Article

Comparison of long-term clinical outcome between transcatheter Amplatzer occlusion and surgical closure of isolated patent ductus arteriosus.

Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
Chinese medical journal (Impact Factor: 0.9). 05/2009; 122(10):1123-7.
Source: PubMed

ABSTRACT Transcatheter Amplatzer occlusion of patent ductus artertiosus (PDA) has emerged as a minimally invasive alternative to surgical closure. The goal of this study was to compare long-term clinical outcomes between two procedures, especially on chronic residual shunt, late or very late procedure-related complications, and regression of pulmonary hypertension and left ventricular dilation.
A total 255 patients having isolated PDA with a minimal diameter of >or= 4 mm treated from January 2000 to July 2003 were included in this study and have been followed up until July 2008. The patients were assigned to either the device or surgical closure group according to the patients' and/or their parents' preference. Baseline physical exams, chest roentgenography, electrocardiography, and echocardiography were performed preprocedure and at each follow-up.
Seventy-two patients accepted the transcatheter procedure (Group-TC) and 183 underwent surgical operation (Group-SO) for PDA closure, both groups were similar in their demographics and preoperative clinical characteristics. There were no cardiac deaths and late complications such as infectious endocarditis and Amplatzer duct occluder (ADO) dislodge in either group. More acute procedure-related complications were recorded in Group-SO (13.7%) compared with Group-TC (1.4%) (P = 0.004). The recovery time was (8.7 +/- 2.3) days for the Group-SO and (1.3 +/- 0.5) days for the Group-TC (P < 0.001). The survival freedom from persistent residual shunt, defined as residual shunt that can not resolve automatically, was 91.3% for Group-SO and 98.6% for Group-TC (P = 0.037 by Log-rank test). There was no significant difference in regression of pulmonary hypertension and left ventricular dilation; neither survival freedom from pulmonary hypertension nor abnormal left ventricular end-diastolic volume index were significantly different between the surgical group and the Amplatzer group.
Our study confirmed the long-term safety and efficacy of transcatheter Amplatzer occlusion. In comparison to the time-proven surgical closure, transcatheter Amplatzer occlusion was less invasive and associated with fewer complications and residual shunt, and as effective in the regression of pulmonary hypertension and left ventricular dilation.

0 Bookmarks
 · 
66 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To present a modified and safe technique of thoracoscopic clipping of patent ductus arteriosus (PDA) in children and its early outcomes. Patients are anesthetized, ventilated via single-lung ventilation, and placed in a right lateral position. The surgeon and the assistant stand at the patient's feet, and a monitor is placed at the patient's head. The ductus is pulled forward with a Vicryl(®) (Ethicon) thread and clipped completely. From May 2010 to February 2011, 58 patients with PDA (27 boys and 31 girls) were operated on using the same technique. Patients' ages varied from 8 days to 36 months. Mean weight of patients was 5.9±2.8 kg (range, 2.1-10 kg). Mean operative time was 33±12 minutes (range, 15-90 minutes). There were no intraoperative complications. Postoperative complications occurred in 2 patients: 1 patient developed a pneumothorax, and 1 patient had pleural effusion. Mean postoperative stay was 4.1±2.1 days for patients >3 months old and 11.9±8.4 days for patients ≤3 months old. No injuries of recurrent laryngeal nerve occurred in any patients, and there were no residual shunts in any patients 3-6 months after discharge. A modified technique of thoracoscopic closure is a safe and effective procedure for PDA in children.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2012; 22(4):422-4. · 1.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patent ductus arteriosus in adults is usually an isolated lesion with a small to moderate degree of shunt, as a larger shunt becomes symptomatic earlier in childhood. The classic murmur of patent ductus arteriosus may be the first clue to its presence, or it may be detected accidently by transthoracic echocardiography, computed tomography, or magnetic resonance angiography for an unrelated condition. The percutaneous approach is safe and effective in more than 98% of patients. Subacute bacterial endocarditis prophylaxis is not indicated routinely except for 6 months following the closure percutaneously or surgically.
    Cardiology clinics 08/2013; 31(3):417-30. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital heart disease contributes significantly to the health burden of children in Nigeria. Interventions for congenital heart disease have been available in the developed world since the first report on device closure of patent ductus arteriosus (PDA) in 1967 by Porstmann. However, this did not start in Nigeria until October 2010. This study aimed to document the profiles of the patients who had undergone interventions for congenital heart diseases since the availability of the procedure, the challenges encountered, and the prospects associated with the interventions at the study site. All the patients referred to undergo interventions for congenital heart disease at the study center between October 2010 and 2012 were studied. The profile of the patient, including diagnosis at referral, indication for interventions, and interventions performed, were documented. The patients ranged in age from 3 to 62 years (mean age, 13.54 ± 17.7 years), and the male-to-female ratio was 1:3. The diagnosis at referral included PDA in 10 (83 %) of the 12 patients and secundum atrial septal defect in 2 patients (17 %). They all had transcatheter closure of the defects. Interventional procedures for congenital heart diseases currently are available locally, but the high degree of manpower training required, the cost, and the local availability of consumables are major factors limiting their use. Regional and international collaboration could be mutually beneficial.
    Pediatric Cardiology 07/2013; · 1.20 Impact Factor

Full-text

View
3 Downloads
Available from