Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: Device and surgical closure

Jeong, Young‐Hoon; Yun, Tae-Jin; Song, Jong-Min; Park, Jung-Jun; Seo, Dong-Man; Koh, Jun Seok; Lee, Se-Whan; Kim, Mi-Jeong; Kang, Duk-Hyun; Song, Jae‐Kwan

doi:10.1016/j.ahj.2007.04.045

Cited by 63 publications

(72 citation statements)

References 13 publications

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“…The immediate effects of PDA closure include an abrupt decrease in preload resulting in a decrease in left atrial and left ventricular size 3, 6. A concurrent increase in afterload associated with increased systemic vascular resistance often contributes to a greater decrease in left ventricular diastolic rather than systolic dimensions resulting in decreased indices of systolic function 3, 6.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“…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: 78%

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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“…This condition increases the LV volume load and right ventricular pressure load simultaneously, leading to LV dilation with possible LV dysfunction and right ventricular hypertrophy. Even after the PDA is closed, recovery of the pulmonary endothelial injury, pulmonary in situ thrombosis, and LV failure can take a long time, 34,35 leaving the PAP suspended at a high level. However, no study has demonstrated how long it takes to return to normal.…”

Section: Definition Of Pp-pah In Patients With Pdamentioning

confidence: 99%

Trial Occlusion to Assess the Risk of Persistent Pulmonary Arterial Hypertension After Closure of a Large Patent Ductus Arteriosus in Adolescents and Adults With Elevated Pulmonary Artery Pressure

Duanzhen

Xianyang

et al. 2014

Circ: Cardiovascular Interventions

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Background-No method is available to predict whether patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) will show persistent postprocedural PAH (PP-PAH) after PDA closure. This study evaluated the usefulness of trial occlusion for predicting PP-PAH after transcatheter PDA closure in patients with severe PAH. Methods and Results-Trial occlusion was performed in 137 patients (age ≥12 years) with PDA and severe PAH. All patients undergoing trial occlusion had a mean pulmonary artery pressure ≥45 mm Hg, pulmonary:systemic flow (Qp/Qs) ratio >1.5, and pulmonary:systemic resistance (Rp/Rs) ratio <0.7. A total of 135 patients (98%) showing stable hemodynamics during occlusion trial underwent successful device closure. Linear correlation analysis revealed weak or moderate relationships between the baseline and post-trial pulmonary artery pressures and pulmonary:systemic pressure (Pp/Ps) ratios. Patients were followed up for 1 to 10 years (median: 5 years). PP-PAH (systolic pulmonary artery pressure >50 mm Hg by Doppler echocardiography) was detected in 17 patients (13%), who displayed no significant differences in sex and age compared with patients without PP-PAH. According to discriminant analysis, the strongest discriminators between patients with and without PP-PAH were the baseline left ventricular end-diastolic volume and the baseline and post-trial systolic Pp/Ps ratios. In particular, a post-trial systolic Pp/Ps ratio >0.5 correctly classified 100% of the PP-PAH and non-PAH patients. Conclusions-Trial

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Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: Device and surgical closure

Cited by 63 publications

References 13 publications

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

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

Trial Occlusion to Assess the Risk of Persistent Pulmonary Arterial Hypertension After Closure of a Large Patent Ductus Arteriosus in Adolescents and Adults With Elevated Pulmonary Artery Pressure

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