Mobile bedside ductus arteriosus closure in severely premature neonates using only echocardiographic guidance
Stanimir GeorgievDaniel TanaseAndreas EickenJürgen HörerEvan M. ZahnKristina BorgmannD. RennerPeter Ewert
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Abstract:
Abstract Background Transcatheter closure of the patent ductus arteriosus (PDA) in premature infants is currently dependent on fluoroscopic guidance and transportation to the catheterization laboratory. Aim We describe a new echocardiographically guided technique to allow our team to move to the bedside at the neonatal intensive care unit (NICU) of the referring center for percutaneous treatment of PDA in premature infants. Methods This is a single‐center, retrospective, primarily descriptive analysis. Clinical details about the procedure, its outcomes, and complications were collected. Results Fifty‐eight neonates with a median weight of 1110 g (range 730–2800) and postnatal age of 28 days (range 9–95) underwent percutaneous PDA closure. Five of them were treated in our center with ultrasound guidance only and the other 53 in 18 different neonatology units in 12 towns. The median duration of the procedure was 40 min (range 20–195 min). There were no procedural deaths. There was one residual shunt for 3 weeks, in all other patients the duct closed completely in the first few hours after the intervention. In one patient the procedure had to be interrupted because of a pericardial effusion which had to be drained, the PDA was closed successfully interventionally 5 days later. One device‐related aortic coarctation had to be stented. One embolization and one late migration occurred and required treatment. Conclusions Echocardiographically guided transcatheter closure of the PDA in prematures was repeatedly possible and allowed that the procedure is performed at the bedside at the NICU with an acceptable rate of complications.Keywords:
Ductus arteriosus
Neonatology
Cardiac catheterization
Single Center
Septum secundum
Necrotizing Enterocolitis
Atrial Septal Defect (ASD) Secundum type was detected in a female patient Miss S.A at 20 years of age. She was operated from Birla Heart Research Center, Kolkata India in 1995.She got married after two years. Her son Master Z.S was also diagnosed as ASD secundum and was operated from Narayana Hrudayalaya Institute of Cardiac Science, Bangalore, India in the year 2005 when he was 8 years old. Her daughter was born in the same year and was diagnosed as a case of large ASD secundum (almost common atrium). This girl is now waiting for device closure from Combined Military Hospital (CMH) Dhaka, but her weight is still low for such procedure. This family is a rare family where mother and both children have ASD secundum and possibility of genetic inheritance was strongly suspected which lead to the writing of this report. DOI: http://dx.doi.org/10.3329/cardio.v1i2.8173 Cardiovasc. j. 2009; 1(2) : 226-228
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To the Editor.—
The finding by the Birth Defects Monitoring Program of the Centers for Disease Control1that patent ductus arteriosus was the most common major malformation in minority groups and the second most common in whites deviates greatly from data published previously. Fyler2found patent ductus arteriosus to be only the sixth most common congenital heart defect; Mitchell et al3listed patent ductus arteriosus as the third most common heart defect. Both studies reported ventricular septal defects to be two to four times more frequent than patent ductus arteriosus. Explanation of the discrepancy undoubtedly lies in the probability that in the Birth Defects Monitoring Program study the discharge diagnosis of patent ductus arteriosus was made mostly in premature infants whose ductus remained open in the neonatal period secondary to their immaturity and to metabolic abnormalities accompanying the respiratory distress syndrome. In these circumstances, patent ductus arteriosusDuctus arteriosus
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Background
Patent ductus arteriosus (PDA) is a common problem in preterm very low birth weight neonates. While PDA is known to have negative impact on neonates, treatment of PDA has its own complications, and not all PDAs need treatment. Therefore, echocardiographic parameters which might help in the management of PDA will be useful for clinicians.Objectives
To study diagnostic accuracy of echocardiographic parameters on the third day of life in predicting spontaneous closure of ductus arteriosus in preterm very low birth weight neonatesMethods
A hospital-based cross-sectional descriptive study was performed in Neonatal Intensive Care Unit (NICU) of 550-bedded Children Hospital, Mandalay, over one year period (from January, 2019 to December, 2019). A total of 63 preterm neonates with birth weight ≤1.5 kg and/or gestational age ≤32 weeks, who had patent ductus arteriosus were studied. Gestational age assessment was made by using the New Ballard Scoring System. On the third day of life, echocardiographic measurement of ductal diameter and LA/Ao ratio was done by the neonatologist. The measurements made by the neonatologist were reviewed and corrected if necessary by the pediatric cardiologist. Decision to treat PDA was made by the neonatologist based on the NICU protocol. On the tenth day of life, patent ductus arteriosus was re-assessed echocardiographically.Results
On the third day of life, most of the PDAs (67.6%) had ductal diameter <1.6 mm. The number of PDAs with LA/Ao ratio <1.5 and those with LA/Ao ratio ≥1.5 were almost equal (31 vs 32). On the tenth day of life, 47.6% of neonates with PDA had spontaneous ductal closure, 38.1% had persistent PDA and 14.3% had ductal closure after treatment. Spontaneous ductal closure was more commonly observed in PDAs with ductal diameter <1.6 mm than those with ductal diameter ≥1.6 mm (61.3% vs 15.7%). There was a statistically significant association between ductal diameter and spontaneous ductal closure (p value = 0.001). The diagnostic accuracy of ductal diameter in predicting spontaneous ductal closure is 68%. In the neonates with LA/Ao ratio <1.5, 64.5% had spontaneous ductal closure on the tenth day of life. In those with LA/Ao ratio ≥1.5, 31.2% had spontaneous ductal closure on the tenth day of life. There was a statistically significant association between LA/Ao ratio and spontaneous ductal closure on the tenth day of life (p value = 0.008). The diagnostic accuracy of LA/Ao ratio in predicting spontaneous ductal closure is 66%. In PDAs with ductal diameter ≥1.6 mm and LA/Ao ratio ≥1.5, only 11% had spontaneous ductal closure. The diagnostic accuracy of ductal diameter and LA/Ao ratio in combination is 70%.Conclusions
In this study, ductal diameter and LA/Ao ratio on the third day of life were found to have acceptable diagnostic accuracy in predicting spontaneous ductal closure on the tenth day of life.When ductal diameter and LA/Ao ratio were used in combination, diagnostic accuracy was found to improve marginally.Ductus arteriosus
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A case of well tolerated secundum atrial septal defect in a woman who died at 86 years of age is described and the lesions responsible for pulmonary hypertension are discussed. Previous reports of over-70-year-old patients with untreated secundum atrial septal defect are also reviewed.
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Objective: To summarize the experience of surgical treatment of patent ductus arteriosus. Methods: We reviewed and analyzed the clinical feature, operated process, and results of patent ductus arteriosus in 1 013 patients. Results: There was no death in the group of pure patent ductus arteriosus. Early severe pulmonary hypertension and heart failure could result from patent ductus arteriosus associated with other congenital heart diseases. The hospital mortality was 7.6%. Conclusion: Surgical treatment through left alar minimal incision has many benefits in treating patent ductus arteriosus. Different managements may be used in the patients with patent ductus arteriosus associated with other congenital heart diseases.
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Aim: There is a limited number of studies on the role of galectin-3 as a cardiac biomarker in the pediatric population. We aimed to investigate galectin-3 level and its relationship with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in children with secundum atrial septal defect (ASD).
Material and Methods: Twenty-seven patients with secundum ASD formed the patient group. Thirty healthy children of similar age and gender formed the control group. The largest ASD diameter measured from any window with transthoracic echocardiography was recorded as the ASD size. Blood samples were collected for NT-ProBNP and galectin-3.
Results: Children with secundum ASD had significantly higher NT-ProBNP levels compared with the healthy children (p=0.003). Galectin-3 levels of children with secundum ASD were similar to those of the healthy children (p=0.377). There was a statistically positive correlation between galectin-3 and NT-ProBNP levels in children with secundum ASD (rho=0.454, p=0.017). The area under the curve of galectin-3 was not statistically significant (AUC=0.537; p=0.643).
Conclusion: Although there was an increase in NT-ProBNP level in patients with secundum ASD, galectin-3 level did not change. Although NT-ProBNP was a valuable biomarker for the prediction of secundum ASD, galectin-3 had no role in predicting this disease.
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Objective To estimate the feasibility and efficacy of real time three dimensional echocardiography(RT 3DE) in closure of secundum atrial septal defect(ASD) using Amplatzer septal occluder(ASO) in children.Methods Ten children patients with ASD and 9 children patients post closure using Amplatzer septal occluder were examined by transthoracic RT 3DE (Live 3D mode and Full Volume mode).Results The three dimensional view of ASD and ASO was displayed clearly by RT 3DE,including size,shape,position and spatial relations of ASD and ASO.Conclusions ASD and ASO could be evaluated quickly and accurately by RT 3DE,which has great value in closure of ASD.
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Heart septal defect
Closure (psychology)
Ventricular volume
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Intrauterine closure of the fetal ductus arteriosus is a rare but serious condition. It can lead to congestive heart failure, fetal hydrops, and fetal death. No intrauterine intervention is currently available to treat this condition. Postnatally, it can present as pulmonary hypertension and can be associated with high mortality and morbidity. Postnatal therapies aimed at pulmonary hypertension or with medications that maintain the patency of the ductus arteriosus are variably successful. We present the neonatal course of a full-term neonate with severe pulmonary hypertension and intrauterine closure of the ductus arteriosus who survived to early infancy.
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