techniques.

RESULTS: Thirty three patients (20 female/13 male), with a median age of 2 years (6 month to 38 years), and median weight of 9.3 kg (6-69.2 kg) were included. The narrowest median PDA diameter was 3mm (1.8-5.8 mm). All the 33 patients were closed successfully using Occlutech ductal occluder, 16 patients (48.4%) had immediate and complete closure on angiography. Within 24 hr, color Doppler revealed complete closure in 27patients (81.8%), 32patients (97%) at 30 days, and in 100% of patients at 90 days. All patients with a large PDA had immediate residual shunt which was closed at the 90-day follow-up. There was no device embolization, hemolysis, or obstruction to the LPA or descending aorta.

CONCLUSION: The new Occlutech® PDA is safe and effective. In patients with a large PDA complete closure tended to take longer time.

Matched MeSH terms: Ductus Arteriosus, Patent/surgery*

Stenting the patent ductus arteriosus in duct-dependent pulmonary circulation: techniques, complications and follow-up issues

Alwi M

Future Cardiol, 2012 Mar;8(2):237-50.

PMID: 22413983 DOI: 10.2217/fca.12.4

Maintaining ductal patency in duct-dependent congenital heart lesions by implantation of coronary stents is an alternative to systemic pulmonary shunt in selected cases and lesions with suitable anatomy. This article focuses on the procedure as the initial palliation in duct-dependent pulmonary circulation, its associated pitfalls and complications. A good understanding of the diverse duct morphology is paramount prior to stenting of the ductus. Long tortuous duct, insufficiently constricted ductus at the pulmonary end and ductus with associated branch pulmonary artery stenosis at the site of insertion are not suitable for stenting. Durability of palliation is generally inferior to a surgical shunt and this may dictate earlier definitive surgical repair. Acceleration of branch pulmonary artery stenosis in certain ductal morphology limits its general applicability. Bioabsorbable and biodegradable stents may offer some solution to this problem.

Matched MeSH terms: Ductus Arteriosus, Patent/surgery

Fulltext Persistent ductus arteriosus in Malaysian patients

Krishnan M, Snelling MR

Br Heart J, 1971 Sep;33(5):699-701.

PMID: 5115012 DOI: 10.1136/hrt.33.5.699

Matched MeSH terms: Ductus Arteriosus, Patent/surgery*

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