Echocardiographic guidance for transcatheter coil occlusion of patent ductus arteriosus in the catheterization laboratory.

The objective of this study was to investigate the feasibility of transthoracic echocardiography as a guide to monitor the completeness of patent ductus arteriosus (PDA) occlusion immediately after coil implantation. In all, 52 patients who underwent Gianturco coil implantation for PDA occlusion were evaluated by transthoracic echocardiography within 15 minutes after the first coil implantation in the catheterization laboratory. According to Doppler echocardiographic findings, these patients were classified into 3 groups: group 1, complete occlusion without residual shunt; group 2, a residual PDA diameter < 1 mm and no continuous waveforms detected; and group 3, a residual PDA diameter >or= 1 mm or continuous waveforms. There were 34 patients in group 1, 10 patients in group 2, and 8 patients in group 3. In a 12-month follow-up the complete occlusion rate was 100%, 90%, and 87.5% in groups 1, 2, and 3, respectively. We conclude that immediate Doppler echocardiography is useful in assessing the status of residual PDA just after coil implantation. Residual shunt < 1 mm and lack of continuous waveform on Doppler scan indicate sufficient ductal closure of PDA.     

儿童动脉导管未闭介入治疗的护理

目的:总结儿童动脉导管未闭介入手术的护理要点,提高手术成功率。方法:回顾性分析126例行动脉导管未闭介入封堵术患儿的护理要点,包括术前访视、了解病情,术中严密监护、密切配合,术后优质的护理。结果:术前准备充分,术中严密监护、配合默契,术后优质的护理,可提高手术成功率,也能及时发现并减少术后并发症的发生。结论:有效的护理是儿童动脉导管未闭介入封堵术成功的重要保障之一。     

可控弹簧栓介入治疗动脉导管未闭的护理

总结 30例可控弹簧栓 (Coil)封堵动脉导管未闭 (PDA)的护理经验 ,重点在于把握术后 2 4h的护理关键时期 ,严密观察病情 ,避免和及早发现并发症 ,一旦发生机械性溶血 ,要及早做好再次手术的准备。其次要做好穿刺伤口及肢体的护理。术前除做好患儿的心理护理外不可忽视家长的心理护理。     

先心动脉导管未闭哑铃状弹簧栓子封堵治疗的体会

目的:应用pfm弹簧栓子封堵器经导管治疗动脉导管未闭并对其疗效进行初步评价。方法:在透视下经6F导管置入pfm哑铃状弹簧栓子,术后10min听诊,行右心导管检查及主动脉弓降部造影,术后48h行超声心动图及心脏x线平片检查评价治疗效果。X线结果:全组技术成功率为91.7％,1例发生并发症,11例术后心脏杂音即消失,3～6个月随访弹簧栓子无移位。无残余分流。结论:应用pfm弹簧栓子经导管治疗中小直径动脉导管未闭是安全有效的非手术方法,操作简便,成功率高,近期疗效可靠,中远期疗效尚待进一步观察。     

The paradoxical patent ductus arteriosus

The ductus arteriosus (DA) is a vessel whose patency is required for fetal survival but is incompatible with postnatal life. Because of developmental insufficiency, the DA in preterm infants often fails to close in a condition known as patent DA (PDA). Although COX inhibitors can be used to close the PDA by lowering circulating prostaglandin levels, their effectiveness is correlated with birth weight, and severely premature infants often require surgical repair. Paradoxically, targeted deletion of COX pathway components in mice results in PDA. In this issue of the JCI, Yokoyama et al. describe dual roles for prostaglandins in DA development and closure, offering new insights into the mechanism of negative effects of COX inhibitors that may influence the treatment of severely premature infants with PDA and lead to improvement of their outcomes (see the related article beginning on page 3026).     

Transcatheter closure of patent ductus arteriosus

More than three decades have passed since the introduction of transcatheter devices for closure of patent ductus arteriosus, and many occluders have been made available since then. The ideal requirements of any procedure are a user-friendly technique, optimum success rate, no residual anomaly, minimal morbidity/mortality, and comparability or superiority to the existing conventional modality of treatment. With various advancements in device design, delivery and assisted systems, the tremendous procedural safety and effectiveness, along with low cost and widespread availability of these devices makes transcatheter closure of patent ductus arteriosus a preferred therapeutic modality in all age groups, with decreasing demographic trends of surgical management.     

Transcatheter closure of patent ductus arteriosus

More than three decades have passed since the introduction of transcatheter devices for closure of patent ductus arteriosus, and many occluders have been made available since then. The ideal requirements of any procedure are a user-friendly technique, optimum success rate, no residual anomaly, minimal morbidity/mortality, and comparability or superiority to the existing conventional modality of treatment. With various advancements in device design, delivery and assisted systems, the tremendous procedural safety and effectiveness, along with low cost and widespread availability of these devices makes transcatheter closure of patent ductus arteriosus a preferred therapeutic modality in all age groups, with decreasing demographic trends of surgical management.     

1例极低出生体质量早产儿动脉导管未闭结扎术的护理

动脉导管未闭是存在于主动脉和肺动脉之间的先天性异常通道,主要采取手术治疗。本文回顾1例极低出生体质量早产儿的临床资料,总结动脉导管未闭结扎手术围手术期的护理措施。     

Transcatheter closure of the patent ductus arteriosus

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Although surgery is still required in symptomatic neonates, the majority of older infants and children can undergo safe and effective transcatheter device closure on an out-patient basis. First described in 1967, over the past four decades, numerous devices have been specifically developed for this purpose. This article will review the current status of transcatheter therapy. The experience with each device is detailed and issues and controversies are reviewed.     

Transcatheter closure of the patent ductus arteriosus

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Although surgery is still required in symptomatic neonates, the majority of older infants and children can undergo safe and effective transcatheter device closure on an out-patient basis. First described in 1967, over the past four decades, numerous devices have been specifically developed for this purpose. This article will review the current status of transcatheter therapy. The experience with each device is detailed and issues and controversies are reviewed.     

Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus.

OBJECTIVE: Our objective was to study the pharmacokinetics of ibuprofen in premature infants with patent ductus arteriosus on day 3 and day 5 after birth. METHODS: Ibuprofen was administered on days 3, 4, and 5 by a 15-minute intravenous infusion of 10, 5, and 5 mg/kg, respectively, with the aim of closing the ductus arteriosus. Blood samples were drawn at time zero and at 0.5, 1, 2, 4, 12, and 24 hours after the first and third doses. Ibuprofen plasma concentrations were assayed by HPLC. RESULTS: A total of 27 premature infants were included (gestational age, 28.6 +/- 1.9 weeks; birth weight, 1250 +/- 460 g; values are mean +/- standard deviation). Ibuprofen pharmacokinetics followed a 2-compartment open model. Between the first and third doses (day 3 and day 5) there was a significant decrease of the volume of distribution of the central compartment (Vd(c)) (0.244 versus 0.171 L/kg; P =.03) and area under the plasma concentration-time curve (524 versus 447 mg. h/L; P =.01). The decrease in Vd(c) was most pronounced in patients with a closing ductus. Total body clearance and plasma half-life did not change significantly. No significant differences were observed in ibuprofen peak plasma concentrations after the first and third doses in relation to ductal status after treatment. CONCLUSION: Ibuprofen pharmacokinetics showed a large interindividual variation in premature infants during treatment for patent ductus arteriosus, and significant changes may occur between day 3 and day 5 after birth in those infants with a closing ductus. These findings may have implications for the treatment schedule with ibuprofen in patients with patent ductus arteriosus.     

Echocardiographic assessment of intimal thickness growth of patent ductus arteriosus in neonates and analysis of influencing factors

The International Journal of Cardiovascular Imaging - The spontaneous closure rate of patent ductus arteriosus (PDA) is high, and the necessity of early intervention is debated. Quantitative...     

Persistent and patent ductus arteriosus. Different forms and sizes

In 563 consecutive heart catheter investigations in sucklings, infants and children 109 open ducti were diagnosed. 75 children (13.3%) had a ductus arteriosus persistens (DAP) and 34 a ductus arteriosus (DAA). We were able to measure 89 ducti. Groups were formed according to the age of the children, of DAP or DAA and the intended treatment. The sizes of the ducti constitute a set of data for improving the methods for closure or newly developed transvasal methods of conservation of the ductus as an aortopulmonary shunt.     

Conservative management of patent ductus arteriosus in preterm infants

We report our experience of medical treatment, chiefly based on prolonged artificial ventilation, of 33 preterm infants with PDA and heart failure whose survival rate was 88%. All of them had clinical criteria used by others to indicate surgical ligation of the ductus arteriosus.This conservative approach seems to give better results than surgical ligation, despite a high frequency of bronchopulmonary dysplasia among survivors.     

Management of the neonate with patent ductus arteriosus

Care of the preterm infant with a suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is a frequent challenge for the neonatal nurse. Management of term infants with cardiac lesions dependent upon a PDA can be even more challenging. It is vital for neonatal nurses to understand the normal cardiovascular and pulmonary changes that occur at birth so they can anticipate pathological processes influencing the clinical course of an infant with a PDA. In addition, knowledge of current and effective treatment approaches is essential to providing optimal care for these vulnerable infants, as well as in guiding their parents. The purpose of this article is to review current information about PDA, including physiology, pathophysiology, pharmacological approaches, surgical considerations, complications and outcomes, parental support, and areas for future research.