Abstract:
:Persistent patency of the arterial duct represents one of the most common lesions in the field of congenital cardiac disease. The strategies for management continue to evolve. In this review, we focus on management beyond the neonatal period. We review the temporal evolution of strategies for management, illustrate the currently available the techniques for permanent closure of the patent arterial duct, review the expected outcomes after closure, discuss the current controversy over the appropriate treatment of the so-called "silent" duct, and provide recommendations for the current state of management of patients with persistent patency of the arterial duct outside of the neonatal period.At the Congenital Heart Institute of Florida, we now recommend closure of all patent arterial ducts, regardless of their size. Before selecting and performing the type of procedure, we explain the natural history of the persistently patent arterial duct to the parents or legal guardian of the child. Particular emphasis is placed on the risks of endocarditis, including the recognition that many cases of endocarditis may not be preventable. The devastating effects of endocarditis, coupled with the perception of more anecdotal reports of endocarditis with the silent duct, as well as the low risk of interventions, has led us to recommend closure of the patent arterial duct in these situations. We now recommend intervention, after informed consent, for all patients with a patent arterial duct regardless of size, including those in which the patent duct is "silent". We recognize, however, that this remains a controversial topic, especially given the new recommendations for endocarditis prophylaxis from American Heart Association. Since 2003, our strategy for closure of the patent arterial duct has changed subsequent to the availability of the Amplatzer occluder. This new device has allowed significantly larger patent arterial ducts to be closed with interventional catheterization procedures that in the past would have been closed at surgery. During the interval between 2002 and 2006 inclusive, the overall surgical volume at our Institute has been stable. Over this period, the number of patients undergoing surgical ligation of the patent arterial duct has decreased, with this decline in volume most notable for the subgroup of patients weighing more than five kilograms. This decrease has been especially notable in thoracoscopic procedures and is attributable to the increased ability to close larger ducts using the Amplatzer occluder. For infants with symptomatic pulmonary overcirculation weighing less than 5 kilograms, our preference is for the surgical approach. For patients who have ductal calcification, significant pleural scarring, or "window-like" arterial ducts, video-assisted ligation is not an option and open surgical techniques are used. When video-assisted ligation is possible, the approach is based on family and surgeon preference. When open thoracotomy is selected, we usually use a muscle-sparing left posterolateral thoracotomy. For patients weighing more than 5 kilograms, we currently recommend percutaneous closure for all patent arterial ducts as the first intervention, reserving surgical treatment for those cases that are not amenable to the percutaneous approach. For symptomatic infants weighing greater than 5 kilogram with large ducts, we prefer to use the Amplatzer occluder. In rare instances, the size of the required ductal occluder is so large that either encroachment into the aorta or pulmonary arteries is noted, and the device is removed. The child is then referred for surgical closure. We can now often predict via echocardiography that a duct is too large for transcatheter closure, even with the Amplatzer occluder, and refer these patients directly to surgery. For patients with an asymptomatic patent arterial duct, we prefer to wait until the weight is from 10 to 12 kilograms, or they are closer to 2 years of age. If the patent arterial duct is greater than 2.0 to 2.5 millimetres in diameter, our preference is to use the Amplatzer occluder. For smaller ducts, we typically use stainless steel coils. Using this strategy, we close all patent arterial ducts, regardless of their size.
journal_name
Cardiol Youngjournal_title
Cardiology in the youngauthors
Giroud JM,Jacobs JPdoi
10.1017/S1047951107001175subject
Has Abstractpub_date
2007-09-01 00:00:00pages
68-74eissn
1047-9511issn
1467-1107pii
S1047951107001175journal_volume
17 Suppl 2pub_type
杂志文章,评审abstract:BACKGROUND:Complications at the vascular access sites are among the most common adverse events in congenital cardiac catheterization. The use of small-gauge catheters may reduce these events; however, other factors can contribute to the development of vascular complications. OBJECTIVES:To determine factors associated ...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951111000989
更新日期:2012-04-01 00:00:00
abstract::Heart failure in children is a complex clinical syndrome with multiple aetiologies. The underlying disorders that lead to heart failure in children differ significantly from those in adults. Some clinical biomarkers for heart failure status and prognosis appear to be useful in both age groups. This review outlines the...
journal_title:Cardiology in the young
pub_type: 杂志文章,评审
doi:10.1017/S1047951115000839
更新日期:2015-08-01 00:00:00
abstract::Milrinone is a drug frequently used for hemodynamic support in children during critical illness. Although the hemodynamic changes induced by milrinone in children may appear similar to those of adults, the physiologic contributors of these changes remain vastly unknown. A systematic review was conducted to identify st...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951119002865
更新日期:2020-01-01 00:00:00
abstract::Scimitar syndrome represents a rare variant of partial anomalous pulmonary venous connection with right lung hypoplasia, dextrocardia, and concomitant airway-vessel abnormalities. Surgical correction is preferred in symptomatic patients or in patients with increased left-to-right shunt. In this report, the first case ...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951117001603
更新日期:2018-01-01 00:00:00
abstract::Partially anomalous pulmonary venous connection of a solitary pulmonary vein in the setting of an intact atrial septum is often subclinical, and the indications for surgical repair are controversial. Here we describe a patient who developed a significant shunt over a period of 10-years. Flow through the anomalously co...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S104795110700159X
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to investigate the relations between the P-wave dispersion and diastolic functions in type 1 diabetic children. PATIENTS:A total of 33 diabetic patients without any cardiovascular disease, with a mean age of 12.3 plus or minus 4.2 years, and 29 healthy controls, with a mean age of 1...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S104795110999031X
更新日期:2010-04-01 00:00:00
abstract::Research that is closely connected with the population it is studying and in which the translational value to healthcare is high is a laudable goal, but it is not often achieved. The Australian and New Zealand Fontan Registry has developed a model for involving patients and parents of children with a Fontan circulatio...
journal_title:Cardiology in the young
pub_type: 杂志文章,评审
doi:10.1017/S1047951117001494
更新日期:2018-04-01 00:00:00
abstract::An intact atrial septum places infants with hypoplasia of the left heart into a group with an extremely high rate of mortality. We report a neonate, diagnosed antenatally, who was delivered by Caesarian section in the cardiac theatre, urgently placed onto cardiopulmonary bypass, and who then underwent an atrial septec...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951107000819
更新日期:2007-08-01 00:00:00
abstract::The purpose of our paper is to assess the prognostic value of balloon occlusion as a test for patients with various types of functionally single ventricle after different palliative surgical procedures who were candidates for further modifications of a cavo-pulmonary operation. In all patients, there were at least two...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:
更新日期:2003-08-01 00:00:00
abstract::An 8-year-old girl, without any previous medical history, presented with a first short syncope. Physical examination was unremarkable. Transthoracic echocardiography revealed a thin-walled, echo-free cystic structure adjacent to the posterior wall of the left ventricle, and compressing it moderately. Other echocardiog...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/s1047951101001056
更新日期:2001-11-01 00:00:00
abstract::We report a case of Uhl's anomaly in a 5-month-old cyanotic infant who presented with thromboembolic stroke and acute hemiparesis. The patient underwent successfully an initial surgical repair, which included exclusion of the right ventricle by patch closure of the tricuspid valve, atrial septectomy and construction o...
journal_title:Cardiology in the young
pub_type: 杂志文章,评审
doi:10.1017/s1047951102000410
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:In very low birth weight infants, persistence of a patent ductus arteriosus results in morbidity and mortality. Therapies to close the ductus are effective, but clinical outcomes may depend on the accuracy of diagnosis and the timing of administration. The objective of the present study was to characterise t...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951117001081
更新日期:2017-11-01 00:00:00
abstract::This review includes a brief discussion, from the perspective of cardiac surgeons, of the rationale for creation and maintenance of multi-institutional databases of outcomes of congenital heart surgery, together with a history of the evolution of such databases, a description of the current state of the art, and a dis...
journal_title:Cardiology in the young
pub_type: 杂志文章,评审
doi:10.1017/S1047951108002813
更新日期:2008-12-01 00:00:00
abstract:OBJECTIVES:To assess clinical presentation, treatment, and outcome of children with Ebstein's anomaly. BACKGROUND:Data on long-term outcome of children with Ebstein's anomaly are scarce. METHODS:Retrospective analysis of all children with Ebstein's anomaly treated between February, 1979 and January, 2009 in a single ...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951112000224
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:The goal of this study was to see whether the open anastomosis technique using vacuum-assisted venous drainage at the time of the Fontan procedure was associated with decreased post-operative pleural effusion. METHODS:We analysed a subgroup of patients with a functional single ventricle who underwent non-fen...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951110001010
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVES:It is accepted treatment to give vasopressin to adults in postcardiotomy shock, but such use in children is controversial. Cardiopulmonary bypass is presumed to attenuate the normal endogenous vasopressin response to shock. We hypothesized that levels of vasopressin in children are altered by bypass, and tha...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951108001881
更新日期:2008-04-01 00:00:00
abstract::Senning operation is a surgical treatment for transposition of great arteries that can be complicated by post-procedural atrial or caval baffle leaks. We present a 6-year-old boy with a history of Senning repair for transposition of great arteries, who developed a pulmonary venous baffle leak. Percutaneous baffle leak...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951120002255
更新日期:2020-10-01 00:00:00
abstract::Improving population-level cardiovascular health is a public health priority. Guided by the American Heart Association's metrics for ideal heart health, we examined the prevalence of behavioural heart health indicators using a representative sample of urban adolescents. Less than 1% (0.6%) of the sample had ideal hear...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951113001121
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:There is no standard dose or protocol for beta-blocker administration as preconditioning in children undergoing coronary CT angiography. METHODS:A total of 63 consecutive patients, with a mean age of 10.0±3.1 years, who underwent coronary CT angiography to assess possible coronary complications were enrolle...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S104795111800118X
更新日期:2018-10-01 00:00:00
abstract::Sudden cardiac death is a rare but socially devastating event. The most common causes of sudden cardiac death are congenital electrical disorders and structural heart diseases. The majority of these diseases have an incomplete penetrance and variable expression; therefore, patients may be unaware of their illness. In ...
journal_title:Cardiology in the young
pub_type: 杂志文章,评审
doi:10.1017/S1047951112001138
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope. METHODS:Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years ...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951114001176
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:To determine styles of coping, that is personal ways of dealing with problems, and social support, or support from the social environment, in a cohort of adults with congenital heart disease. METHODS:We subjected 362 patients with congenital heart disease, aged from 20 to 46 years, belonging to five diagnost...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951104002033
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVE:The concept of self-management of oral anticoagulation has been shown to entail better quality of treatment than conventional management when assessed in selected adults. We have extended the concept of self-management to include children with congenital cardiac disease, hypothesizing self-management of oral ...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/s1047951101000282
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Patients with CHD exhibit reduced isometric muscle strength and muscle mass; however, little is known how these parameters relate. Therefore, the aim was to investigate the relation between isometric limb muscle strength and muscle mass for patients in comparison to age- and sex-matched control subjects. ME...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951120004709
更新日期:2021-01-18 00:00:00
abstract:AIMS:To assess results of closure of atrial septal defects within the oval fossa by devices delivered by catheterisation in symptomatic infants and children under 2 years of age. METHODS AND RESULTS:The Amplatzer septal occluder was used. Results, and complications of transcatheter device treatment in patients aged be...
journal_title:Cardiology in the young
pub_type: 临床试验,杂志文章
doi:10.1017/s1047951100008234
更新日期:2000-09-01 00:00:00
abstract::A newborn presented with an aorto-right ventricular tunnel, a defect connecting the left aortic sinus to the right ventricle. The patient underwent repair on 4th day of life. ...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951115001572
更新日期:2016-01-01 00:00:00
abstract::Pulmonary sequestration is a rare congenital anomaly that can be asymptomatic or present with recurrent infections, respiratory symptoms, or rarely heart failure. Sequestration is classified as intralobar or extralobar on the basis of whether there is separation from normal lung tissue by its own visceral pleura. Clas...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951116000901
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Perceived correlation between the coronary arterial anatomy in patients with complete transposition, and the outcome of the arterial switch procedure, has made preoperative identification of their patterns standard practice. PURPOSE:Our purpose was to assess the accuracy of preoperative echocardiographic id...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/s1047951102000537
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:Few data are available on the neuropsychological, behavioural, or structural brain imaging outcomes in adolescents who underwent corrective surgery in infancy for tetralogy of Fallot. METHODS:In this single-centre cross-sectional study, we enrolled 91 adolescents (13-16 years old) with tetralogy of Fallot a...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951114000031
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Post-operative severe vascular stenosis and proliferating endothelial tissue lead to severe circulatory disorders and impair organ perfusion. Bioabsorbable magnesium scaffolds may help to overcome these obstructions without leaving obstructing stent material. We analyse their role in the treatment of vascula...
journal_title:Cardiology in the young
pub_type: 杂志文章
doi:10.1017/S1047951120000384
更新日期:2020-04-01 00:00:00