Left Ventricular Dysfunction after Closure of Large Patent Ductus Arteriosus

Galal, Omar; Amin, Mohamed; Hussein, A A Emad; Kouatli, Amjad; Al-Ata, Jameel; Jamjoom, Ahmed A.

doi:10.1177/021849230501300106

Cited by 41 publications

(65 citation statements)

References 19 publications

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“…In accordance with the present study Galal et al [13] reported that closure of a relatively large PDA results in a sudden reduction in LV volume overload, thereby reducing muscle fiber stretch and decreasing systolic function. He hypothesized that changes in after load may be another contributory factor adversely affecting LV systolic performance.…”

Section: Discussionsupporting

confidence: 93%

Echocardiograpic Evaluation of Short-term Outcome of Patent Ductus Arteriosus Closure using Amplatzer Occluder Device

Elsheikh¹,

Hegab²,

Salama³

2015

J Cardiovasc Dis Diagn

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This study was retrospective case series controlled study. It included 30 patients who were referred to Tanta University hospital with the diagnosis of PDA for comparing the clinical and echocardiographic data before and after transcatheter closure of PDA with occluder device from September 2012 to August 2013. All patients parents gave their written informed consent. Included in the study 8 males (26.7%) and 22 females (72.3%) with PDA, with a mean age of 5.26 ± 3.84 years (range 7 months to 12 years) and with sinus rhythm. The weight of the patients ranged from 7 to 25 Kg with a mean of 16.03 ± 5.99, the height of the patients ranged from 40 to 106 cm with a mean 82.2 ± 22.1, the body surface area (BSA) of the patients ranged from 0.5 to 1.5 with a mean of 0.84 ± 0.26. While patients with Coexisting congenital cardiac defects that may need heart surgery, age less than 6 months, body weight less than 6 Kg, Irregular rhythm, systemic infections or endocarditis, blood diseases (haemorragic or thrombtic), very large PDA (more than 10 mm pulmonary end), hypertensive PDA or small restrictive ductus arteriosus (less than 2 mm pulmonary end with no significant hemodynamic effects) were excluded from the study. IntroductionIn full-term newborns, DA routinely closes within one to five days after delivery, however it's considered abnormal if it remains patent more than three months after birth in term infants [1,2]. The physiological impact and clinical significance of PDA depend largely on its size and the underlying cardiovascular status of the patient, so patients with large PDA may develop left-sided volume overload and pulmonary hypertension at younger ages, leading to diagnosis early in life. If left untreated, PDA can foster the development of infective endarteritis, Eisenmenger syndrome, and other conditions, with an annual mortality rate of 1.8% [3][4][5]. Ductus closure is clearly indicated for any child or adult who is symptomatic from significant left-to-right shunting through PDA [3].Percutaneous closure of PDA has been performed for more than 30 years with several generations of devices and is the preferred mode of therapy worldwide, it has largely replaced surgical ligation in different age groups and become the treatment of choice at many institutions, since it is safe as well as cost-effective and offers considerable advantages over surgical ligation [6,7].The present study designed to compare clinical and echocardiographic data before and after transcatheter closure of PDA with occluder device. AbstractObjective: To compare clinical and echocardiographic data before and after transcatheter closure of patent ductusarteriosus (PDA) with occluder device. Methods:The study population consisted of 30 children with PDA who were subjected to history taking and clinical examination to detect symptoms and signs suggestive of significant shunting. Doppler, two-dimensional echocardiography studies with measurement of mitral inflow velocities in early and late diastole (E and A wave), early and late diastolic mi...

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Section: Discussionsupporting

confidence: 93%

Echocardiograpic Evaluation of Short-term Outcome of Patent Ductus Arteriosus Closure using Amplatzer Occluder Device

Elsheikh¹,

Hegab²,

Salama³

2015

J Cardiovasc Dis Diagn

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“…Immediate reduction in preload and an increase in afterload are associated with effective closure of left‐to‐right shunting PDA and result in decreases in left ventricular size (typically diastolic more than systolic dimensions) and left atrial size, as well as a reduction in left ventricular fractional shortening (FS) 3, 4, 5, 6, 7, 8. Within 6 months of PDA closure in human patients, left ventricular size continues to decrease and systolic function often improves, although recovery of systolic function can take longer, particularly in patients presenting for PDA closure as adults 3, 9, 10. Additional factors that affect the degree of left ventricular reverse remodeling (normalization of size and systolic function) include low ejection fraction before PDA closure in human patients, the presence of residual ductal flow after PDA closure in human patients and dogs, and acquired heart disease (HD) in dogs 3, 4, 5, 11.…”

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confidence: 99%

Long‐Term Outcome in Dogs with Patent Ductus Arteriosus: 520 Cases (1994–2009)

Saunders

Gordon

Boggess

et al. 2013

Veterinary Internal Medicne

111

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BackgroundPublished information regarding survival and long‐term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited.ObjectivesTo report outcome and identify prognostic variables in dogs with PDA, and to identify risk factors for persistent remodeling in dogs with a minimum of 12 months of follow‐up after closure.AnimalsFive hundred and twenty client‐owned dogs.MethodsRetrospective review of medical records of 520 dogs with PDA. Outcome was determined by contacting owners and veterinarians. Dogs with PDA closure and ≥ 12 months of follow‐up were asked to return for a re‐evaluation.ResultsIn multivariable analysis of 506 dogs not euthanized at the time of diagnosis, not having a PDA closure procedure negatively affected survival (HzR = 16.9, P < .001). In 444 dogs undergoing successful PDA closure, clinical signs at presentation (HzR = 17, P = .02), concurrent congenital heart disease (HD) (HzR = 4.8, P = .038), and severe mitral regurgitation (MR) documented within 24 hours of closure (HzR = 4.5, P = .028) negatively affected survival. Seventy‐one dogs with ≥ 12 months follow‐up demonstrated a significant reduction in radiographic and echocardiographic measures of heart size (P = 0) and increased incidence of acquired HD (P = .001) at re‐evaluation. Dogs with increased left ventricular size and low fractional shortening at baseline were more likely to have persistent remodeling at re‐evaluation.Conclusions and Clinical ImportancePatent ductus arteriosus closure confers important survival benefits and results in long‐term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital HD, and severe MR negatively affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling.

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“…PDA closure is required in patients with signs of LV volume overload, pulmonary arterial hypertension or symptoms of heart failure (3). Transient LV dysfunction following PDA closure has previously been reported, although severe complications are rare (7)(8)(9)(10). The present study reported the case of an adult patient with PDA and bicuspid aortic valve (AV) who experienced transient severe LV dysfunction following percutaneous closure of PDA.…”

Section: Introductionmentioning

confidence: 87%

“…PDA presents with a broad spectrum of clinical manifestations ranging from asymptomatic cardiac murmur to severe complications, including congestive heart failure or Eisenmenger syndrome, which are predominantly associated with the amount of left-to-right shunting and the size of PDA (3,5). Treatment of the majority of PDAs is accomplished by surgical or catheter closure with a complete closure rate of 90-95% (3,(6)(7)(8)(9). PDA closure is required in patients with signs of LV volume overload, pulmonary arterial hypertension or symptoms of heart failure (3).…”

Section: Introductionmentioning

confidence: 99%

Transient severe left ventricular dysfunction following percutaneous patent ductus arteriosus closure in an adult with bicuspid aortic valve: A case report

Hwang

Yoon

Sohn

2016

Experimental and Therapeutic Medicine

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Abstract. The present study reported the case of a 60-year-old female with patent ductus arteriosus (PDA) and a bicuspid aortic valve, who presented with transient severe left ventricular (LV) dysfunction following percutaneous closure of PDA, as identified by speckle tracking analysis. Transient LV dysfunction following PDA closure has previously been reported; however, severe LV dysfunction is rare. In the present case, the combination of a large PDA size, large amount of shunting, LV remodeling and bicuspid aortic valve may have induced serious deterioration of LV function following PDA closure. Furthermore, speckle-tracking echocardiography may be useful in the estimation of functional alterations in the myocardium of the LV following PDA closure. The observations detailed in the present study may improve the understanding of the pathophysiology and myocardial patterns of transient left ventricular dysfunction following PDA closure in adult humans.

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Left Ventricular Dysfunction after Closure of Large Patent Ductus Arteriosus

Abstract: Changes in left ventricular dimensions and performance were studied in 43 patients after transcatheter occlusion or surgical ligation of patent ductus arteriosus. The patients were assigned to 2 groups based on their ductal diameter: >/= 3.1 mm to group A (n = 27) and Show more

Cited by 41 publications

References 19 publications

Echocardiograpic Evaluation of Short-term Outcome of Patent Ductus Arteriosus Closure using Amplatzer Occluder Device

Echocardiograpic Evaluation of Short-term Outcome of Patent Ductus Arteriosus Closure using Amplatzer Occluder Device

Long‐Term Outcome in Dogs with Patent Ductus Arteriosus: 520 Cases (1994–2009)

Transient severe left ventricular dysfunction following percutaneous patent ductus arteriosus closure in an adult with bicuspid aortic valve: A case report

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