Surgical treatment of patent ductus arteriosus: a new historical perspective

The conventional surgical history of ligation of a patent ductus arteriosus (PDA) dates from August 26, 1938, when Robert E. Gross of Boston, Massachusetts, successfully ligated a PDA. It is largely unknown that in the same year and before Gross, Emil Karl Frey, a Surgeon at the Medizinische Akademie in Dusseldorf, Germany, already ligated a PDA successfully. Assuming that he would soon perform more ligations, Frey did not publish his findings, and this historic ductal operation escaped attention.     

介入治疗疑难动脉导管未闭的临床研究

目的：介绍利用改良Porstmann方法和带阀门内支架（WYW方法）介入治疗疑难动脉导管未闭（PDA）的临床应用经验。方法：172例PDA患，女性134例，男性38例；年龄3－62岁，平均25岁；3－12岁58例，13－62岁114例。降主动脉造影显示PDA内径（最狭处）1．4－13．3mm，平均5．6mm。PDA形态：漏斗型16例、管型109例、乳头型30例、窗型5例、PDA结扎术后再通12例（其中2例为两次结扎术后再通，1例为体外循环下缝扎术后再通）。其中属疑难PDA范畴共计67例（39％），应用改良Porstmann方法堵闭PDA44例，WYW方法堵闭PDA22例，Spiral Coil方法堵闭1例。结果：用WYW方法一次堵闭成功率为97％（共37例）。即刻PDA造影显示无残余分流，术后第一天，检查胸部正侧位片，见支架固定良好，出院前直声心动图检查无残余分流，随访1－64个月，无一例再通，恢复良好。结论：用改良Porstmann法和WYW方法治疗疑难PDA，该技术及其装置可靠、有效，简化了手术，可堵闭各种类型的PDA，尤其适用于疑难的PDA，值得临床的推广应用。     

Transfemoral plug closure of patent ductus arteriosus: experiences at Osaka Prefectural Hospital

Transfemoral plug closure of PDA (patent ductus arteriosus), which was originally introduced by Porstmann in 1968, was successful in 73 of 74 consecutive patients at Osaka Prefectural Hospital. Some instrumental and technical modifications were made. There has been no mortality, and no dislodgment of the plug occurred after the modified plug with a barbed head was used although a major complication during the procedure was the dislodgment of the plug into the aorta, which occurred early in three cases. There was no recurrence of shunting or any other complications in the long-term follow-up studies. For the patient with a simple isolated PDA over 3 years of age, the catheter technique is considered to be the method of choice to close the ductus.     

Transcatheter closure of large patent ductus arteriosus at high altitude with a novel nitinol device

Background : Patent ducti arteriosi (PDAs) are more frequent and larger at high altitude than at sea level. A novel PDA closure device, the Nitocclud PDA‐R, is designed specifically for both large and medium size PDAs. The initial clinical experience with a new nitinol‐based device in high altitude patients with large PDAs is described. Methods : The Nitocclud PDA‐R is a self‐expandable, self‐centering, repositionable occluder made of one nitinol wire without use of welding. It contains several polyester membranes, is delivered with a central guide wire and is released by retraction of the central wire into the delivery catheter. The efficacy of this device was evaluated at several high altitude centers. Results : Fifty‐one patients without other congenital cardiac defects underwent transcatheter closure of PDA. Complete occlusion of the PDA was achieved in 98% of the patients. Nearly 49% of the patients had no shunt immediately after device implantation. Echocardiography revealed a complete closure rate by Doppler interrogation of 69% after 24 hr, 96% after 6 months, and 98% after 1 year. In two cases, device embolization was observed after release, and in both cases the device was easily retrieved with standard interventional techniques. There have been no episodes of delayed device migration, endocarditis, hemolysis, wire fracture, device disruption, or death. Conclusions : The Nitocclud PDA‐R device is safe and effective and can easily close very large PDAs. This device has a high rate of complete occlusion within 1 year and is easily retrieved if embolized. © 2011 Wiley Periodicals, Inc.     

Protrusion of the device: a complication of catheter closure of patent ductus arteriosus

Objective—To assess the medium term results of percutaneous transvenous closure of patent ductus arteriosus, in particular with regard to protrusion of the device with or without turbulence of the bloodflow.

Design—Clinical examination and echocardiographic study (cross sectional Doppler, and colour Doppler examination) within 24 hours of and at least 6 months after implantation (range 6–26 (mean 15) months).

Setting—Multicentre study at the departments of paediatric cardiology of three academic hospitals. Tertiary clinical care of the first group of patients in the Netherlands treated by the percutaneous transvenous method.

Patients—36 patients (12 male, 24 female) mean age 8·2 years, (range 1·7–58·3), mean weight 25·5 kg (range 11–67·8 kg). The total group consisted of 46 patients. In one the implantation had failed and nine others were not available for regular follow up. All 36 patients underwent non-surgical closure of the patent ductus arterisus with a Rashkind double umbrella prosthesis.

Main outcome measures—Diagnosis or exclusion of protrusion of the Rashkind device with or without turbulence of the blood flow with follow up of changes in protrusion and turbulence.

Results—In 17 patients the prosthesis protruded into an arterial lumen: the aorta in 13 and the (left) pulmonary artery in four, with turbulence in seven and two cases respectively. After six months the aortic protrusion disappeared in three, including one who had had turbulent blood flow. At the end of follow up the prosthesis still protruded into the aorta in 10 but in three the turbulence had vanished. In two of the three remaining patients with turbulence in the descending aorta the degree of turbulence had decreased. There was no lessening of turbulence in the four patients in whom the device protruded into the pulmonary artery.

Conclusions—The Rashkind double umbrella can protrude into the descending aorta and the left pulmonary artery without causing turbulent blood flow. Turbulence and the protrusion itself can disappear. Endocarditis prophylaxis may be required for as long as the device causes turbulence.

     

Noninfectious thrombosis of a patent ductus arteriosus: Report of a case,with autopsy

An elderly woman was admitted to the hospital following an attack of severe precordial pain. On the seventh hospital day she developed abdominal pain which continued until her death, two days later. Postmortem examination disclosed embolic occlusion of the superior mesenteric artery. The embolus arose from fragments coming from a recently thrombosed patent ductus arteriosus. The clinical, pathologic, and bacteriologic observations indicated that the thrombus was not infectious in origin.     

Protrusion of the device: a complication of catheter closure of patent ductus arteriosus.

OBJECTIVE--To assess the medium term results of percutaneous transvenous closure of patent ductus arteriosus, in particular with regard to protrusion of the device with or without turbulence of the bloodflow. DESIGN--Clinical examination and echocardiographic study (cross sectional Doppler, and colour Doppler examination) within 24 hours of and at least 6 months after implantation (range 6-26 (mean 15) months). SETTING--Multicentre study at the departments of paediatric cardiology of three academic hospitals. Tertiary clinical care of the first group of patients in the Netherlands treated by the percutaneous transvenous method. PATIENTS--36 patients (12 male, 24 female) mean age 8.2 years, (range 1.7-58.3), mean weight 25.5 kg (range 11-67.8 kg). The total group consisted of 46 patients. In one the implantation had failed and nine others were not available for regular follow up. All 36 patients underwent non-surgical closure of the patent ductus arteriosus with a Rashkind double umbrella prosthesis. MAIN OUTCOME MEASURES--Diagnosis or exclusion of protrusion of the Rashkind device with or without turbulence of the blood flow with follow up of changes in protrusion and turbulence. RESULTS--In 17 patients the prosthesis protruded into an arterial lumen: the aorta in 13 and the (left) pulmonary artery in four, with turbulence in seven and two cases respectively. After six months the aortic protrusion disappeared in three, including one who had had turbulent blood flow. At the end of follow up the prosthesis still protruded into the aorta in 10 but in three the turbulence had vanished. In two of the three remaining patients with turbulence in the descending aorta the degree of turbulence had decreased. There was no lessening of turbulence in the four patients in whom the device protruded into the pulmonary artery. CONCLUSIONS--The Rashkind double umbrella can protrude into the descending aorta and the left pulmonary artery without causing turbulent blood flow. Turbulence and the protrusion itself can disappear. Endocarditis prophylaxis may be required for as long as the device causes turbulence.     

Transcatheter closure of a very large patent ductus arteriosus in a pregnant woman at 22 weeks of gestation.

Successful transcatheter closure of a large PDA in a pregnant patient is reported using the Amplatzer ductal occluder device. This procedure was safe and uncomplicated, obviating the need for surgery in this high risk patient.     

Double aortic arch with patent ductus arteriosus in a premature infant: an unusual vascular malformation

We recently encountered a premature infant with a very unusual form of vascular ring consisting of a double aortic arch with atretic left segment and patent ductus arteriosus. The initial presentation was that of patent ductus arteriosus with left-to-right shunting, but conventional surgical therapy was complicated by the abnormal aortic arch anatomy.