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PubMed1996

Echocardiographic and radionuclide pulmonary blood flow patterns after transcatheter closure of patent ductus arteriosus.

BACKGROUND: Transcatheter occlusion of patent ductus arteriosus (PDA) has been associated with protrusion of the occluder device into the left pulmonary artery (LPA). This study was conducted to evaluate the significance of occluder protrusion and its implications for potential obstruction of the LPA and associated decrease of left lung perfusion. METHODS AND RESULTS: Fifty-two patients underwent successful transcatheter PDA occlusion over a period of 5 years. In this study, 49 were reexamined between March and June 1995. In addition to clinical and echocardiographic examination, lung scintigraphy was performed. Protrusion into the LPA was present in 5 of 49 patients (10%). In these patients, maximal flow velocity in the LPA was significantly (P < .01) increased. Decreased left lung perfusion, defined as < 40% of total pulmonary blood flow, was found in 7 of 49 patients (14%). Although mean left pulmonary perfusion was significantly (P = .02) decreased in patients with protrusion, there was considerable overlap with patients without protrusion, and only a weak correlation was found (r = -.35, P = .01) between flow-velocity and left lung perfusion. CONCLUSIONS: Our results demonstrate that protrusion of the device in the LPA is an infrequent finding. If present, it is associated with increased maximal flow velocity in the LPA and diminished left lung perfusion. However, echocardiography and lung scintigraphy are weakly correlated: Increased maximal blood flow velocities in the proximal LPA proved to be a poor indicator or impaired left lung perfusion. Also, decreased perfusion occurs in the absence of echocardiographic evidence of device protrusion.

Blood Flow Velocity↗
PubMedDate not supplied

Pulmonary embolization of vascular occlusion coils in dogs with patent ductus arteriosus.

Transcatheter coil embolization of patent ductus arteriosus (PDA) was performed in 206 dogs between 1994 and 2003 at Texas A&M University, of which 7 (3%) had embolization of coils to the pulmonary vasculature. Thoracic radiographs indicated that coils were located in the right pulmonary artery in 6 of the 7 dogs. Pulmonary perfusion scans were available for review in 5 dogs, and moderate perfusion defects were observed in the right caudal lung lobe in 4 dogs within 24 hours of embolization. Perfusion deficits observed initially in 2 of the dogs resolved on perfusion scans performed at 6 months and 3.1 years. One dog did not have evidence of focal perfusion defects on a perfusion scan performed 4.5 months after embolization. All pulmonary embolizations occurred during the procedure. Attempts at retrieval of coils were unsuccessful in the 2 dogs in which it was attempted. No short- or long-term clinical complications were observed in any of the dogs with pulmonary embolization. We conclude that pulmonary embolization of vascular occlusion coils is an uncommon event and is not typically associated with adverse clinical effects in dogs with PDA.

Animals↗
PubMed1999

The anesthetic management of a preterm infant weighing 500 grams undergoing ligation of patent ductus arteriosus--a case report.

PDA (patent ductus arteriosus) is a common congenital heart disease. Usually surgical intervention through left thoracotomy or recently through video assisted thoracoscopy will be recommended if the preceding or intent medical treatment fails or is contraindicated. However, once surgical intervention is decided, various complications are still a real fear in the mind of the surgeon and the anesthesiologist, particularly if the infant is premature or very sick. Here we report an anesthetic management in a female preterm infant weighing 500 grams, who underwent PDA ligation. She was born at gestation age of 28 weeks at our hospital, and since her birth she was noted to have infant respiratory distress syndrome associated with renal dysfunction. She was admitted to the neonatal intensive care unit (NICU) straightaway. After thorough examination, a severe PDA was disclosed. The possibility of pulmonary hemorrhage and heart failure could be predicted in view of the large left to right shunt. Worst of all was that her poor renal function contradicted a medical treatment. So we decided to carry out the ligation procedure at once although she was premature and only 5 days old. The NICU was chosen as the operation theater for transferring concerns. General anesthesia was induced and maintained by atropine 0.01 mg, pancuronium 0.1 mg, fentanyl 2 micrograms, and ketamine 0.15 mg intravenously. Supplemental oxygen was given throughout the operation. The PDA was ligated through left thoracotomy and blood loss was minimal. The peri-operative course was uneventful. The patient recovered well following surgery and anesthesia.

Adult↗
PubMed1985

[Pulsed Doppler and bidimensional echocardiography in patent ductus arteriosus].

The classical form of patent ductus arteriosus (PDA) does not usually pose any difficulty in diagnosing. When the auscultatory signs are atypical, for example in the newborn or in cases with pulmonary hypertension, pulsed Doppler echocardiography may be a useful diagnostic aid. This study reports the results of pulsed Doppler examination in PDA. Twenty-four children with a suspected PDA underwent pulsed Doppler examination during 2D echocardiography. This population was divided into 2 groups; Group I: children who underwent catheterisation, and group II: in which catheterisation was not performed. The mean age in Group I was 7 years compared to 50 days in Group II, which mainly comprised newborn and premature babies. Direct visualisation of PDA by 2D echo was attempted in all cases. The search for a PDA by pulsed Doppler was made by positioning the sample volume at the bifurcation of the main pulmonary artery. PDA is associated with turbulent systolo-diastolic flow away from the transducer. Suprasternal and subcostal views were also used. In Group I (13 cases) PDA was directly visualised by 2D echo in 7 children (53 p. 100). By comparison, pulsed Doppler examination diagnosed all 13 cases of PDA; these results were confirmed at catheterisation or surgery. In Group II (11 cases) direct visualisation of PDA was successful in 6 cases (54 p. 100). Pulsed Doppler was non-specific, showing typical flow disturbances in 8 cases and systolic turbulence in 3 cases at the level of bifurcation.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1995

Aneurysm following ligation of patent ductus arteriosus.

Complications following ligation of patent ductus arteriosus are rare. Aneurysm following ligation requires careful evaluation and individualized repair. We report 2 cases that highlight the clinical course and operative management of this unusual but significant postoperative complication.

Adolescent↗
PubMed1994

Percutaneous closure of the small patent ductus arteriosus using occluding spring coils.

OBJECTIVES: This report summarizes our experience with the use of occluding spring coils to close the small patent ductus arteriosus. BACKGROUND: Several patent ductus arteriosus occluders (most notably the Rashkind device) have been developed and studied. Occluding spring coils have been used to close abnormal vessels and vascular connections. We previously reported the use of occluding spring coils to close the small patent ductus arteriosus in a small group of patients. This report describes our series of patients having patent ductus arteriosus closure with occluding spring coils. METHODS: Between June 1990 and June 1993, 30 patients underwent cardiac catheterization to have patent ductus arteriosus closure by occluding spring coils. Selection criteria were age > 6 months and narrowest patent ductus arteriosus internal dimension < or = 3.0 mm by color flow imaging. Definitive selection was based on review of aortograms performed at catheterization. A 5.2F coronary catheter was used to deliver one or two standard occluding spring coils. A loop was delivered in the main pulmonary artery, and the remainder of the coil was delivered across the patent ductus arteriosus and into the aortic diverticulum. Patent ductus arteriosus closure was confirmed by aortography or color flow imaging, or both. Follow-up after coil placement occurred at 6 weeks and 6 months and included two-view chest radiography, echocardiography and color flow imaging. RESULTS: Of the 30 patients, 29 had successful implantation by one (27 patients) or two (2 patients) occluding spring coils. Of these 29 patients, 19 had a clinically apparent and 10 had a silent patent ductus arteriosus. Average ductus minimal internal dimension was 1.7 mm (range 1.0 to 3.0). Complete closure of the ductus was confirmed in 27 patients by aortography or color flow imaging or both (in 24 within 4 h, in 2 after 6 weeks and in 1 after 6 months). Six weeks after implantation, two patients had a tiny residual patent ductus arteriosus noted on color flow imaging. One patient did not have successful implantation. This patient had a 3.2-mm ductus, and two coils migrated to the distal left pulmonary artery and could not be retrieved. There were no deaths or any significant complications noted during early or late follow-up in these patients. CONCLUSIONS: Occluding spring coils may have additional application in closing the small patent ductus arteriosus.

Aortography↗
PubMed1983

[Pulsatile flow dynamics of the ductus arteriosus, thoracic aorta and pulmonary artery in patients with patent ductus arteriosus].

In 20 infants or children with an isolated or complicated patent ductus arteriosus (PDA), we qualitatively and quantitatively studied pulsatile flow dynamics of the ductus, descending thoracic aorta and pulmonary artery by means of a catheter-tip electromagnetic flow velocity probe. They were divided into four groups according to ductal shunt states as follows: 14 patients with a continuous left-to-right (L-R) shunt (Group I), three patients with a bidirectional but a dominant L-R shunt (Group IIA), two patients with a bidirectional but dominant right-to-left (R-L) shunt (Group IIB), and one patient without a significant ductal flow (Group III). In Group I, the ductal flow was pulsatile and showed continuous L-R shunting. The timing of a peak flow velocity was coincident with the peak aortic pressure at the mid-ductus, and it shifted to diastolic phase as the flow sensor approached the pulmonary end of the ductus arteriosus. In Group IIA, the peak velocity of a L-R shunt flow was located at mid-diastole and a transiently reversed R-L shunt flow was seen during systole. Two patients of Group IIB showed that the peak flow velocity of a dominantly reversed shunt was at mid-diastole, while a low grade L-R shunt flow was seen over a wide range of diastolic period. One patient of Group III who underwent operation for aortic arch interruption did not show any significant ductal flow because of a narrow PDA. In most cases of the present study, a diastolic backflow reflecting a L-R ductal shunt during diastole was demonstrated both in the descending thoracic aorta and main pulmonary artery. The peak flow velocity of the thoracic aorta was correlated with the ductal L-R shunt ratio determined by the Fick method (r = 0.46), and the diastolic regurgitant flow fraction of the thoracic aorta was increased in patients with a larger L-R shunt or with a reversed shunt. Therefore, it was suggested that a net forward flow of the thoracic aorta is reduced in these patients. On the other hand, the quantitative evaluation of a pulmonary flow during systole was found unreliable and expected to be underestimated because of the occurrence of turbulence at the site of the main pulmonary artery by the confluence of ejection stream from the right ventricle and a shunted flow from the aorta.(ABSTRACT TRUNCATED AT 400 WORDS)

Aorta, Thoracic↗