Cardiac Reverse Remodeling After Transcatheter Patent Ductus Arteriosus Closure in Adults

Whereas most patent ductus arteriosus (PDAs) are identified and treated in the childhood, and the long term outcome studies have approved the outstanding results (positive cardiac reverse remodeling) in these group of patients, the outcome of percutaneous PDA closure in adults is not comprehensible. The aim of this retrospective cohort study which consecutively recruited 121 adult patients (age >16 years) who underwent the transcatheter closure (TCC) of PDAs between 2012 and 2018 is, evaluation at least 1-year follow-up of adult patients after PDA closure and compare the hemodynamic and the cardiac reverse remodeling findings with the previous studies in adults and children.     

Patent Ductus Arteriosus Closure

Patent ductus arteriosus is a common clinical lesion which increases the risk of endocarditis and may lead to heart failure and pulmonary hypertension. Devices and techniques have advanced to the point that in most patients percutaneous closure should be the procedure of choice. Devices are best selected by fully examining the anatomy of the defect. In general coils are best suited for smaller defects and the Amplatzer Duct Occluder excels in moderate to large defects. Follow-up should include echocardiography to ensure complete closure.     

经皮穿刺动脉导管闭合术的临床应用及并发症的处理

采用改进的Porstmann法对8例动脉导管未闭（PDA）患者实施经皮穿刺堵塞术。以彩色多普勒，球囊导管探测PDA大小，结合导管尺测量塞子并实施堵塞术。6例关闭成功，其血流动力学各参数均明显改善或恢复正常。随访2～4年无栓子移位或再分流发生。失败2例：1例未闭导管呈反漏斗型，塞子脱入肺动脉，经送至股静脉并切开取出；另1例系股动脉太细而不能送入选定的塞子。因此，严格选择适应证是手术成功的关键。     

未闭动脉导管经皮弹簧栓栓堵方法的临床研究

目的：研究建立一种经皮可释放性弹簧栓栓堵治疗动脉导管未闭（ＰＤＡ）的新方法。方法：经主动脉造影测定ＰＤＡ内径及长度，在Ｘ线和超声心动图监测引导下，经心导管将可释放性弹簧栓栓堵于ＰＤＡ。分别采用Ｊａｃｋｓｏｎ弹簧栓（Ｊ组）和ＰＤＡ弹簧栓（Ｐ组）。经临床、主动脉造影和超声心动图确定疗效。结果：采用本法治疗２１例，ＰＤＡ平均最狭窄处内径３．１８±０．６２ｍｍ（范围１．５～４．７ｍｍ，其中８１％超过３ｍｍ），平均长度５．１７±２．１３ｍｍ。２０例获得成功且无并发症，术后经临床、主动脉造影和超声心动图检查，无残余分流。其中Ｊ组８例均获成功；Ｐ组１３例，成功１２例、失败１例。结论：本法属于安全可靠的非开胸治疗ＰＤＡ的新方法，创伤性很小，值得使用。     

160例动脉导管未闭堵闭术的体会

目的报道非开胸160例动脉导管未闭治疗的体会。方法采用经皮股动、静脉穿刺心导管动脉导管未闭堵闭法。结果一次堵闭成功156例，二次堵闭成功3例，改变治疗方案1例。堵闭成功率为99％。随访14～132个月，疗效满意。结论本方法创伤小、操作简便、费用低、病人恢复快。     

Outcomes of Percutaneous Closure of Patent Ductus Arteriosus Accompanied With Unilateral Absence of Pulmonary Artery

Background

Limited data have reported the outcomes of percutaneous closure of patent ductus arteriosus (PDA) in patients with unilateral absence of pulmonary artery (UAPA). This study aimed to evaluate the symptomatology, diagnosis and therapy, especially the transcatheter closure of PDA in patients with PDA associated with UAPA.

经导管介入治疗动脉导管未闭

采用介入方法治疗动脉导管未闭(PDA)已在临床上探索了近40年。Masura等[1]1998年首次报道应用蘑菇形伞封堵PDA获得成功,同期国产新型PDA封堵器成功应用于临床[2]。我院自2004年6月始应用国产封堵器治疗PDA患者18例,获得满意疗效,现报道如下。1资料与方法1.1临床资料18例患者,男     

Transcatheter Closure of Persistent Ductus Arteriosus in Adults

Objective: To describe the technical aspects and outcome of duct occlusion in adults over a 12-year period. Methods: A single center review of all transcatheter duct closures performed between 2000 and 2012. Results: Of 518 transcatheter duct closures performed, 31 patients were over the age of 16 at the time of procedure (6%). In 10 of the 31 cases, it was not possible to cross the duct from the pulmonary artery. In 4 of those, the duct was small enough to be closed with coils delivered from the aorta (although 1 required a second procedure for a residual shunt). In the remaining 6 cases, it was necessary to cross the duct from the aorta and create an arterio-venous "circuit" using a snare to deliver an Amplatzer device from the femoral vein. In none of the 487 children who underwent transcatheter duct closure during the same time period was it necessary to deliver the device using an arterio-venous wire circuit. The increased complexity of the procedure in adults compared with children was further reflected by longer procedure times (median of 37 minutes in adults vs. 24 minutes in children [P < 0.01]) and longer fluoroscopy times (median of 8.4 minutes in adults vs. 4.3 minutes in children [P < 0.025]). There were no major complications. Conclusions: Closure of the arterial duct in adults is safe and effective but ductal anatomy may differ from that seen in childhood, making transcatheter closure technically much more demanding than in children. (J Interven Cardiol 2012;25:501-504).     

应用可控弹簧栓子封堵动脉导管未闭

目的：评价可控弹簧栓子封堵动脉导管未闭（ＰＤＡ）的初步疗效。　　方法：应用可控弹簧栓子经导管封堵ＰＤＡ共１２例。其中静脉法８例,动脉法４例。封堵前、后均行Ｘ线胸片、心电图、超声心动图、右心导管及主动脉弓降部造影检查。ＰＤＡ最窄直径１．３～３．４ ｍ ｍ ,平均２．５±０．６ ｍ ｍ 。　　结果：应用可控弹簧栓子封堵ＰＤＡ,全组１２例均封堵成功,无残余分流及并发症。　　结论：可控弹簧栓子封堵小ＰＤＡ安全、有效,一枚弹簧栓子适用于封堵直径≤２．５ ｍ ｍ 的ＰＤＡ     

经胸超声心动图指导动脉导管未闭封堵术的应用

经胸超声心动图在封堵术的术前诊断、术中监测引导、术中效果评价及术后长期随访中发挥着重要作用。     

The Duct-Occlud Device for Closure of Patent Ductus Arteriosus

The Duct-Occlud device is a coil-type device designed to occlude small-to-moderate patent ductus arteriosus. The design of the device, its delivery system, and the implant procedure are described, and the experimental and clinical experiences accumulated utilizing the device for occlusion of patent ductus arteriosus are reviewed.     

Summary and Comparison of Patent Ductus Arteriosus Closure Devices

A number of patent ductus arteriosus (PDA) occluding devices have been studied in an attempt to develop a transcatheter method of closure of PDA. Some devices were tested in only animal models, whereas others progressed to clinical trials in human subjects. Some devices have been discontinued, some received approval for general clinical use, and many have not yet received approval by regulatory authorities. No prospective randomized clinical trials have been undertaken and, therefore, data on separate clinical trials are used to determine relative efficacy of the devices. Selection of a method of PDA closure depends largely on its minimal diameter and to some degree on its shape. Silent PDAs do not need occlusion. Very small to small PDAs may be occluded by free or detachable Gianturco coils (Cook Cardiology, Bloomington, IN). Moderate-to-large PDAs require closure by devices, conventional surgery, and videothoracoscopic interruption. The choice in the latter group depends largely on the availability of a given method at a given institution at that particular time. Approval of several of the devices by regulatory authorities may result in conduct of prospective randomized clinical trials and use of a device or method most appropriate to the size and shape of the PDA.     

Historical Aspects of Transcatheter Closure of the Patent Ductus Arteriosus

The patent ductus arteriosus was the first congenital cardiac lesion to undergo successful closure in the cardiac catheterization laboratory. Porstmann in 1966 reported the successful closure of the ductus with an Ivalon foam plug. Since then numerous devices have been used to close the ductus. For the smaller ductus (< 4 mm in diameter), the Gianturco coil is now routinely used. For a ductus more than 4 mm in diameter, the devices used are currently undergoing clinical trials.     

Clinical Exploration of Transcatheter Closure of Patent Ductus Arteriosus With Duct Occluder in Infants

Objectives To explore the feasibility, necessity, and security of transcatheter closure of patent ductus arteriosus (PDA) in infants. Methods There were 230 infants with PDA. The ages were (7.3±3.2) months and the weight (6.6±2.8) Kg in average. They were separated into two groups. Group A was formed by the infants weighing less than 6 Kg, Group B over 6 Kg. Right heart catheterization was performed first to calculate the ratio of Qp/Qs. Then descending aortography demonstrated the diameter and shape of PDA. Proper occluder was selected to finish the intervention. Echocardiography was performed after intervention 24 hours and 1, 3, 6, 12 and 24 months. Results In Group A the technical achievement ratio was 94.6% with the average diameter of PDA (6.2±3.2) mm. In Group B the technical achievement ratio was 100% with the average diameter of PDA (4.8±2.5) mm. We used the Amplatzer Duct Occluder with the type from 6-8 mm to 12-14 mm, the delivery sheath from 6 French to 8 French. 24 hours after intervention, echocardiography demonstrated that there were 6 residual shunts in Group A while 22 in Group B. After 1 year, residual shunt existed in neither group. There were 4 patients whose femoral arteries pulsed weakly after intervention in Group A, while in Group B there were 3. They all recovered 24 hours after the application of urokinase. In Group A blood flow velocity in descending aorta increased in 5 infants, while in Group B there were 3. They all resumed in 6-12 months. Conclusions Transcatheter closure of PDA in infants is safe and technically feasible. However, indication should be strictly selected and the intervention should be performed by experienced physician.     

Safety and Outcomes of Transcatheter Closure of Patent Ductus Arteriosus in Children With Pulmonary Artery Hypertension

To investigate whether transcatheter device closure of patent ductus arteriosus (PDA) is safe in children with pulmonary artery hypertension, we retrospectively analyzed our experience with 33 patients who underwent the procedure from January 2000 through August 2015.Pulmonary artery hypertension was defined as a pulmonary vascular resistance index (PVRI) >3 WU · m². All 33 children (median age, 14.5 mo; median weight, 8.1 kg) underwent successful closure device implantation and were followed up for a median of 17.2 months (interquartile range [IQR], 1.0–63.4 mo). During catheterization, the median PVRI was 4.1 WU · m² (IQR, 3.6–5.3 WU · m²), and the median mean pulmonary artery pressure was 38.0 mmHg (IQR, 25.5–46.0 mmHg). Premature birth was associated with pulmonary vasodilator therapy at time of PDA closure ( P=0.001) but not with baseline PVRI (P=0.986). Three patients (9.1%) had device-related complications (one immediate embolization and 2 malpositions). Two of these complications involved embolization coils. Baseline pulmonary vasodilator therapy before closure was significantly associated with intensive care unit admission after closure (10/12 [83.3%] with baseline therapy vs 3/21 [14.3%] without; P <0.001). Of 11 patients receiving pulmonary vasodilators before closure and having a device in place long-term, 8 (72.7%) were weaned after closure (median, 24.0 mo [IQR, 11.0–25.0 mo]).We conclude that transcatheter PDA closure can be performed safely in many children with pulmonary artery hypertension and improve symptoms, particularly in patients born prematurely. Risk factors for adverse outcomes are multifactorial, including coil use and disease severity. Multicenter studies in larger patient populations are warranted.